Abstract
Aims:To assess the effect of oral anticoagulant (OAC) administration on
incidence of dementia in patients with atrial fibrillation (AF) with
Systematic review and meta-analysis in according with the Preferred
Reporting Items for Systematic Review and Meta-analysis Protocols.
Methods: We systematically searched the electronic databases
including Pubmed, Embase, Cochrane library, and ClinicalTrails.gov for
relevant articles. The primary outcome was the incidence of dementia.
The adjusted risk ratio (RR), odds ratio, or hazard ratio were extracted
and pooled by the random-effects models. Subgroup analysis was performed
according to the setting observational window. Risk of bias was assessed
using the Newcastle-Ottawa Scale, while publication bias was assessed by
the Begg’s and Egger’s tests.
Results: Nine studies included in this review (2 prospective
and 7 retrospective observational studies, including 613,920 patients).
The results presented the significant association between OAC therapy
and the reduced risk of dementia compared with no treatment (RR
[95%CI] =0.72 [0.60, 0.86], I2=97.2%;P =0.000). In the subgroup analysis, the pooled RR became
statistically non-significant (including four studies, RR [95%CI]
=0.75 [0.51, 1.10], I2=98.8%; P =0.000).
There is no significant risk of bias and publication bias.
Conclusions: This study indicated the protective effect of OAC
therapy for dementia in patients with AF. However, the results are
limited because of high heterogeneity, inconsistent direction of effect
in subgroup analysis. Further prospective well-designed study is needed
with longer follow-up duration in younger patients.
Keywords:atrial
fibrillation; anticoagulant; dementia; cognitive impairment