Department of Aging, Sapienza Università di Roma, Umberto I Policlinico di Roma, Roma, Italy.
Arch Gerontol Geriatr. 2009;49 Suppl 1:71-6. doi: 10.1016/j.archger.2009.09.014.
Atrial fibrillation (AF), which is a very common disease among the elderly, is already well known as a risk factor for arterial thromboembolism and stroke. The attention of medical research is now focused on establishing a possible role of AF in the development of cognitive impairment in order to include this arrhythmia among risk factors for dementia. The aim of this work was to investigate the relationship between AF and various types of dementia, such as vascular dementia (VaD), Alzheimer's disease (AD) and mixed dementia (MD). The study consisted of 71 VaD, AD or MD patients, 31 males and 40 females. The sample has been divided in 2 groups according to the sex, and these two groups have been analyzed separately. In females, a statistically significant association was found between mini mental state examination (MMSE) and clinical dementia rating (CDR) scores and AF occurrence (r=-0.32; p<0.05; r=0.33; p<0.05). On the contrary, no significant linear correlation was found between AF and a lower activities if daily living (ADL) and instrumental activities if daily living (IADL) scores. In males, AF/MMSE, AF/CDR, AF/ADL and AF/IADL variables have not been found to be linearly related to each other. Unexpectedly, AF turned to be associated to AD more often than to VAD, becoming a possible risk factor for this neurodegenerative disease. Our results are supported by many studies in literature attributing a basic role of brain hypoperfusion in sporadic AD patho-genesis. More and more scientific data suggest that the already well known risk factors for AD could be considered just the top of an iceberg, providing powerful arguments for impaired cerebral perfusion as the primary trigger in the development of this disease. Moreover, the mildly favorable treatment response in patients with AD to therapy that improves cerebral blood flow is a consistent finding; the same cannot be said of antiamyloid treatments. This opens new possibilities to find an effective way to treat this dramatic pathology.
心房颤动（AF）是老年人中非常常见的疾病，已被广泛认为是动脉血栓栓塞和中风的危险因素。医学研究现在的注意力集中在确定 AF 是否可能在认知障碍的发展中起作用，以便将这种心律失常纳入痴呆症的危险因素。本工作旨在研究 AF 与各种类型的痴呆症（如血管性痴呆（VaD）、阿尔茨海默病（AD）和混合性痴呆（MD））之间的关系。研究包括 71 名 VaD、AD 或 MD 患者，其中男性 31 名，女性 40 名。根据性别将样本分为两组，并分别对这两组进行分析。在女性中，发现 mini mental state examination (MMSE) 和 clinical dementia rating (CDR) 评分与 AF 发生之间存在显著的关联（r=-0.32；p<0.05；r=0.33；p<0.05）。相反，AF 与较低的日常生活活动（ADL）和工具性日常生活活动（IADL）评分之间没有发现显著的线性相关性。在男性中，AF/MMSE、AF/CDR、AF/ADL 和 AF/IADL 变量之间没有发现线性关系。出乎意料的是，AF 与 AD 的关联比与 VaD 的关联更为常见，成为这种神经退行性疾病的一个潜在危险因素。我们的结果得到了文献中许多研究的支持，这些研究认为脑灌注不足在散发性 AD 发病机制中起基本作用。越来越多的科学数据表明，AD 的已知危险因素可能只是冰山一角，为脑灌注受损作为这种疾病发展的主要触发因素提供了有力的论据。此外，改善脑血流的治疗对 AD 患者的轻度有利反应是一个一致的发现；抗淀粉样蛋白治疗则不然。这为寻找有效的治疗这种严重病理的方法开辟了新的可能性。
