Clearing the cognitive cloud: direct oral anticoagulants or vitamin K antagonists for reducing dementia risk in patients with atrial fibrillation?

It is now widely acknowledged that cognitive decline and dementia present a challenge in the treatment and management of patients with atrial fibrillation (AF). Cognitive difficulties in patients with AF directly impact their care.1 In particular, they reduce understanding of treatment options, which are increasingly requiring patient input in joint clinical decision-making. They also have a negative impact on adherence to treatment as medications such as oral anticoagulants (OACs) need to be taken consistently in a timely manner over a long period of time to maintain their efficacy for stroke prevention. It is also clear that cognitive decline and dementia impact independent living, progressively interfering with tasks of daily life and the ability to sustain healthy living choices such as exercise which are important in AF management. Over time, these challenges lead to an overall reduction in quality of life.

The exact mechanisms linking AF and dementia are likely...