Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a community-based cohort.

AIMS To estimate the incidence of dementia after the first atrial fibrillation (AF), and its impact on survival in a community-based cohort. METHODS AND RESULTS Olmsted County, Minnesota adult residents diagnosed with first AF during 1986-2000 were identified, and followed until 2004. The primary outcome was new detection of dementia. Interim stroke was censored in the analyses. Of 2837 subjects (71 +/- 15 years old) diagnosed with first AF and without any evidence of cognitive dysfunction or stroke at the time of AF onset, 299 were diagnosed with dementia during a median follow-up of 4.6 years [interquartile (IQR) range 1.5-7.9 years], and 1638 died. The Kaplan-Meier cumulative rate of dementia was 2.7% at 1 year and 10.5% at 5 years. After adjustment for age and sex, dementia was strongly related to advancing age [hazard ratio (HR)/10 years, 2.8; 95% confidence interval (CI), 2.5-3.2], but did not vary with sex (P = 0.52). The occurrence of post-AF dementia was associated with significantly increased mortality risk (HR 2.9; 95% CI 2.5-3.3), even after adjustment for multiple comorbidities, and did not vary with age (P = 0.75) or sex (P = 0.33). CONCLUSION Dementia appeared common following the diagnosis of first AF, and was associated with premature death.

[1]  Z. Qin,et al.  Accumulation of beta-amyloid in the brain microvessels accompanies increased hyperphosphorylated tau proteins following microsphere embolism in aged rats , 2008, Neuroscience.

[2]  W. Kukull,et al.  Age‐Varying Association Between Blood Pressure and Risk of Dementia in Those Aged 65 and Older: A Community‐Based Prospective Cohort Study , 2007, Journal of the American Geriatrics Society.

[3]  R. Sulkava,et al.  Atrial Fibrillation, Stroke, and Cognition: A Longitudinal Population-Based Study of People Aged 85 and Older , 2007, Stroke.

[4]  J. Saczynski,et al.  The Honolulu-Asia Aging Study , 2007 .

[5]  J. Seward,et al.  Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades. , 2006, European heart journal.

[6]  D. Leys,et al.  Stroke Syndromes: Poststroke dementia , 2001 .

[7]  J. Seward,et al.  Time Trends of Ischemic Stroke Incidence and Mortality in Patients Diagnosed With First Atrial Fibrillation in 1980 to 2000: Report of a Community-Based Study , 2005, Stroke.

[8]  Shen Fei,et al.  Poststroke Dementia , 2005 .

[9]  B. Winblad,et al.  The age-dependent relation of blood pressure to cognitive function and dementia , 2005, The Lancet Neurology.

[10]  K Yaffe,et al.  Midlife cardiovascular risk factors and risk of dementia in late life , 2005, Neurology.

[11]  B. Gersh,et al.  Outcome of patients with newly diagnosed atrial fibrillation at the Mayo Clinic and residing in that area. , 2004, The American journal of cardiology.

[12]  J. C. Torre.  Is Alzheimer's disease a neurodegenerative or a vascular disorder? Data, dogma, and dialectics , 2004, The Lancet Neurology.

[13]  J. Murabito,et al.  Temporal Relations of Atrial Fibrillation and Congestive Heart Failure and Their Joint Influence on Mortality The Framingham Heart Study , 2003, Circulation.

[14]  A. Hofman,et al.  Silent brain infarcts and the risk of dementia and cognitive decline. , 2003, The New England journal of medicine.

[15]  L. Kuller,et al.  Prospective study of alcohol consumption and risk of dementia in older adults. , 2003, JAMA.

[16]  Juan F Granada,et al.  A population-based study of mortality among patients with atrial fibrillation or flutter. , 2002, The American journal of medicine.

[17]  Simon Stewart,et al.  A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. , 2002, The American journal of medicine.

[18]  R. Petersen,et al.  Dementia and Alzheimer disease incidence rates do not vary by sex in Rochester, Minn. , 2002, Archives of neurology.

[19]  Albert Hofman,et al.  Alcohol consumption and risk of dementia: the Rotterdam Study , 2002, The Lancet.

