Correlates of Dementia and Mild Cognitive Impairment in Patients With Atrial Fibrillation: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).
Correlates of Dementia and Mild Cognitive Impairment in Patients With Atrial Fibrillation: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).
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DOI：
10.1161/jaha.117.006014
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发表时间：
2017-07-24
影响因子：
5.4
通讯作者：
Chen LY
中科院分区：
文献类型：
--
作者：
Alonso A;Knopman DS;Gottesman RF;Soliman EZ;Shah AJ;O'Neal WT;Norby FL;Mosley TH;Chen LY
心房颤动（AF）与认知能力下降速度加快和痴呆风险增加有关。与房颤患者痴呆相关的因素很少被研究。我们研究了来自ARIC - NCS（社区动脉粥样硬化风险神经认知研究）的6432名个体。在2011年至2013年期间，参与者接受了身体检查、超声心动图、详细的认知评估和脑磁共振成像。痴呆和轻度认知障碍（MCI），以及MCI/痴呆的病因，阿尔茨海默病相关或血管，由专家小组裁决。房颤是通过研究心电图和过去的住院情况来定义的。我们使用逻辑回归来估计AF状态下MCI/痴呆的比值比和95% CI，并评估AF患者中MCI/痴呆的横断面相关性。在6432名参与者中，611名（9.5%）患有普遍AF。AF与痴呆和MCI的比值增加相关（比值比，95% CI分别为2.25,1.64-3.10和1.28,1.04-1.56）。AF患者的阿尔茨海默病相关MCI/痴呆和血管性MCI/痴呆患病率高于无AF患者（比值比，95% CI分别为1.29,1.04-1.61和1.50,0.99-2.25）。在多变量分析中，年龄较大、体重指数较低、糖尿病、卒中和APOE基因型与房颤参与者的痴呆患病率相关。在评估MCI/痴呆亚型的模型中，糖尿病与阿尔茨海默病相关的MCI/痴呆相关，而男性和卒中是血管性MCI/痴呆的危险因素。在一项基于社区的大型研究中，房颤与MCI和痴呆的高患病率相关。控制心脏代谢危险因素是预防房颤患者不良认知结局的潜在目标。
Atrial fibrillation (AF) has been associated with faster cognitive decline and increased dementia risk. Factors associated with dementia in patients with AF have been seldom studied. We studied 6432 individuals from the ARIC‐NCS (Atherosclerosis Risk in Communities Neurocognitive Study). In 2011 to 2013, participants underwent a physical exam, echocardiography, detailed cognitive assessments, and a subset, brain magnetic resonance imaging. Dementia and mild cognitive impairment (MCI), as well as etiology of MCI/dementia, Alzheimer's disease–related or vascular, were adjudicated by an expert panel. AF was defined by study ECGs and past hospitalizations. We used logistic regression to estimate odds ratios and 95% CI of MCI/dementia by AF status and to assess cross‐sectional correlates of MCI/dementia in patients with AF. Among 6432 participants, 611 (9.5%) had prevalent AF. AF was associated with increased odds of dementia and MCI (odds ratio, 95% CI, 2.25, 1.64–3.10, and 1.28, 1.04–1.56, respectively). Prevalence of Alzheimer's disease–related MCI/dementia and vascular MCI/dementia were higher in participants with AF than without AF (odds ratio, 95% CI, 1.29, 1.04–1.61, and 1.50, 0.99–2.25, respectively). In multivariable analyses, older age, lower body mass index, diabetes mellitus, stroke, and APOE genotype were associated with dementia prevalence in participants with AF. In models evaluating MCI/dementia subtypes, diabetes mellitus was associated with Alzheimer's disease–related MCI/dementia, whereas male sex and stroke were risk factors for vascular MCI/dementia. In a large, community‐based study, AF was associated with higher prevalence of MCI and dementia. Controlling cardiometabolic risk factors is a potential target for prevention of adverse cognitive outcomes in AF patients.