{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:08:03Z","timestamp":1790140083409,"version":"4.0.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Clinically diagnosed Alzheimer\u2019s disease (AD) and atrial fibrillation (AF) are prevalent in the elderly, and their co-occurrence presents a complex management dilemma, balancing stroke prevention against bleeding risks, particularly in the context of cognitive impairment. This real-world cohort study aimed to evaluate the clinical outcomes of anticoagulant therapy in elderly patients with AD and AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed data from 342 patients (mean age 78.5 years; 58.3% female) with non-valvular AF and AD. Patients were categorized into anticoagulant (\n                      <jats:italic>n<\/jats:italic>\n                      = 247; 72.2%) and non-anticoagulant (\n                      <jats:italic>n<\/jats:italic>\n                      = 95; 27.8%) groups, with direct oral anticoagulants (DOACs) used in 57.9% of treated patients. Over a mean follow-up of 2.1 years, outcomes were compared between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Anticoagulation was associated with a significantly lower incidence of ischemic stroke\/systemic embolism (annualized rate 2.9% vs. 7.1%; hazard ratio [HR] = 0.35, 95% CI 0.17\u20130.73,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.005) and all-cause mortality (6.3% vs. 15.1%; HR = 0.32, 95% CI 0.19\u20130.54,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) compared to no anticoagulation. DOACs were superior to warfarin in preventing stroke\/embolism (HR = 0.36, 95% CI 0.15\u20130.87,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.022). While major bleeding was higher with anticoagulation (6.1% vs. 0.9%; HR = 4.31, 95% CI 1.02\u201318.19,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.047), the critical risk of intracranial hemorrhage was not significantly increased (1.6% vs. 1.0%; HR = 0.46, 95% CI 0.11\u20131.98,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.30), and DOACs demonstrated a safer profile versus warfarin for major bleeding (HR = 0.24, 95% CI 0.06\u20130.89,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.034). Key predictors for bleeding and thromboembolism, for example, advanced age, previous stroke history, and high HAS-BLED scores, were identified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In conclusion, anticoagulation, particularly with DOACs, provides a favorable net clinical benefit by significantly reducing stroke and mortality without a marked increase in intracranial hemorrhage in elderly AD patients with AF, supporting its judicious use. Further prospective studies are warranted to refine personalized decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251271276<\/jats:ext-link>\n                      , Identifier: CRD420251271276.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fncel.2026.1874032","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:54:24Z","timestamp":1790139264000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of anticoagulation therapy in elderly patients with clinically diagnosed Alzheimer\u2019s disease and atrial fibrillation: a clinical outcomes study"],"prefix":"10.3389","volume":"20","author":[{"given":"Xinhui","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Geriatrics, Henan Provincial People\u2019s Hospital, People\u2019s Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinying","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Henan Provincial People\u2019s Hospital, People\u2019s Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiman","family":"Huang","sequence":"additional","affiliation":[{"name":"Henan Provincial People's Clinical Medical School of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Henan Provincial People\u2019s Hospital, People\u2019s Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Henan Provincial People\u2019s Hospital, People\u2019s Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref1001","doi-asserted-by":"publisher","first-page":"e209753","DOI":"10.1212\/WNL.0000000000209753","article-title":"Influence of Different Diagnostic Criteria on Alzheimer Disease Clinical Research","volume":"103","author":"Bieger","year":"2024","journal-title":"Neurology,"},{"key":"ref1","doi-asserted-by":"publisher","first-page":"1633","DOI":"10.3390\/jcm9061633","article-title":"Effectiveness and safety of oral anticoagulants among NVAF patients with obesity: insights from the ARISTOPHANES study","volume":"9","author":"Deitelzweig","year":"2020","journal-title":"J. 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