Study selection and outcome measurement
Two reviewers
(Mingjie
Lin and Wenqiang Han) independently screened the titles and abstracts
according to the designed criteria; and full articles were obtained for
all titles potentially meeting inclusion and exclusion criteria. Endnote
Version x9.1 (Clarivate Analytics (US) LLC) was used to manage
identified studies and recode the decisions. Reviewers were blinded to
each other’s decisions.
Disagreements
between individual judgements were resolved by discussion between
themselves and another senior reviewer (Jingquan Zhong). The inclusion
criteria were: i) patients with AF who were ≥ 18 years; ii)
investigating the effects of OACs on the incidence of dementia; iii)
reporting the outcomes as HR, RR, or OR, with 95%CIs; iv) RCTs or
observational studies. The exclusion criteria were: i) patients with the
history of dementia or moderate to severe cognitive dysfunction; ii)
only crude or unadjusted HR, RR, or OR; iii) cross-sectional studies;
iv) following types of articles:
conference abstracts, editorials,
letters, expert opinions, case reports, case series, or reviews. OACs
included vitamin K antagonists (VKAs) and non-vitamin K OACs (NOACs);
the control, i.e. Non-OACs included antiplatelet agents or no
antithrombotic therapy; dementia included
Alzheimer’s/Lewy-body/senile/vascular dementia; for overlapping
participants, the studies with the longest follow-up and the most
detailed information were chosen. The PICOS criteria are presented in
Supplementary Table S2.
The primary outcome was the incidence of dementia during the follow-up
in AF patients with and without OAC use. The
dementia
was diagnosed based on patient narrative, collateral information from
families, clinical examination, the standardized cognitive
tests,2 and diagnostic criteria for dementia including
Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-IV,
DSM-V, diagnosis based on international classification of diseases codes
(ICD), or United Kingdom (UK) Read codes.9, 23 The
additional outcomes were the incidence of dementia in AF patients with:
VKAs vs. non-OACs, VKAs vs. NOACs, NOACs vs. non-OACs, and in AF
patients with and without OACs use whose
CHA2DS2-VASc score was ≥ 2.