Factors associated with changes in global cognitive functioning in patients with atrial fibrillation aged between 45 and 65 years
DOI:
https://doi.org/10.67667/NEU.v27i2.238Keywords:
atrial fibrillation, cognitive impairment, cognitive reserve, dyslipidemia, eGFR, MoCAAbstract
Introduction: Atrial fibrillation (AF) is associated with an increased risk of cognitive decline, even in the absence of clinically apparent stroke. Data on the factors determining cognitive functioning and its dynamics over time in middle-aged patients remain limited, especially in the Bulgarian population.
Objective: To investigate the sociodemographic, clinical-laboratory and vascular factors associated with global cognitive functioning and its change over time in patients with AF.
Materials and methods: A prospective study was conducted with 56 patients with AF and concomitant cardiometabolic diseases aged 45–65 years, followed for a period of 12 months. Cognitive functioning was assessed using the MoCA, MMSE and IST tests at baseline and at follow-up. Multivariate linear regression models were used to assess factors associated with cognitive outcomes and their change
Results: Higher educational level was consistently associated with better cognitive performance on both MoCA and MMSE. Higher total cholesterol levels were associated with lower MoCA scores, while a history of COVID-19 infection showed a positive association. Higher estimated glomerular filtration rate (eGFR) was independently associated with better IST performance. The explanatory power of the models was low, suggesting the involvement of additional unaccounted factors.
Conclusion: Cognitive functioning in patients with AF and concomitant cardiometabolic diseases in middle age is associated with a complex of metabolic, clinical and socio-demographic factors.
The results suggest the need for an integrated approach to the assessment of cognitive risk and emphasize the importance of modifiable risk factors. Larger prospective and representative studies are needed to confirm the observed relationships.
References
1. Carson, A.J., Stephenson, M.D., Wardlaw, J.M., Dennis, M.S., Bamford, J.M., Whiteley, W.N. Cognitive impairment, dementia, and atrial fibrillation: a systematic review and meta-analysis. Stroke. 2018,49,6,1423–1431.
2. Chopard, G., Pitard, A., Ferreira, S., Vanholsbeeck, G., Rumbach, L., Galmiche, J. Combining the Memory Impairment Screen and the Isaacs Set Test: a practical tool for screening dementias. J Am Geriatr Soc. 2007 Sep,55,9,1426-1430. doi: 10.1111/j.1532-5415.2007.01271.x. PMID: 17767686. DOI: https://doi.org/10.1111/j.1532-5415.2007.01271.x
3. Colita, E., Mateescu, V.O., Olaru, D.G., Popa-Wagner, A. Cognitive decline in ageing and disease: risk factors, genetics and treatments. J Med Life. 2024,50,2,170–180.
4. Elkana, O., Beheshti, I. The protective role of education in white matter lesions and cognitive decline. Brain Cogn. 2025,187,106304. DOI: https://doi.org/10.1016/j.bandc.2025.106304
5. Etgen, T., Sander, D., Bickel, H., Förstl, H. Mild cognitive impairment and dementia. Dtsch Arztebl Int. 2011,108,44,743–70. DOI: https://doi.org/10.3238/arztebl.2011.0743
6. Folstein,, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-Mental State Examination (MMS, MMSE) [Database record]. APA PsycTests. DOI: https://doi.org/10.1037/t07757-000
7. Hampshire, A., Azor, A., Atchison, C,, Trender, W., Hellyer, P.J., Giunchiglia, V. et al. Cognition and memory after COVID-19 in a large community sample. N Engl J Med. 2024,390,9,806–818. DOI: https://doi.org/10.1056/NEJMoa2311330
8. Huang, L.J., Chen, J.S., Song, Y.Z., Chang, P. Atrial fibrillation and cognitive impairment: mechanisms, influencing factors, and prospects. Front Cardiovasc Med. 2025,12. DOI: https://doi.org/10.3389/fcvm.2025.1527802
