Silent lacunar infarcts in elderly patients with chronic non valvular atrial fibrillation

Zito, M.; Muscari, Antonio; Marini, Enrico; Iorio, Angelo Di; Puddu, Giovanni M.; Abate, G

doi:10.1007/bf03339591

Cited by 28 publications

(21 citation statements)

References 30 publications

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“…The relation between atrial fibrillation and manifest stroke is well established. 18 Atrial fibrillation has also been associated with silent lacunar infarcts in elderly patients without previous stroke or carotid lesions, 19 and it may be a more common cause of silent embolic cerebrovascular lesions than previously assumed. Myocardial dysfunction may also cause periodic disability in maintaining cerebral blood flow, with subsequent ischemic lesions.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation Is an Independent Determinant of Low Cognitive Function

Kilander

Andrén

Nyman

et al. 1998

Stroke

183

102

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Background and Purpose-Cerebrovascular disease is increasingly recognized as a cause of dementia and cognitive decline. We have previously reported an association between hypertension and diabetes and low cognitive function in the elderly. Atrial fibrillation is another main risk factor for cerebrovascular disease. The aim of this study was to investigate whether atrial fibrillation is associated with low cognitive function in elderly men with and without previous manifest stroke. Methods-This was a cross-sectional study based on a cohort of 952 community-living men, aged 69 to 75 years, in Uppsala, Sweden. Cognitive functions were assessed by the Mini-Mental State Examination and the Trail Making Tests, and a composite z score was calculated. The relation between atrial fibrillation and cognitive z score was analyzed, with stroke and other vascular risk factors taken into account. Results-All analyses were adjusted for age, education, and occupational level. Men with atrial fibrillation (nϭ44) had lower mean adjusted cognitive z scores (Ϫ0.26Ϯ0.11) than men without atrial fibrillation (ϩ0.14Ϯ0.03; Pϭ0.0003).The exclusion of stroke patients did not alter this relationship; the mean cognitive z score was Ϫ0.24Ϯ0.12 in the 36 men with atrial fibrillation and ϩ0.17Ϯ0.03 in those without atrial fibrillation (Pϭ0.0004), corresponding to a difference of 0.4 SDs between groups. Adjustments for 24-hour diastolic blood pressure and heart rate, diabetes, and ejection fraction did not change this relationship. Men with atrial fibrillation who were treated with digoxin (nϭ27) performed markedly better (Ϫ0.05Ϯ0.21) than those without treatment (nϭ9; Ϫ1.14Ϯ0.34; adjusted Pϭ0.0005). Previous myocardial infarction was not associated with impaired cognitive results. Conclusions-In these community-living elderly men, we found an association between atrial fibrillation and low cognitive function independent of stroke, high blood pressure, and diabetes. Interventional studies are needed to answer the question of whether optimal treatment of atrial fibrillation may prevent or postpone cognitive decline and dementia.

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation Is an Independent Determinant of Low Cognitive Function

Kilander

Andrén

Nyman

et al. 1998

Stroke

183

102

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“…The first mechanism, related to the presence of cerebral ischemic lesions by microembolism, has been demonstrated in 15-26% of patients with AF as well as the presence of ischemic lesions in the silent brain which are common in patients with AF [23][24][25]. In a study of elderly patients with nonvalvular AF, where the use of anticoagulants was low, the number of lacunar lesions was associated with a reduced value of the MMSE [26]. It should be pointed out that in our cohort study subjects with stroke were excluded from the analysis.…”

Section: Discussionmentioning

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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“…140,141 In a meta-analysis including 77 668 patients, of whom 11 700 had AF, AF was associated with a 42% greater risk of dementia after adjustment for other known stroke-promoting conditions. 142 Hypothesized pathophysiological mechanisms include cerebral hypoperfusion, 143 microembolization, 144 inflammation, and platelet dysfunction. 145 Unfortunately 141,146 Consequently, the pathogenitic role of microemboli is uncertain, given the observation that antithrombotic therapy did not modify the association between AF and cognitive decline in these studies.…”

Section: Cognitive Dysfunctionmentioning

confidence: 99%

The Clinical Profile and Pathophysiology of Atrial Fibrillation

Andrade

Khairy

Dobrev

et al. 2014

Circulation Research

978

364

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Atrial fibrillation (AF) is the most common arrhythmia (estimated lifetime risk, 22%–26%). The aim of this article is to review the clinical epidemiological features of AF and to relate them to underlying mechanisms. Long-established risk factors for AF include aging, male sex, hypertension, valve disease, left ventricular dysfunction, obesity, and alcohol consumption. Emerging risk factors include prehypertension, increased pulse pressure, obstructive sleep apnea, high-level physical training, diastolic dysfunction, predisposing gene variants, hypertrophic cardiomyopathy, and congenital heart disease. Potential risk factors are coronary artery disease, kidney disease, systemic inflammation, pericardial fat, and tobacco use. AF has substantial population health consequences, including impaired quality of life, increased hospitalization rates, stroke occurrence, and increased medical costs. The pathophysiology of AF centers around 4 general types of disturbances that promote ectopic firing and reentrant mechanisms, and include the following: (1) ion channel dysfunction, (2) Ca 2+ -handling abnormalities, (3) structural remodeling, and (4) autonomic neural dysregulation. Aging, hypertension, valve disease, heart failure, myocardial infarction, obesity, smoking, diabetes mellitus, thyroid dysfunction, and endurance exercise training all cause structural remodeling. Heart failure and prior atrial infarction also cause Ca 2+ -handling abnormalities that lead to focal ectopic firing via delayed afterdepolarizations/triggered activity. Neural dysregulation is central to atrial arrhythmogenesis associated with endurance exercise training and occlusive coronary artery disease. Monogenic causes of AF typically promote the arrhythmia via ion channel dysfunction, but the mechanisms of the more common polygenic risk factors are still poorly understood and under intense investigation. Better recognition of the clinical epidemiology of AF, as well as an improved appreciation of the underlying mechanisms, is needed to develop improved methods for AF prevention and management.

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Silent lacunar infarcts in elderly patients with chronic non valvular atrial fibrillation

Cited by 28 publications

References 30 publications

Atrial Fibrillation Is an Independent Determinant of Low Cognitive Function

Atrial Fibrillation Is an Independent Determinant of Low Cognitive Function

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

The Clinical Profile and Pathophysiology of Atrial Fibrillation

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