- Researchers are reporting that women with atrial fibrillation (AFib) have a higher risk of cognitive decline than women without the condition.
- They also report that women in general have more rapid cognitive decline than men, whether they have AFib or not.
- Experts say AFib is becoming more common and women with the condition are often not properly diagnosed.
Women with atrial fibrillation (AFib) experience a more rapid cognitive decline than women without the condition.
That’s according to a study published today in Alzheimer’s & Dementia.
Researchers analyzed medical records from the
The average person was 78 years old and 46% were women.
Before inclusion in the study, participants needed at least three annual clinic visits with neuropsychological tests and were categorized as having healthy cognition, mild cognitive impairment, or dementia.
For the study, the scientists looked at the following:
- AFib and baseline cognitive diagnosis
- AFib and the time to progression to a cognitive diagnosis
They adjusted their analysis for age, sex, race, education, body mass index, smoking, depression, hypertension, diabetes, high cholesterol, heart failure, stroke, and sleep apnea.
The researchers compared men and women with AFib to those without the condition and examined differences by gender.
The findings included:
- Women with AFib were three times more likely to have mild cognitive impairment and dementia at baseline compared to women without AFib.
- Comparisons for men were not considered statistically significant.
At a four-year follow-up, 30% of the participants progressed to a worse cognitive impairment stage while 21% developed dementia.
Women were more likely to continue to a worse state, transitioning from healthy cognition to mild cognitive impairment and from mild cognitive impairment to vascular dementia, compared to women without AFib or men with or without AFib.
“Atrial fibrillation is the most common arrhythmia or abnormal heart rhythm and the prevalence of this condition is only increasing,” said Dr. Nadia Jafar, a cardiologist with Torrance Memorial Medical Center, an affiliate of Cedars Sinai in Los Angeles who was not involved in the study.
“It is important for clinicians to promptly diagnose atrial fibrillation, as it is associated with stroke and increased mortality. Prior studies have shown that men are at greater risk for developing atrial fibrillation than women,” Jafar told Medical News Today.
“The female sex may confer a higher risk for atrial fibrillation when controlling for height and/or body size. This highlights that women should not get overlooked when assessing for atrial fibrillation, offering preventive education, and considering diagnostic testing.”
— Dr. Nadia Jafar, cardiologist
The study’s authors note that symptoms of atrial fibrillation in women are often ignored by healthcare professionals or attributed to stress or anxiety, which means it could go undiagnosed for a long time.
Men, on the other hand, are more likely to be diagnosed and treated quickly.
This means females could have a delay in treatment. Women could also have clots that go to the small blood vessels in their brains, causing cognitive impairment but going undetected.
“The findings are interesting and likely corroborate other investigative efforts documenting a gender bias in cardiovascular medicine,” said Dr. Dennis Finkielstein, a board certified cardiologist and vice-chair of cardiology at Northwell Lenox Hill Hospital in New York, who was not involved in the study.
“When symptomatic, the most common symptoms people experience with atrial fibrillation are palpitations and shortness of breath,” Finkielstein told Medical News Today.
“Unfortunately, historically, women presenting with these symptoms were often inferred to have a psychosomatic etiology of their complaints, and a proper workup was often not pursued.”
Earlier detection of AFib in women is crucial for preventing cognitive decline.
The researchers suggest that cognitive screening — especially in women — should be included in annual cardiology visits for adults with AFib to identify those at higher risk of cognitive disease earlier in their trajectory.
Dr. Finkielstein noted that when AFib is diagnosed, medical professionals “often pursue thromboembolism (i.e., stroke) prophylaxis with anticoagulants.”
“Going back to the last point of under-diagnosis in women, it would stand to reason that this would lead to under-treatment. Ironically, when employing modern risk scoring algorithms to assist in the decision to start anticoagulation in people with atrial fibrillation, the female gender is assigned an additional risk point.”
— Dr. Dennis Finkielstein, cardiologist