[20]  C. Maffeis,et al.  Long-Term Effects of Childhood Obesity on Morbidity and Mortality , 2001, Hormone Research in Paediatrics.

[21]  B. Gersh,et al.  Epidemiology and natural history of atrial fibrillation: clinical implications. , 2001, Journal of the American College of Cardiology.

[22]  A. Folsom,et al.  Cardiovascular risk factors and cognitive decline in middle-aged adults , 2001, Neurology.

[23]  J S Alpert,et al.  Atrial fibrillation: a growth industry in the 21st century. , 2000, European heart journal.

[24]  T. del Ser,et al.  Poststroke dementia : clinical features and risk factors. , 2000, Stroke.

[25]  A. Hofman,et al.  Atrial fibrillation and the risk of cerebral white matter lesions , 2000, Neurology.

[26]  G. Frisoni,et al.  Atrial Fibrillation and Cognitive Disorders in Older People , 2000, Journal of the American Geriatrics Society.

[27]  T. Ser,et al.  Dementia Clinical Features and Risk Factors , 2000 .

[28]  L. Beckett,et al.  Current and remote blood pressure and cognitive decline. , 1999, JAMA.

[29]  M. Scheinman.  Atrial fibrillation and congestive heart failure: the intersection of two common diseases. , 1998, Circulation.

[30]  D. Levy,et al.  Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. , 1998, Circulation.

[31]  LarsLind,et al.  Atrial Fibrillation Is an Independent Determinant of Low Cognitive Function , 1998 .

[32]  I. Robertson,et al.  Atrial fibrillation and cognitive function: case-control study , 1998, Journal of neurology, neurosurgery, and psychiatry.

[33]  L. Lind,et al.  Atrial fibrillation is an independent determinant of low cognitive function: a cross-sectional study in elderly men. , 1998, Stroke.

[34]  E. Braunwald.  Shattuck lecture--cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. , 1997, The New England journal of medicine.

[35]  C. Mariani,et al.  Neuropsychological deficits in asymptomatic atrial fibrillation , 1997, Acta neurologica Scandinavica.

[36]  A Hofman,et al.  Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. , 1997, Stroke.

[37]  R. Frye,et al.  A population-based model of risk factors for ischemic stroke , 1996, Neurology.

[38]  L. Fried,et al.  Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. , 1996, Stroke.

[39]  B. Lernfelt,et al.  15-year longitudinal study of blood pressure and dementia , 1996, The Lancet.

[40]  L. Melton,et al.  History of the Rochester Epidemiology Project. , 1996, Mayo Clinic proceedings.

[41]  R. Havlik,et al.  The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. , 1995, JAMA.

[42]  M. Ezekowitz,et al.  Silent cerebral infarction in patients with nonrheumatic atrial fibrillation. The Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. , 1995, Circulation.

[43]  F A Mathewson,et al.  The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. , 1995, The American journal of medicine.

[44]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[45]  P. Wolf,et al.  Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. , 1991, Stroke.

[46]  R. Kronmal,et al.  The Cardiovascular Health Study: design and rationale. , 1991, Annals of epidemiology.

[47]  J. Seeger,et al.  Epidemiologic features of asymptomatic cerebral infarction in patients with nonvalvular atrial fibrillation. , 1990, Archives of internal medicine.

[48]  L R White,et al.  Longitudinally measured blood pressure, antihypertensive medication use, and cognitive performance: the Framingham Study. , 1990, Journal of clinical epidemiology.

[49]  J. Kastrup,et al.  Cerebral Blood Flow before and after Cardioversion of Atrial Fibrillation , 1989, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[50]  L R White,et al.  Correlates of cognitive function in an elderly community population. , 1988, American journal of epidemiology.

[51]  K. Haaland,et al.  CARDIOGENIC DEMENTIA , 1981, The Lancet.

[52]  A. Belanger,et al.  The Framingham study. , 1976, British medical journal.

[53]  W. Kannel,et al.  The natural history of congestive heart failure: the Framingham study. , 1971, The New England journal of medicine.