Do Sex Differences Exist in Cognitive Function in Patients with Atrial Fibrillation?

Abstract

AbstractBackgroundAtrial fibrillation (AF) is a risk factor for mild cognitive impairment (MCI) and dementia. To address sex differences in AF‐related MCI, we examined disease prevalence and progression among adults with and without AF in the National Alzheimer’s Coordinating Center (NACC) cohort.MethodData freeze/extraction of NACC data (N = 43,746) took place March 2021. Participants with ≥ 3 annual visits, diagnostic data, and AF status (self‐reported or diagnosed) were included. Diagnostic categories were normal, MCI, and dementia. Multinomial logistic regression and Cox proportional hazard model were used to examine association between AF and baseline cognitive diagnosis and time to progression in cognitive diagnosis, respectively. Covariates included age, sex, race, education, BMI, smoking, depression, hypertension, diabetes, hypercholesterolemia, heart failure, stroke, and sleep apnea. Interactions with sex were examined in all models.Result4,593 participants had AF at baseline (46% female, mean age 78.5 years, 81% White, 8% Black, 11% other ethnicities). AF is associated with higher odds of having MCI (OR 3.43 [1.48, 7.91] in females; OR 1.73 [0.81, 3.71] in males) and dementia (OR 3.00 [1.22, 7.38] in females; OR 2.60 [1.16, 5.81] in males) at baseline. Among the 13,683 subjects included in the survival analysis, 4066 (30%) progressed from normal cognition to MCI and 2895 (21%) developed dementia (2434 [18%] AD) with median follow‐up of 4 years. Women with AF had higher risk of disease progression (HR 1.21 [1.04, 1.40]) compared to women without AF, but the association was not significant in men (HR 0.96 [0.83, 1.11]). AF was significantly associated with faster transition from normal cognition to MCI (HR 1.17 [1.03, 1.33]) and from MCI to vascular dementia (HR 2.51 [1.63, 3.85]) but not MCI to AD.ConclusionThis is the first study to examine sex differences in rate of cognitive change in patients with AF. Women with AF are at higher risk of MCI and dementia with more rapid trajectories to dementia than women without AF or men with or without AF. Identification of those at highest risk of cognitive decline will inform future interventions to prevent or slow AF‐related MCI and AD.