Association between atrial fibrillation and cognitive performance in older individuals.

Introduction: Atrial fibrillation (AF) coexists with dementia in older population. AF often remains undiagnosed in its asymptomatic, silent form, that is, silent AF (SAF).

Objectives: The aim of the study was to evaluate the relationships between cognitive performance and both symptomatic and asymptomatic AF, diagnosed via a long‑term (up to 30 days) wearable noninvasive electrocardiography monitoring system in a representative Polish population younger than 65 years.

Patients and methods: A sample of 2203 participants from the cross‑sectional NOMED‑AF (Noninvasive Monitoring for Early Detection of Atrial Fibrillation) study were enrolled in the analyses (mean [SD] age, 77.1 years; 48.4% women), out of which 491 (22.3%) were diagnosed with AF (41.3%, with SAF).

Results: Mean (SD) number of points obtained by the respondents in the Mini‑Mental State Examination (MMSE) was 25.8 (0.1), and it was lower in the patients with AF than those with sinus rhythm (25.2 [0.22] vs 26 [0.11]; P <0.001). Moreover, there was a difference in the number of points obtained by the patients with symptomatic AF and SAF, with the latter group having the lower score (25.8 [0.26] vs 24.3 [0.38]; P = 0.001). Finally, in a multivariable logistic regression model, the impact of SAF (but not that of symptomatic AF) on MMSE scores was demonstrated.

Conclusions: In the older population, AF is associated with a lower MMSE score. In the case of SAF, this relationship is independent of other risk factors. This suggests the need for an active search for SAF in the group of patients with dementia and, on the other hand, screening for cognitive disorders in older patients with accidentally detected SAF.