Background A higher risk of developing
dementia is observed in patients with
atrial fibrillation (AF). Results are inconsistent regarding the risk of
dementia when patients with AF use different
anticoagulants. We aimed to investigate the risk of
dementia in patients with AF receiving non-
vitamin K antagonist oral
anticoagulants (NOACs) compared with those receiving
warfarin. Methods and Results We conducted a nationwide population-based cohort study of incident cases using the Taiwan National Health Insurance Research Database. We initially enlisted all incident cases of AF and then selected those treated with either NOACs or
warfarin for at least 90 days between 2012 and 2016. First-ever diagnosis of
dementia was the primary outcome. We performed propensity score matching to minimize the difference between each cohort. We used the Fine and Gray competing risk regression model to calculate the hazard ratio (HR) for
dementia. We recruited 12 068 patients with AF (6034 patients in each cohort). The mean follow-up time was 3.27 and 3.08 years in the groups using NOACs and
warfarin, respectively. Compared with the HR for the group using
warfarin, the HR for
dementia was 0.82 (95% CI, 0.73-0.92; P=0.0004) in the group using NOACs. Subgroup analysis demonstrated that users of
NOAC aged 65 to 74 years, with a high risk of
stroke or
bleeding were associated with a lower risk of
dementia than users of
warfarin with similar characteristics. Conclusions Patients with AF using NOACs were associated with a lower risk of
dementia than those using
warfarin. Further randomized clinical trials are greatly needed to prove these findings.