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Background  Atrial fibrillation ( AF ) has been associated with faster cognitive decline and increased dementia risk. Factors associated with dementia in patients with  AF  have been seldom studied.    Methods and Results  We studied 6432 individuals from the  ARIC ‐NCS (Atherosclerosis Risk in Communities Neurocognitive Study). In 2011 to 2013, participants underwent a physical exam, echocardiography, detailed cognitive assessments, and a subset, brain magnetic resonance imaging. Dementia and mild cognitive impairment ( MCI ), as well as etiology of  MCI /dementia, Alzheimer's disease–related or vascular, were adjudicated by an expert panel.  AF  was defined by study ECGs and past hospitalizations. We used logistic regression to estimate odds ratios and 95%  CI  of  MCI /dementia by  AF  status and to assess cross‐sectional correlates of  MCI /dementia in patients with  AF . Among 6432 participants, 611 (9.5%) had prevalent  AF .  AF  was associated with increased odds of dementia and  MCI  (odds ratio, 95%  CI , 2.25, 1.64–3.10, and 1.28, 1.04–1.56, respectively). Prevalence of Alzheimer's disease–related  MCI /dementia and vascular  MCI /dementia were higher in participants with  AF  than without  AF  (odds ratio, 95%  CI , 1.29, 1.04–1.61, and 1.50, 0.99–2.25, respectively). In multivariable analyses, older age, lower body mass index, diabetes mellitus, stroke, and   APOE   genotype were associated with dementia prevalence in participants with  AF . In models evaluating  MCI /dementia subtypes, diabetes mellitus was associated with Alzheimer's disease–related  MCI /dementia, whereas male sex and stroke were risk factors for vascular  MCI /dementia.    Conclusions  In a large, community‐based study,  AF  was associated with higher prevalence of  MCI  and dementia. Controlling cardiometabolic risk factors is a potential target for prevention of adverse cognitive outcomes in  AF  patients.

journal of the american heart association

Correlates of Dementia and Mild Cognitive Impairment in Patients With Atrial Fibrillation: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC‐NCS)