Design of the Swiss Atrial Fibrillation Cohort Study (Swiss-AF): structural brain damage and cognitive decline among patients with atrial fibrillation (original) (raw)
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Background: Atrial fibrillation (AF) is the most frequent of all cardiac arrhythmias, with an increasing prevalence in the last 20 years. Cardio-embolic brain complications (CEBC) related to AF often occur or recur, even following appropriate treatment. Method: We conducted a retrospective study and analyzed the presence of stroke, dementia, and Parkinson’s disease (PD) in both paroxysmal and permanent AF patients. The records of 1111 consecutive admitted patients with primary diagnosis of AF at the Municipal Emergency University Hospital, Timisoara, between 2015 and 2016 were examined. Statistical analysis was performed on the patients included in the study based on the inclusion and exclusion criteria. Results: A significant statistical difference was noted among the permanent AF group for stroke (48.75% vs. 26.74%, p < 0.001) and dementia (10.25% vs. 3.86%, p < 0.001) compared to paroxysmal AF patients. Permanent AF patients presented a higher risk of developing stroke, dem...
Atrial Fibrillation and Risk of Dementia: A Prospective Cohort Study
Journal of the American Geriatrics Society, 2011
Background/Objectives-Atrial fibrillation may increase dementia risk, but prior studies yielded conflicting results. Many had low power or limited measures of dementia. We investigated whether atrial fibrillation is associated with increased risk of incident dementia or Alzheimer disease, beyond its effect on stroke. Design-A prospective cohort study Setting-An integrated healthcare delivery system Participants-A population-based sample of 3,045 community-dwelling adults age 65 and older without dementia or clinical stroke, followed from 1994-2008. Measurements-Atrial fibrillation was identified from health plan electronic data using International Classification of Diseases, version 9, codes from inpatient and outpatient encounters. Covariates came from self-report, study measures, and health plan data. Participants were screened every 2 years with the Cognitive Abilities Screening Instrument (score range, 0-100), with detailed neuropsychological and clinical assessment of those scoring less than 86. The outcomes of allcause dementia and possible or probable Alzheimer disease were determined by a multidisciplinary consensus committee using standard research criteria. Results-Atrial fibrillation was present in 132/3,045 (4.3%) participants at baseline and was diagnosed in 370 (12.2%) more over a mean of 6.8 years of follow-up. 572 participants (18.8%) developed dementia (449 with Alzheimer disease). The adjusted hazard ratio for all-cause dementia associated with atrial fibrillation was 1.38 (95% CI 1.10-1.73) and for possible or probable Alzheimer disease, 1.50 (95% CI 1.16-1.94). Results were similar for participants with or without clinically recognized stroke during follow-up and in sensitivity analyses examining only probable Alzheimer disease. Conclusion-Atrial fibrillation is associated with higher risk of developing Alzheimer disease and dementia. Future studies should examine whether specific treatments including optimal anticoagulation can decrease this risk.
Atrial Fibrillation and Deterioration in Cognitive Function
Current Problems in Cardiology, 2018
The link between Atrial fibrillation and cognitive decline and dementia have gained interest of the medical community lately. More research is being conducted to prevent and or delay this morbidity as no curative therapy is available for cognitive decline and dementia. The exact mechanism of causation is unclear. Multiple pathophysiological mechanisms have been implicated. Lately, treatment for atrial fibrillation including anticoagulation and catheter ablation therapies have shown to decrease the risk of deterioration of cognitive function. In this review we summarize epidemiological studies linking the association, potential mechanisms and impact of various modalities of therapy of atrial fibrillation on cognitive function outcomes.
Stroke and Dementia in Atrial Fibrillation
Atrial Fibrillation - Basic Research and Clinical Applications, 2012
Introduction 1.1 Incidence and prevalence Atrial fibrillation (AF) and its consequences are today's main epidemiologic concerns. Two most important population based studies, the Framingham Study and the Rotterdam Study, report a lifetime risk of developing AF as one in four people after the age of 40 years. This is opposed to breast cancer which affects one in eight women, or heart failure affecting every fifth individual. (Lloyd-Jones et al., 2004, Mattace-Raso et al., 2006) With aging population, both AF prevalence and incidence are also increasing. (Lakatta & Levy, 2003b) AF represents the most common, highly prevalent cardiac arrhythmia which is the strongest risk factor for ischemic stroke, currently affecting 4,5 to 6 million Europeans and 2,3 to 5,1 million Americans. The prevalence of AF ranges from 2,5% in individuals over 40 yrs of age, 6% in those older than 65, to 12-16% in those over 75 yrs.
Cognitive Impairment Associated With Atrial Fibrillation
Annals of Internal Medicine, 2013
Background-Atrial fibrillation (AF) has been linked with an increased risk of cognitive impairment and dementia. Purpose-To complete a meta-analysis of studies examining the association between AF and cognitive impairment. Data Sources-Electronic search of 5 large databases and hand search of article references. Study Selection-Prospective and non-prospective studies reporting adjusted risk estimates for the relationship between AF and cognitive impairment.
Atrial Fibrillation and Cognitive Impairment
Hospital chronicles, 2015
Growing evidence suggests that atrial fibrillation (AF), in addition to its known thromboembolic risk, is a risk factor for significant cognitive impairment via several pathways, further contributing to morbidity and mortality. Whether anticoagulation, rhythm control strategies and other interventions aiming at preventing thromboembolic events and ameliorating the clinical outcome of AF patients, may also have a beneficial effect on long-term cognitive function remains to be seen in future studies. (Rhythmos 2015;10(3):45-52)
Stroke, 2013
Background and Purpose-Atrial fibrillation (AF) has been associated with cognitive decline independent of stroke, suggesting additional effects of AF on the brain. We aimed to assess the association between AF and brain function and structure in a general elderly population. Methods-This is a cross-sectional analysis of 4251 nondemented participants (mean age, 76±5 years) in the populationbased Age, Gene/Environment Susceptibility-Reykjavik Study. Medical record data were collected for the presence, subtype, and time from first diagnosis of AF; 330 participants had AF. Brain volume measurements, adjusted for intracranial volume, and presence of cerebral infarcts were determined with magnetic resonance imaging. Memory, speed of processing, and executive function composites were calculated from a cognitive test battery. In a multivariable linear regression model, adjustments were made for demographic factors, cardiovascular risk factors, and cerebral infarcts. Results-Participants with AF had lower total brain volume compared with those without AF (P<0.001). The association was stronger with persistent/permanent than paroxysmal AF and with increased time from the first diagnosis of the disease. Of the brain tissue volumes, AF was associated with lower volume of gray and white matter hyperintensities (P<0.001 and P=0.008, respectively), but not of white matter hyperintensities (P=0.49). Participants with AF scored lower on tests of memory. Conclusions-AF is associated with smaller brain volume, and the association is stronger with increasing burden of the arrhythmia. These findings suggest that AF has a cumulative negative effect on the brain independent of cerebral infarcts. (Stroke. 2013;44:1020-1025.) The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl/
Atrial fibrillation is associated with cognitive decline in stroke-free subjects: The Tromsø Study
European Journal of Neurology
Background: Previous studies have shown associations between atrial fibrillation (AF) and cognitive decline. We investigated this association in a prospective population study, focusing on whether stroke risk factors modulated this association in stroke-free women and men. Methods: We included 4983 participants (57% women) from the 5 th survey of the Tromsø Study