A recent study from Karolinska Institutet shows that newer oral anticoagulants, known as NOACs, are linked to slower cognitive decline in patients who have both atrial fibrillation and Alzheimer’s disease.

The research, published online August 12 in the European Heart Journal, analyzed data from the Swedish Register for Cognitive/Dementia Disorders. It included 7,308 individuals with both conditions.

Patients were divided into groups using NOACs, the older anticoagulant warfarin, or no anticoagulant treatment. NOAC users showed significantly slower decline in Mini-Mental State Examination scores compared with non-users, at a rate of 0.23 points per year, and compared with warfarin users, at 0.21 points per year.

NOAC treatment was also associated with lower rates of mortality, ischemic stroke or systemic embolism, and fractures without raising major bleeding risk, relative to no anticoagulation. Warfarin showed some benefits over no treatment but carried a higher bleeding risk.

Compared directly with warfarin, NOACs reduced rates of stroke or embolism and showed trends toward lower mortality and fracture risk.

Researchers noted the findings suggest NOACs may offer advantages in both cognitive and clinical outcomes for this patient group. The study used nationwide registry data and matched groups for analysis.

Atrial fibrillation is common in older adults and often co-occurs with Alzheimer’s disease. Standard care involves anticoagulants to prevent strokes, with NOACs increasingly prescribed over warfarin in recent years.

The results add to evidence on anticoagulant benefits beyond stroke prevention in patients with cognitive impairment.