warfarin and Dementia--Vascular

Topics: Activities of Daily Living; Anticoagulants; Cholinesterase Inhibitors; Dementia, Vascular; Donepezil; Humans; Indans; Patient Care Team; Piperidines; Quality of Life; Secondary Prevention; Selective Serotonin Reuptake Inhibitors; Warfarin

The genetic variant rs9923231 (VKORC1) is associated with differences in the coagulation of blood and consequentially with sensitivity to the drug warfarin. Variation in VKORC1 has been linked in a gene-based test to dementia/Alzheimer's disease in the parents of participants, with suggestive evidence for an association for rs9923231 (p = 1.8×10-7), which was included in the genome-wide significant KAT8 locus.. Our study aimed to investigate whether the relationship between rs9923231 and dementia persists only for certain dementia sub-types, and if those taking warfarin are at greater risk.. We used logistic regression and data from 238,195 participants from UK Biobank to examine the relationship between VKORC1, risk of dementia, and the interplay with warfarin use.. Parental history of dementia, APOE variant, atrial fibrillation, diabetes, hypertension, and hypercholesterolemia all had strong associations with vascular dementia (p < 4.6×10-6). The T-allele in rs9923231 was linked to a lower warfarin dose (βperT - allele = -0.29, p < 2×10-16) and risk of vascular dementia (OR = 1.17, p = 0.010), but not other dementia sub-types. However, the risk of vascular dementia was not affected by warfarin use in carriers of the T-allele.. Our study reports for the first time an association between rs9923231 and vascular dementia, but further research is warranted to explore potential mechanisms and specify the relationship between rs9923231 and features of vascular dementia.

Topics: Aged; Anticoagulants; Dementia, Vascular; Female; Genetic Predisposition to Disease; Genotype; Humans; Male; Middle Aged; Polymorphism, Single Nucleotide; Vitamin K Epoxide Reductases; Warfarin

The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. We previously found a significantly increased risk of dementia in AF patients taking warfarin with a low percentage of time in therapeutic range. The purpose of this study was to determine the extent to which AF itself increases dementia risk, in addition to long-term anticoagulation exposure.. A total of 10 537 patients anticoagulated with warfarin (target INR 2-3), managed by the Clinical Pharmacist Anticoagulation Service with no history of dementia were included. Warfarin indication was for AF (n=4460), thromboembolism (n=5868), and mechanical heart valve(s) (n=209). Patients in the latter 2 categories were included only if they had no prior history of AF. The primary outcome was dementia. Patients with AF were older and had higher rates of hypertension, diabetes, heart failure, and stroke. AF patients experienced higher rates of total dementia (5.8% versus 1.6%, P<0.0001), Alzheimer disease (2.8% versus 0.9%, P<0.0001), and vascular dementia (1.0% versus 0.2%, P<0.0001). A propensity analysis of 6030 patients was performed to account for baseline demographics differences. Long-term risk of dementia remained significant in AF patients compared with matched non-AF patients (total dementia: hazard ratio [HR]=2.42 [1.85-3.18], P<0.0001; Alzheimer: HR=2.04 [1.40-2.98], P<0.0001; senile: HR=2.46 [1.58-3.86], P<0.0001). Low percent therapeutic range compared with a higher percent therapeutic range was associated with dementia risk in both AF (26-50% versus >75%: HR=2.51, P=0.005) and non-AF groups (≤25% versus >75%: HR=3.92, P<0.0001).. The presence of AF significantly increases risk of dementia, including Alzheimer's disease, compared with matched patients receiving warfarin anticoagulation for other reasons. Quality of anticoagulation management remains an important risk factor for dementia in all patients.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Anticoagulants; Atrial Fibrillation; Dementia; Dementia, Vascular; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Stroke; Thromboembolism; Warfarin

Topics: Alzheimer Disease; Anticoagulants; Atrial Fibrillation; Dementia, Vascular; Humans; Incidence; Risk Factors; Vitamin K Deficiency; Warfarin

Antiphospholipid syndrome (APS) is identified as the presence of antiphospholipid antibodies (aPLs) in patients with vascular thrombosis and/or pregnancy morbidity (including fetal death, premature birth and habitual abortion). Neurological manifestations in patients with APS are common, whereas movement disorders are rarely seen. We report an extremely rare case of APS presented with parkinsonism and review the literature to address the clinical profile and possible pathophysiologic mechanism of this disorder.

Topics: Adult; Anticoagulants; Antiparkinson Agents; Antiphospholipid Syndrome; Brain; Cerebral Arteries; Corpus Striatum; Dementia, Vascular; Female; Humans; Intracranial Thrombosis; Levodopa; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; Parkinsonian Disorders; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Warfarin

Topics: Aged; Anticoagulants; Antipsychotic Agents; Dementia, Vascular; Dibenzothiazepines; Drug Synergism; Drug Therapy, Combination; Female; Humans; International Normalized Ratio; Quetiapine Fumarate; Thrombophlebitis; Warfarin

Topics: Aged; Alzheimer Disease; Anticoagulants; Dementia, Vascular; Humans; Palliative Care; Warfarin

Topics: Aged; Aspirin; Atrial Fibrillation; Cerebrovascular Disorders; Dementia, Vascular; Humans; Hypertension; Ischemic Attack, Transient; Risk Factors; Warfarin

Topics: Alzheimer Disease; Anticoagulants; Clinical Trials as Topic; Dementia, Vascular; Humans; Tacrine; Warfarin