Silent Cerebral Infarction in East Asian vs. Non-Asian Atrial Fibrillation Patients　― Meta-Analysis ―

Abstract

AF is also a well-established risk factor for dementia. For example, Liao et al reported a consistently higher rate of cognitive decline and risk of dementia in patients with AF. 11 These associations are partly due to the increased risk of clinical stroke in AF, but other mechanisms are likely to contribute, including the occurrence of SCI and microbleeds. 12 Current evidence is not sufficient to support a trend of increased prevalence of dementia in East Asia over the last few decades, but AF may contribute to dementia risk. We conducted a meta-analysis to compare the association of AF and SCI between East Asian and non-Asian patients. Methods Data SourcesPubMed were searched from their inception to 7 October 2017. No language restriction was applied. To ensure a comprehensive search of the literature, we also manually A trial fibrillation (AF) is the most common cardiac arrhythmia 1 and a major cause of stroke. The estimated global prevalence of AF is approximately 1-2%. 2 In Asia, the prevalence of AF has been reported to be slightly lower than that in Western populations. 3,4 Due to the much larger population in Asia, the burden of AF is estimated to be much greater in Asian than in Western populations. Indeed, it has been estimated that in 2050 there will be 72 million patients with AF in Asia, 4 more than double the combined number of patients from Europe and the USA. 1,5 Therefore, it is particularly important that AF is effectively managed in the ageing population of Asia.Silent cerebral infarction (SCI) is defined as the presence of cerebral infarction with the absence of corresponding clinical symptoms. In a recent meta-analysis, AF was associated with a more than 2-fold increased risk for SCI. 6 Several studies have reported an association between AF and increased risk of SCI in East Asian countries, 7-10 with the presence of SCI predicting subsequent clinically overt stroke. Thus, the prevalence of SCI and its effect as a risk factor for overt stroke are important considerations during the evaluation of AF.

Application of Concomitant Disease Scoring in Acute Cerebral Infarction

“…This further reduces cerebral blood flow, and causes the insufficiency of blood supply for brain tissues, aggravating the cerebral infarction. This conclusion is basically consistent with the results reported in literature (13)(14)(15)(16).…”

Novel Therapeutic Target of Anticoagulation Therapy in Patients With Atrial Fibrillation ― Cognitive Decline and Dementia ―

“…Overall, the RR was 2.02 (95% CI 1.35-2.48) and no racial difference was found. Although the association between AF and cognitive decline or dementia is difficult to conclude directly from the present study, 14 it can be easily speculated, because SCI is a risk factor of dementia. 13 In addition, the authors also list microbleeds, impaired cardiac function, and subsequent reduced cerebral perfusion as possible mediating mechanisms of dementia in patients with AF.…”

Cough Test Results during Screening for Silent Aspiration Are Affected by Risk Factors for Silent Cerebral Infarct in Older Adults with Chronic Disease

“…We obtained the participants’ medical histories and information on their difficulty in swallowing from interviews or medical records. We also considered the presence of renal dysfunction, hypertension, diabetes, and heart disease as significant risk factors for SCI [ 10 , 11 ]. We conducted a power analysis using the G*Power 3.1 software (Kiel University, Kiel, Germany).…”

“…Older adults and patients with dysphagia may have various diseases, among which the presence of a silent cerebral infarct (SCI) in the basal ganglia region has been reported to reduce the cough reflex [ 9 ]. The risk factors for SCI include renal dysfunction, hypertension, diabetes, and heart disease [ 10 , 11 ], which are often evident in older adults [ 12 ]. SCI is also reported to be a cause of aspiration pneumonia [ 13 ].…”