Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: the atherosclerosis risk in communities study.
Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: the atherosclerosis risk in communities study.
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DOI：
10.1161/strokeaha.114.005243
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发表时间：
2014-09
期刊：
影响因子：
8.3
通讯作者：
Alonso A
中科院分区：
文献类型：
--
作者：
Chen LY;Lopez FL;Gottesman RF;Huxley RR;Agarwal SK;Loehr L;Mosley T;Alonso A
心房颤动（AF）与无卒中个体认知能力下降相关的机制尚不清楚。我们通过脑MRI扫描的亚临床脑梗死（SCIs）对无卒中个体进行分层，研究了AF事件与认知能力下降的关系。我们分析了1993-1995年至2004-2006年社区动脉粥样硬化风险研究中935名无卒中参与者（平均年龄±SD， 61.5±4.3岁，62%为女性，51%为黑人）的数据，这是一项基于社区的双种族前瞻性队列研究。在1993-1995年、1996-1998年和2004-2006年分别进行了认知测试（包括数字符号替换[DSS]和单词流畅性[WF]测试），并在1993-1995年和2004-2006年进行了脑MRI扫描。随访期间，有48例AF事件。AF事件与DSS （- 0.77; 95% CI, - 1.55至0.01；P=0.054）和WF （- 0.80; 95% CI, - 1.60至- 0.01；P=0.048）的年平均下降率较高相关。在脑MRI扫描中没有SCIs的参与者中，AF事件与认知能力下降无关。相反，在1993-1995年SCIs流行的参与者中，AF事件与WF的年平均下降率（- 2.65;95% CI, - 4.26至- 1.03；P=0.002）相关。在随访期间发生SCIs的参与者中，AF事件与DSS年平均下降率较高相关（- 1.51;95% CI, - 3.02至- 0.01；P=0.049）。在无卒中个体中，偶发性房颤与认知能力下降的关联可以通过SCIs的存在或发展来解释，这提高了抗凝治疗作为预防房颤认知能力下降策略的可能性。
The mechanism underlying the association of atrial fibrillation (AF) with cognitive decline in stroke-free individuals is unclear. We examined the association of incident AF with cognitive decline in stroke-free individuals, stratified by subclinical cerebral infarcts (SCIs) on brain MRI scans. We analyzed data from 935 stroke-free participants (mean age±SD, 61.5±4.3 years; 62% women; and 51% black) from 1993–1995 through 2004–2006 in the Atherosclerosis Risk in Communities Study, a biracial community-based prospective cohort study. Cognitive testing (including the Digit Symbol Substitution [DSS] and the Word Fluency [WF] test) was performed in 1993–1995, 1996–1998, and 2004–2006, and brain MRI scans in 1993–1995 and 2004–2006. During follow-up, there were 48 incident AF events. Incident AF was associated with greater annual average rate of decline in DSS (−0.77; 95% CI, −1.55 to 0.01; P=0.054) and WF (−0.80; 95% CI, −1.60 to −0.01; P=0.048). Among participants without SCIs on brain MRI scans, incident AF was not associated with cognitive decline. In contrast, incident AF was associated with greater annual average rate of decline in WF (−2.65; 95% CI, −4.26 to −1.03; P=0.002) among participants with prevalent SCIs in 1993–1995. Among participants who developed SCIs during follow-up, incident AF was associated with a greater annual average rate of decline in DSS (−1.51; 95% CI, −3.02 to −0.01; P=0.049). The association of incident AF with cognitive decline in stroke-free individuals can be explained by the presence or development of SCIs, raising the possibility of anticoagulation as a strategy to prevent cognitive decline in AF.