Non-valvular atrial fibrillation and cognitive decline: a longitudinal cohort study
Non-valvular atrial fibrillation and cognitive decline: a longitudinal cohort study
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DOI：
10.1093/ageing/afl164
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发表时间：
2007-03-01
期刊：
影响因子：
6.7
通讯作者：
O'Connell, Janice
中科院分区：
文献类型：
--
作者：
Park, Helen;Hildreth, Anthony;O'Connell, Janice
目的：非瓣膜性心房颤动（NVAF）是血栓栓塞和中风的一个确定的危险因素。小型横断面研究表明非瓣膜性房颤、无症状性脑梗死和认知功能下降之间存在关联。我们比较了基线评估后12个月和36个月新发非瓣膜性房颤患者和对照组的认知功能变化，并检查了抗血栓治疗的影响。设计：前瞻性纵向队列研究，随访12个月和36个月。地理位置：桑德兰和南泰恩赛德，英格兰东北部。参与者：居住在社区的60岁以上的男性和女性，最近确诊为非瓣房性房颤或窦性心律，年龄、性别和一般情况相匹配（N = 362，非瓣房性房颤174，窦性心律188）。参与者被分层使用抗血栓治疗。测量方法：评估包括中风风险因素和一系列全面的神经心理学测试。结果：在3年时，74例病例和86例对照组仍然存在，病例损失率为59%，对照组为52%；P = 0.15。12个月和36个月的基线和随访期间的认知功能变化分析显示，病例和对照组之间没有临床重要差异，服用阿司匹林、华法林或两者都不服用的亚组之间也没有。年龄和其他混杂因素对结果没有影响。结论：经3年随访，总体认知能力下降与非瓣膜性房颤无相关性，抗栓治疗无明显效果。这与我们的基线结果一致，但与以前的研究相冲突。认知能力下降可能是多因素的，本研究未发现非瓣膜性房颤的任何影响。
Objectives: non-valvular atrial fibrillation (NVAF) is an established risk factor for thromboembolism and stroke. Small cross-sectional studies suggest associations between NVAF, silent cerebral infarction and decreased cognitive function. We compared change in cognitive function between patients with recent onset NVAF and controls 12 and 36 months after baseline assessment, and examined the impact of anti-thrombotic therapy.Design: prospective longitudinal cohort study with follow-up at 12 and 36 months.Setting: Sunderland and South Tyneside, North East of England.Participants: community-dwelling men and women aged over 60 with recently identified NVAF or in sinus rhythm, matched for age, sex and general practice (N = 362, 174 NVAF, 188 sinus rhythm). Participants were stratified for use of anti-thrombotic therapy.Measurements: assessment included stroke risk factors and a comprehensive battery of neuropsychological tests.Results: at 3 years, 74 cases and 86 controls remained, giving an attrition rate for cases (59%) versus controls (52%); p = 0.15. Analysis of change in cognitive function between baseline and follow-up at 12 and 36 months revealed no clinically important differences between cases and controls, nor between subgroups on aspirin, warfarin or neither. Age and other confounders did not influence the results.Conclusions: there was no association between overall cognitive decline and NVAF after 3 years' follow-up, nor any apparent effect of anti-thrombotic therapy. This is consistent with our baseline results, but conflicts with previous studies. Cognitive decline is probably multifactorial and any influence of NVAF was not identified in this study.