Comparison of Cognitive Functions between Paroxysmal and Persistent Atrial Fibrillation Patients without Clinical Stroke

Caepy Gomer, Paulus Anam Ong, Sobaryati Sobaryati, Badai Bhatara Tiksnadi


Objective: To compare cognitive functions between paroxysmal and persistent atrial fibrillation patients without clinical stroke, in terms of MoCA-Ina total score and MoCA-Ina cognitive subdomains scores.

Methods: A comparative study that compared MoCA-Ina scores between paroxysmal and persistent AF patients without clinical stroke, who came for treatment at the Cardiology Clinic Dr. Hasan Sadikin General Hospital, Bandung and Dustira Hospital, Cimahi from September 2018–January 2019.

Results: Sixty four subjects were recruited, consisted of 24 paroxysmal and 40 persistent AF patients. There were no difference in clinical characteristics between two groups, except that there were more subjects in the persistent AF group using anticoagulants therapy: 97.5% vs 62.5% (p=0.005) and more prevalence of type 2 Diabetes Mellitus in the paroxysmal AF group: 25% vs 2.5% (p=0.009). Cognitive impairment (MoCA-Ina score <25) were seen in 70.8% of paroxysmal AF group and 82.5% of persistent AF group (p=0.274). The mean MoCA-Ina total score in the paroxysmal and persistent AF groups were 21.04±4.75 vs 20.70±4.21 (p=0.989), respectively. The median MoCA-Ina cognitive subdomains scores were similar for the two groups (p>0.05).

Conclusion: There were no differences in cognitive functions between paroxysmal and persistent AF patients, both in terms of MoCA-Ina total score and MoCA-Ina cognitive subdomains scores, although in both groups had cognitive decline.


atrial fibrillation; cognitive impairment; MoCA-Ina; paroxysmal AF; persistent AF

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Singh–Manoux A, Fayosse A, Sabia S, Canonico M, Bobak M, Elbaz A, et al. Atrial fibrillation as a risk factor for cognitive decline and dementia. Eur Heart J. 2017;38(34):2612–8.

Alonso A, Knopman DS, Gottesman RF, Soliman EZ, Shah AJ, O’Neal WT, et al. Correlates of dementia and mild cognitive impairment in patients with atrial fibrillation: the atherosclerosis risk in communities neurocognitive study (ARIC‐NCS). J Am Heart Association. 2017;6(7):e006014.

Alonso A, de Larriva APA. Atrial fibrillation, cognitive decline and dementia. Eur Cardiol Rev. 2016;11(1):49–53.

Rivard L, Khairy P. Mechanisms, clinical significance, and prevention of cognitive impairment in patients with atrial fibrillation. Canadian Journal of Cardiology. 2017;33(12):1556–64.

Kalantarian S, Ay H, Gollub RL, Lee H, Retzepi K, Mansour M, et al. Association between atrial fibrillation and silent cerebral infarctions: a systematic review and meta–analysis. Annals of internal medicine. 2014;161(9):650–8.

Gaita F, Corsinovi L, Anselmino M, Raimondo C, Pianelli M, Toso E, et al. Prevalence of silent cerebral ischemia in paroxysmal and persistent atrial fibrillation and correlation with cognitive function. J Am College Cardiol 2013;62(21):1990–7.

Husein N, Lumempouw S, Ramli Y, Herqutanto. Montreal Cognitive Assessment versi Indonesia (MoCA–Ina) untuk skrining gangguan fungsi kognitif. Neurona. 2010;27(4):1–13.

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Ger Soc. 2005;53(4):695–9.

Rossetti HC, Lacritz LH, Cullum CM, Weiner MF. Normative data for the Montreal Cognitive Assessment (MoCA) in a population–based sample. Neurology. 2011;77(13):1272–5.

Salam S, Muis A, Aliah A, Akbar M, Kabo P, Jaya Ganda I. Hubungan Fibrilasi Atrium dengan Gangguan Kognitif. 2014 April [cited 2018 January 14]. Available from:

Ball J, Carrington MJ, Stewart S, investigators S. Mild cognitive impairment in high–risk patients with chronic atrial fibrillation: a forgotten component of clinical management?. Heart. 2013;99(8):542–7.

Knecht S, Oelschläger C, Duning T, Lohmann H, Albers J, Stehling C, et al. Atrial fibrillation in stroke–free patients is associated with memory impairment and hippocampal atrophy. European heart journal. 2008;29(17):2125–32.

Gardarsdottir M, Sigurdsson S, Aspelund T, Rokita H, Launer LJ, Gudnason V, et al. Atrial fibrillation is associated with decreased total cerebral blood flow and brain perfusion. Ep Europace. 2018;20(8):1252–8.

Rozzini R, Sabatini T, Trabucchi M. Chronic atrial fibrillation and low cognitive function. Stroke. 1999;30(1):190–1.

Chen LY, Agarwal SK, Norby FL, Gottesman RF, Loehr LR, Soliman EZ, et al. Persistent but not paroxysmal atrial fibrillation is independently associated with lower cognitive function: ARIC Study. J Am College Cardiol. 2016;67(11):1379–80.

Jacobs V, Woller SC, Stevens S, May HT, Bair TL, Anderson JL, et al. Time outside of therapeutic range in atrial fibrillation patients is associated with long–term risk of dementia. Heart Rhythm. 2014;11(12):2206–13.

Demir S, Ozdag MF, Kendirli MT, Togrol RE. What Do Anticoagulants Say about Microemboli?. J Stroke Cerebrovascular Dis. 2015;24(11):2474–7.

Marseglia A, Fratiglioni L, Kalpouzos G, Wang R, Bäckman L, Xu W. Prediabetes and diabetes accelerate cognitive decline and predict microvascular lesions: A population–based cohort study. Alzheimers Dement. 2019;15(1):25–33.

Gudala K, Bansal D, Schifano F, Bhansali A. Diabetes mellitus and risk of dementia: A meta‐analysis of prospective observational studies. J Diabetes Investig. 2013;4(6):640–50.

Jia X, Levine GN, Birnbaum Y. The CHA2DS2–VASc score: Not as simple as it seems. Int J Cardiol. 2018;257:92–6.

Freedman B, Potpara TS, Lip GY. Stroke prevention in atrial fibrillation. Lancet. 2016;388(10046):806–17.


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