9. Islam, N., Hashem, R., Gad, , Brown, A., Levis, B., Renoux, C., Thombs, B.D., McInnes, M.D. Accuracy of the Montreal Cognitive Assessment tool for detecting mild cognitive impairment: A systematic review and meta-analysis. Alzheimers Dement. 2023 Jul;19,7,3235-3243. doi: 10.1002/alz.13040. Epub 2023 Mar 19. PMID: 36934438. DOI: https://doi.org/10.1002/alz.13040
10. Jiao, M., Li,u C.L., Liu ,Y., Wang, Y., Gao, Q., Ma, A. Estimates of the global, regional, and national burden of atrial fibrillation in older adults from 1990 to 2019: insights from the Global Burden of Disease Study 2019. Front Public Health. 2023,11. DOI: https://doi.org/10.3389/fpubh.2023.1137230
11. Kim, D., Yang, P.S., Yu, H.T., Kim, T.H., Jan,g E.,, Sung J.H. et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort. Eur Heart J. 2019,40,28,2313–2323. DOI: https://doi.org/10.1093/eurheartj/ehz386
12. Kuhn, H.G., Skau, S., Nyberg, J. A lifetime perspective on risk factors for cognitive decline with a special focus on early events. Cereb Circ Cogn Behav. 2024,100217. DOI: https://doi.org/10.1016/j.cccb.2024.100217
13. Lancet Public Health. ,2,:e69. DOI: 10.1016/S2468-2667(26)00007-1 DOI: https://doi.org/10.1016/S2468-2667(26)00007-1
14. Nowak, D.A., Trojanowski, T., Kubica, J. Chronic kidney disease and cognitive impairment: a systematic review. Neurol Neurochir Pol. 2023,57,2,123–132. doi:10.5603/PJNNS.a2023.0012. DOI: https://doi.org/10.5603/PJNNS.a2023.0012
15. Pal, T., Iantovics, L.B., Preg, Z., Nemes-Nagy, E., Nyulas, K.I., Baba, D.F, et al. Risk factors for cognitive dysfunction amongst patients with cardiovascular diseases. Front Public Health. 2024,12. DOI: https://doi.org/10.3389/fpubh.2024.1385089
16. Potpara, T.S., Balkan-AF Investigators, Lip GYH. Patterns in atrial fibrillation management and real-world adherence to guidelines in the Balkan region: an overview of the Balkan–atrial fibrillation survey. Eur Heart J. 2015,3,30,1943–1944.
17. Saglietto, A., Ballatore, A., Xhakupi, H., De M, Anselmino M. Atrial fibrillation and dementia: epidemiological insights on an undervalued association. Medicina (Kaunas). 2022,58,3,361. DOI: https://doi.org/10.3390/medicina58030361
18. Santamaria, A., Antón, C., Ibarra, N.,, Fernández M., González, P.,, Carrasco R. Atrial fibrillation and cognitive decline: a systematic review of pathophysiological mechanisms, therapeutic strategies, and digital health technologies in neuroprotection. J Clin Med. 202,15,5,1744. DOI: https://doi.org/10.3390/jcm15051744
19. Suchy-Dicey, A.M., Longstreth, W.T., Buchwald, D.S., Rhoads, K., Grabowski, T.J. Cognitive reserve is associated with education, social determinants, and cognitive outcomes among older American Indians. Commun Psychol. 2025,3,1. DOI: https://doi.org/10.1038/s44271-025-00198-6
20. Tang, X., Luo, Y., Chen, Z., et al. Association of kidney function and brain health: a systematic review and meta-analysis of cohort studies. Front Aging Neurosci. 2022,14:1018054. doi:10.3389/fnagi.2022.1018054.
21. Zhao, S., Toniolo, S.,, Hampshire, , Husain, M. Effects of COVID-19 on cognition and brain health. Trends Cogn Sci. 2023,27,11. DOI: https://doi.org/10.1016/j.tics.2023.08.008
22. Zhao, Y., Zhang, H., Cheng, J., Zou, Y., Zhang, D., Dua,n X. Association between dyslipidaemia and cognitive impairment: a meta-analysis of cohort and case-control studies. J Integr Neurosci. 2024,23,2,40–50 DOI: https://doi.org/10.31083/j.jin2302040
23. Zhong, T., Li, S., Liu, P., Wang, Y., Chen, L. The impact of education and occupation on cognitive impairment: a cross-sectional study in China. Front Aging Neurosci. 2024,16. DOI: https://doi.org/10.3389/fnagi.2024.1435626
