Patients with atrial fibrillation (AF) have a higher risk of dementia and mild cognitive impairment, in addition to a fivefold higher risk of stroke, compared with patients in normal sinus rhythm. Potential mechanisms of cognitive impairment or dementia related to AF include recurrent micro emboli versus cerebral hypoperfusion in association with increased oxidative stress, inflammation and disruption of the blood-brain barrier. Using linked electronic health records from the Clinical Practice Research Datalink in the UK, Cadogan and colleagues1 compared the incidence of dementia or mild cognitive impairment in 39 200 patients (median age 76 years, 45% women) with AF treated with either a vitamin-K antagonist (VKA) or a direct oral anticoagulant (DOAC). Incident dementia was diagnosed in 3.2% with a 16% lower risk of dementia in patients treated with a DOAC versus VKA (adjusted HR 0.84, 95% CI: 0.73 to 0.98) . Mild cognitive impairment was diagnosed in 4.0% with a 26% lower risk in those treated with a DOAC versus VKA (adjusted HR 0.74, 95% CI: 0.65 to 0.84) (figure 1). For patients taking a VKA, greater time with anticoagulation in therapeutic range was associated with a lower risk of dementia. Figure 1 Association between oral anticoagulant use and incident dementia and mild cognitive impairment, defined using clinical codes. ∧Adjusted for age, calendar year, time-on-treatment and sex. *Adjusted for age, calendar year, time-on-treatment, sex, body mass index, smoking status, hazardous alcohol consumption, socioeconomic status (practice level Index of Multiple Deprivation), primary care consultation frequency, diabetes, hypertension, myocardial infarction, statins, heart failure, stroke, vascular disease, renal disease, liver disease, antiplatelet drugs, ACE/ARB inhibitors, beta-blockers, antiarrhythmics, digoxin, diuretics, antipsychotics, antidepressants and proton …

中文翻译：

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心跳：对于房颤患者，与维生素 K 拮抗剂相比，直接口服抗凝剂可降低痴呆风险

与正常窦性心律的患者相比，房颤 (AF) 患者患痴呆症和轻度认知障碍的风险更高，而且中风的风险要高 5 倍。与 AF 相关的认知障碍或痴呆的潜在机制包括复发性微栓子与脑灌注不足与氧化应激增加、炎症和血脑屏障破坏相关。使用来自英国临床实践研究数据链的链接电子健康记录，Cadogan 及其同事 1 比较了 39 200 名接受维生素 K拮抗剂 (VKA) 或直接口服抗凝剂 (DOAC)。3 例确诊痴呆。与 VKA 相比，接受 DOAC 治疗的患者患痴呆症的风险降低了 2%（调整后的 HR 0.84，95% CI：0.73 至 0.98）。与 VKA 相比，DOAC 治疗的轻度认知障碍的诊断率为 4.0%，风险降低 26%（调整后的 HR 0.74，95% CI：0.65 至 0.84）（图 1）。对于服用 VKA 的患者，在治疗范围内进行抗凝治疗的时间越长，患痴呆症的风险就越低。图 1 使用临床代码定义的口服抗凝剂使用与痴呆和轻度认知障碍之间的关联。∧根据年龄、日历年、治疗时间和性别进行调整。*根据年龄、日历年、治疗时间、性别、体重指数、吸烟状况、有害饮酒、社会经济状况（多重剥夺的实践水平指数）、初级保健咨询频率、糖尿病、