Atrial Fibrillation, Stroke, and Cognition

Rastas, Sari; Verkkoniemi, Auli; Polvikoski, Tuomo; Juva, Kati; Niinistö, Leena; Mattila, Kimmo; Länsimies, Esko; Pirttilä, Tuula; Sulkava, Raimo

doi:10.1161/strokeaha.106.477299

Cited by 87 publications

(39 citation statements)

References 57 publications

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“…In contrast, in the prospective CAFÉ (Cognition and Atrial Fibrillation Evaluation) study on 362 patients older than 60 years (174 in nonvalvular AF and 188 in sinus rhythm), no correlation between AF and cognitive decline at 12 and 36 months of follow-up was found [20]. Similar results were obtained in the VANTAA study, a prospective study conducted in Finland on 553 patients older than 85 years, in which the development of dementia did not differ in patients with and without AF (16.4 vs. 16.8%) [21]. A recent meta-analysis including 15 relevant studies covering 46,637 participants (mean age 71.7 years) showed that AF was associated with a significant increase in dementia development (OR = 2.0, 95% CI = 1.4-2.7).…”

Section: Discussionsupporting

confidence: 63%

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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Section: Discussionsupporting

confidence: 63%

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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“…In addition, a standardized set of samples were obtained from the middle frontal, superior temporal and middle temporal gyri, inferior parietal lobule, uncal region, hippocampal body, cingulate gyrus, occipital lobe (including the primary visual cortex) and midbrain. The protocols for quantifying Alzheimer-type [Braak stage (0 to 6); neuritic amyloid plaque (none 0 to severe 3)] (Polvikoski et al ., 1995, 2006), infarcts (present or absent) (Rastas et al ., 2007; Ahtiluoto et al ., 2010) and Lewy body [neuronal loss in substantia nigra (none 0 to severe 3); α-synucleinopathy (none 0 to severe 3) (Oinas et al ., 2009)] pathologies have been described in detail previously (Supplementary material). …”

Section: Methodsmentioning

confidence: 99%

Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study

Davis

Muniz‐Terrera

Keage

et al. 2012

Brain

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487

387

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Recent studies suggest that delirium is associated with risk of dementia and also acceleration of decline in existing dementia. However, previous studies may have been confounded by incomplete ascertainment of cognitive status at baseline. Herein, we used a true population sample to determine if delirium is a risk factor for incident dementia and cognitive decline. We also examined the effect of delirium at the pathological level by determining associations between dementia and neuropathological markers of dementia in patients with and without a history of delirium. The Vantaa 85+ study examined 553 individuals (92% of those eligible) aged ≥85 years at baseline, 3, 5, 8 and 10 years. Brain autopsy was performed in 52%. Fixed and random-effects regression models were used to assess associations between (i) delirium and incident dementia and (ii) decline in Mini-Mental State Examination scores in the whole group. The relationship between dementia and common neuropathological markers (Alzheimer-type, infarcts and Lewy-body) was modelled, stratified by history of delirium. Delirium increased the risk of incident dementia (odds ratio 8.7, 95% confidence interval 2.1–35). Delirium was also associated with worsening dementia severity (odds ratio 3.1, 95% confidence interval 1.5–6.3) as well as deterioration in global function score (odds ratio 2.8, 95% confidence interval 1.4–5.5). In the whole study population, delirium was associated with loss of 1.0 more Mini-Mental State Examination points per year (95% confidence interval 0.11–1.89) than those with no history of delirium. In individuals with dementia and no history of delirium (n = 232), all pathologies were significantly associated with dementia. However, in individuals with delirium and dementia (n = 58), no relationship between dementia and these markers was found. For example, higher Braak stage was associated with dementia when no history of delirium (odds ratio 2.0, 95% confidence interval 1.1–3.5, P = 0.02), but in those with a history of delirium, there was no significant relationship (odds ratio 1.2, 95% confidence interval 0.2–6.7, P = 0.85). This trend for odds ratios to be closer to unity in the delirium and dementia group was observed for neuritic amyloid, apolipoprotein ε status, presence of infarcts, α-synucleinopathy and neuronal loss in substantia nigra. These findings are the first to demonstrate in a true population study that delirium is a strong risk factor for incident dementia and cognitive decline in the oldest-old. However, in this study, the relationship did not appear to be mediated by classical neuropathologies associated with dementia.

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“…In a study from Umeå, the prevalence of stroke in the groups 85-89, 90-94 and ≥95 years was 21% in all groups (20). In Finland the prevalence in Vantaa in the age group 85 years and older was 20.1 (21).…”

Section: Prevalencementioning

confidence: 95%

Epidemiology of stroke in the elderly in the Nordic countries. Incidence, survival, prevalence and risk factors

Engstad¹,

Engstad²,

Viitanen³

et al. 2012

Nor J Epidemiol

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Objective:To review what is known at present with respect to incidence, survival, risk factors and prevalence among the elderly stroke patients in the Nordic countries. Method: This article is based mainly on literature identified through search engines (Mc Master Plus, Cochrane Library, Medline and PubMed), restricted to first-ever stroke in Nordic population-based studies and having applied to the standard WHO definition, a prospective study design and no upper age limit. Results: Data from the Nordic countries show an incidence rate of 1250 to 1796/100 000 in the age group 75-84, and 1628 to 2234 in those above 85 years. The incidence rates are higher among men, but women are expected to contribute more to incident cases due to their higher life expectancy. If the age-specific incidence of stroke remains stable, the proportion of stroke patients aged 80 years and older may reach 50% in a few decades. The elderly stroke patients have a higher 30-days case fatality, and a higher risk of dependency. Better treatment of stroke patients has improved the survival over the last two decades. The prevalence is expected to increase due to the decrease in lethality, a slower fall in incidence and a higher proportion of elderly. Cardiovascular risk factors increase with age. Hypertension is a major risk factor for stroke mortality in the elderly. Cardioembolic stroke due to atrial fibrillation is the most common stroke subtype in the elderly. Lifestyle risk factors are less prevalent in the older stroke patients. Conclusion:The growing proportion of elderly stroke patients is a major challenge for future stroke care. The elderly stroke patients have a different risk factor profile compared to younger stroke patients. Treatment should focus on regaining independency. The age-specific epidemiology of stroke needs to be studied further in large studies in order to plan for future health care.

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Atrial Fibrillation, Stroke, and Cognition

Cited by 87 publications

References 57 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

Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study

Epidemiology of stroke in the elderly in the Nordic countries. Incidence, survival, prevalence and risk factors

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