Association of Atrial Fibrillation and Focal Neurologic Deficits With Impaired Cognitive Function in Hospitalized Patients ≥65 Years of Age

Jóźwiak, Andrzej; Guzik, Przemysław; Mathew, Anup; Wykretowicz, Andrzej; Wysocki, Henryk

doi:10.1016/j.amjcard.2006.05.058

Cited by 35 publications

(15 citation statements)

References 16 publications

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“…Moreover, cognitive impairment is frequently associated with AF but the rationale of this relationship for the risk of dementia is still controversial, especially in the absence of stroke [7][8][9]. For example, the role of ventricular rate response (VRr) in AF as risk factor in the development of dementia has never been investigated.…”

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confidence: 99%

Role of Ventricular Rate Response on Dementia in Cognitively Impaired Elderly Subjects with Atrial Fibrillation: A 10-Year Study

Cacciatore

Testa

Langellotto

et al. 2012

Dement Geriatr Cogn Disord

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Background: The role of ventricular rate response (VRr) on the incidence of dementia in elderly subjects with cognitive impairment and atrial fibrillation (AF) is not known. Thus, we examined the ability of VRr to predict dementia in cognitively impaired elderly subjects with and without AF. Methods: A total of 358 cognitively impaired elderly subjects (MMSE <24) with and without AF were stratified in low/high (<50/>90) and moderate (>50/<90 bpm) VRr. A 10-year follow-up was performed. Results: Cognitively impaired subjects with dementia at the end of the follow-up were 135 (37.7%): 33 in the presence (75.0%) and 102 (32.5%) in the absence of AF (p < 0.001). Multivariate analysis shows that AF is a strong predictor of dementia (hazard ratio, HR = 4.10; 95% confidence interval, CI = 1.80–9.30, p < 0.001). More importantly, low/high VRr (<50/>90 bpm) is predictive of dementia in the presence (HR = 7.70, 95% CI = 1.10–14.20, p = 0.03) but not in the absence (HR = 1.85; 95% CI = 0.78–4.47; p = 0.152) of AF. Conclusions: This study demonstrates that AF predicts dementia in elderly subjects with cognitive impairment. Moreover, VRr seems to play a key role in the incidence of dementia in cognitively impaired elderly subjects with AF.

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confidence: 99%

Role of Ventricular Rate Response on Dementia in Cognitively Impaired Elderly Subjects with Atrial Fibrillation: A 10-Year Study

Cacciatore

Testa

Langellotto

et al. 2012

Dement Geriatr Cogn Disord

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“…3 An association between the presence of atrial fibrillation and cognitive deficit as measured by, for example, the Mini-Mental State Examination (MMSE), has been reported in a number of cross-sectional studies in hospital and community settings after controlling for a range of covariates, such as previous transient ischemic attack or stroke, cardiovascular risk factors, other cardiovascular disease, medications, and depression. [4][5][6][7][8] A systematic review of 15 prospective studies found that AF was associated with an increased risk of dementia in people with stroke, but the association was only of borderline significance in people without stroke. 2 A subsequent post hoc analysis of 2 randomized controlled trials involving 31 506 participants found that AF was associated with an increased risk of cognitive decline and dementia in both people with and without stroke.…”

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confidence: 99%

Warfarin Versus Aspirin for Prevention of Cognitive Decline in Atrial Fibrillation

Mavaddat

Roalfe

Fletcher

et al. 2014

Stroke

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Therefore, it can be inferred that anticoagulation reduces risk of cognitive decline in AF by preventing overt strokes. What is not known is whether anticoagulation reduces the risk of cognitive decline in AF through any other mechanism, such as by reducing the risk of silent stroke. The aim of this analysis is to compare the efficacy of warfarin with aspirin for prevention of cognitive decline in a primary care population of Background and Purpose-Atrial fibrillation is associated with decline of cognitive function. Observational evidence suggests that anticoagulation might protect against this decline. We report the first randomized controlled trial evidence on the effect of anticoagulation on cognitive function in elderly patients with atrial fibrillation. Methods-A total of 973 patients aged ≥75 years with atrial fibrillation were recruited from primary care and randomly assigned to warfarin (n=488; target international normalized ratio, 2-3) or aspirin (n=485; 75 mg/d). Neither participants nor investigators were masked to group assignment. Follow-up was for a mean of 2.7 years (SD, 1.2). Cognitive outcome was assessed using the Mini-Mental State Examination at 9-, 21-, and 33-month follow-up. Participants who had a stroke were censored from the analysis, which was by intention to treat with imputation for missing data. Results-There was no difference between mean Mini-Mental State Examination scores in people assigned to warfarin or aspirin at 9 or 21 months. At 33-month follow-up, there was a nonsignificant difference of 0.56 in favor of warfarin that decreased to 0.49 (95% confidence interval, -0.01 to 0.98) after imputation. Conclusions-We

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“…21 AF is also a risk factor for impaired cognitive function. 41 In 2384 persons (mean age, 81 years), AF was present in 17% of older persons with LV hypertrophy and in 8% of persons without LV hypertrophy. 27 Both AF (risk ratio ϭ 3.2) and LV hypertrophy (risk ratio ϭ 2.8) were independent risk factors for new thromboembolic stroke at 44-month followup.…”

Section: Aronowmentioning

confidence: 99%

Etiology, Pathophysiology, and Treatment of Atrial Fibrillation

Aronow

2008

Cardiology in Review

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Atrial fibrillation (AF) is associated with a higher incidence of mortality, stroke, and coronary events than is sinus rhythm. AF with a rapid ventricular rate may cause a tachycardia-related cardiomyopathy. Immediate direct-current cardioversion should be performed in patients with AF and acute myocardial infarction, chest pain due to myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous beta blockers, verapamil, or diltiazem may be given to immediately slow a very rapid ventricular rate in AF. An oral beta blocker, verapamil, or diltiazem should be used in persons with AF if a fast ventricular rate occurs at rest or during exercise despite digoxin. Amiodarone may be used in selected patients with symptomatic life-threatening AF refractory to other drugs. Digoxin should not be used to treat patients with paroxysmal AF. Nonpharmacologic therapies should be used in patients with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drugs. This is part 1 of a 2-part review of the etiology, pathophysiology, and treatment of atrial fibrillation. The second part will be published in the subsequent issue of Cardiology in Review.

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Association of Atrial Fibrillation and Focal Neurologic Deficits With Impaired Cognitive Function in Hospitalized Patients ≥65 Years of Age

Cited by 35 publications

References 16 publications

Role of Ventricular Rate Response on Dementia in Cognitively Impaired Elderly Subjects with Atrial Fibrillation: A 10-Year Study

Role of Ventricular Rate Response on Dementia in Cognitively Impaired Elderly Subjects with Atrial Fibrillation: A 10-Year Study

Warfarin Versus Aspirin for Prevention of Cognitive Decline in Atrial Fibrillation

Etiology, Pathophysiology, and Treatment of Atrial Fibrillation

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