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Mild cognitive impairment common in AF patients

Mild cognitive impairment (MCI) is highly prevalent amongst typically older high-risk patients hospitalised with atrial fibrillation (AF), according to a study1 published recently in Heart.

Researchers performed a prospective substudy of a multicentre randomised trial of an AF-specific disease management intervention (the Standard versus Atrial Fibrillation spEcific managmenT studY; SAFETY).

Cognitive function was assessed at baseline (during inpatient stay), using the Montreal Cognitive Assessment (MoCA) score, in a total of 260 patients with chronic AF (mean age 72±11 years, 53% men, mean CHA2DS2-VASc score 4±2).

Overall, 169 patients were found to have mild cognitive impairment (defined as a MoCA score <26) at baseline. Multiple deficits in cognitive domains were identified, most notably in executive functioning, visuospatial abilities and short-term memory.

Predictors of MCI (age and sex-adjusted) were lower education level (technical/trade school level OR 6.00, 95% CI 2.07 to 17.42; <8 years school education OR 5.29, 95% CI 1.95 to 14.36 vs. 8–13 years), higher CHA2DS2-VASc score (OR 1.46, 95% CI 1.23 to 1.74) and prescribed digoxin (OR 2.19, 95% CI 1.17 to 4.10).

Professor Simon Stewart

Professor Simon Stewart

Routine assessment of cognitive function with adjustment of clinical management is indicated for this patient group the authors add.

Co-author, Professor Simon Stewart (Baker IDI Heart and Diabetes Institute, Melbourne, Australia), spoke to BJC Arrhythmia Watch on the study’s key findings:

“The MoCA is being increasingly used as a useful cognitive assessment tool in the clinical setting. Unfortunately, there are no data documenting how often this and other important screening tools are administered in various parts of the world. It only takes 5–10 minutes to administer (the tool is confined to a single page and easily calculated summative score) and is user-friendly,” he said.

“The well known Mini-Mental Test is the most commonly applied tool for rapidly assessing cognitive function. The MoCA has some important advantages whilst still being easy to apply and interpret. However, neither tools can replace more exhaustive cognitive screening tools applied by suitably trained personnel that examine, more explicitly, specific cognitive domains,” he continued.

“From a number of perspectives, it is imperative that hospitalised patients with AF should undergo screening for potential cognitive impairment – particularly those being discharged to home and expected to follow complicated instructions relating to their anti-coagulation therapy,” he added.

“Age-related decline) is difficult to quantify without reliable sex and age-matched normative data. However, we do know that the prevalence of cognitive impairment is particularly high in those individuals with AF and that the pathological consequences of AF and its antecedents include impaired cerebral function,” he concluded.


1. Ball J, Carrington MJ, Stewart S, on behalf of the SAFETY investigators. Mild cognitive impairment in high-risk patients with chronic atrial fibrillation: a forgotten component of clinical management? Heart 2013.

Published on: January 25, 2013

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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