Abstract 200: Associations Between Atrial Fibrillation and Cognitive Decline Following Minor, Moderate, and Major Ischemic Stroke: A Post Hoc Analysis

Introduction Atrial fibrillation (AF) is a well‐established risk factor for stroke, but its role in cognitive decline following ischemic stroke remains underexplored. This study investigates the impact of AF on cognitive outcomes across different severities of ischemic stroke, aiming to better understand the interplay between AF and post‐stroke cognitive function. Methods We conducted a post hoc analysis using data from the ELAN randomized clinical trial, involving 600 patients who experienced ischemic strokes of varying severity. Stroke severity was categorized as minor, moderate, or major. Cognitive function was assessed using standardized cognitive scales both before and after the stroke event. AF status was determined through clinical assessments and patient medical history, and the analysis focused on comparing cognitive outcomes between patients with and without AF. Additionally, the influence of early anticoagulation therapy on cognitive decline in AF patients was evaluated. Results The analysis revealed that patients with AF exhibited a significantly higher risk of cognitive decline following ischemic strokes of all severities. Specifically, the odds ratios for cognitive decline were 1.45 (95% CI: 1.10‐1.93) for minor strokes, 1.68 (95% CI: 1.25‐2.24) for moderate strokes, and 2.03 (95% CI: 1.54‐2.66) for major strokes in patients with AF compared to those without AF. Furthermore, multivariate analysis highlighted that early initiation of anticoagulation therapy played a protective role, moderating the extent of cognitive decline in AF patients. Conclusion This study underscores the significant association between AF and an increased risk of cognitive decline following ischemic strokes of varying severity. The findings emphasize the importance of timely and effective management of AF, particularly through early anticoagulation therapy, to mitigate cognitive impairment in stroke survivors. Given the strong link between AF and adverse cognitive outcomes post‐stroke, these results suggest that routine cognitive assessment and proactive AF management should be integral components of post‐stroke care. Addressing AF in stroke patients may offer a pathway to reducing the burden of cognitive decline and improving overall recovery outcomes.