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Newer Blood Thinners May Slow Alzheimer's Cognitive Decline

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A Karolinska study of 7,308 patients found NOAC blood thinners tied to slower cognitive decline in people with Alzheimer's and atrial fibrillation.

People living with both Alzheimer's disease and atrial fibrillation tended to lose their thinking and memory abilities more slowly when treated with a newer class of blood thinners, according to a study from Sweden's Karolinska Institutet. The findings, published in the European Heart Journal, drew on records from 7,308 patients diagnosed with the two conditions.

The research team, led by Maria Eriksdotter, a professor at the Department of Neurobiology, Care Sciences and Society at Karolinska Institutet and a senior consultant in geriatric medicine at Karolinska University Hospital, compared three matched groups of patients. One group took newer anticoagulants called NOACs, a second used the older drug warfarin, sold as Waran, and a third took no blood thinner at all.

Atrial fibrillation, an irregular heart rhythm, is frequent among older people and shows up often in those with Alzheimer's. Physicians commonly put such patients on anticoagulants to cut their odds of clots and stroke. Prior work had hinted that these medicines might lower the chance of developing dementia, but researchers had far less evidence on what happens to memory and reasoning once Alzheimer's has already set in.

Tracking memory with the MMSE

To measure change over time, the team pulled data from SveDem, Sweden's national quality registry for cognitive disorders and dementia, and scored patients using the Mini-Mental State Examination, a standard test of thinking and memory. Patients on NOACs held onto their cognitive function noticeably better than those on warfarin or those given no anticoagulant.

The gap came to a little over 0.2 MMSE points each year in favour of the NOAC group. That is a slight difference across any single year. The researchers argue, however, that a small yearly edge could accumulate into something that matters as the disease runs its course.

"The difference is modest for an individual patient from one year to the next, but over a longer period even such an effect could influence how cognitive function develops," said Nanbo Zhu, a researcher in the same department. "Our findings suggest that NOAC treatment may also be significant for cognition in this patient group."

Eriksdotter offered a possible biological explanation. "There are reasons to believe that the treatment could have a positive effect on cognition, for example by improving blood flow and reducing small-scale damage in the brain," she said.

Fewer strokes, clots and deaths

The advantages went beyond memory. Set against patients who received no anticoagulant, those on NOACs faced lower risks of dying, of stroke, of blood clots and of fractures. Warfarin also came with reduced risks of death, stroke and clots. But patients on warfarin ran a higher risk of serious bleeding.

The authors were careful about how far the results can be pushed. The study observed patients rather than assigning treatments at random, so it cannot establish that NOACs were the direct cause of the slower decline or the other improvements in the figures. Some influences that might shape both a patient's prescription and the course of their health could not be fully accounted for. The team also noted that certain participants may have switched between medications while they were being followed.

Funding for the work came from several sources, including the Swedish Research Council, the Swedish Brain Foundation, CIMED, ALF project funding and Karolinska Institutet's own funds. Eriksdotter has served as a consultant in individual meetings with BioArctic AB, Roche, Eli Lilly, Biogen/Eisai and Novo Nordisk, and has lectured at symposia backed by Roche and BioArctic/Eisai. The study reported no other conflicts of interest.

The results speak to a large group of patients, since both conditions become more common with age and frequently occur together. For clinicians already weighing which anticoagulant to prescribe for stroke prevention, the data add cognition to the list of outcomes that may differ between the older and newer drugs. Confirming whether NOACs truly protect thinking and memory would require a trial that randomly assigns patients to each treatment and tracks them over years.

NOAC blood thinners, Alzheimer's cognitive decline, atrial fibrillation, warfarin, Karolinska Institutet, anticoagulants dementia, MMSE, stroke prevention

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