Stroke Research Group, Gunthorpe Acute Stroke Unit, Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
Neurology. 2011 Mar 8;76(10):914-22. doi: 10.1212/WNL.0b013e31820f2e38.
Previous systematic reviews that examined whether atrial fibrillation (AF) is associated with dementia have relied on different study designs (including retrospective ones) and did not evaluate risk using meta-analysis.
We searched Medline, Embase, and PsychINFO in September 2010 for published prospective studies reporting on the association between baseline AF and incident dementia. Pooled odds ratios for AF and dementia were calculated using the random effects model, with heterogeneity assessed using I(2).
We identified 15 relevant studies covering 46,637 participants, mean age 71.7 years. One study that reported no significant difference in Mini-Mental State Examination scores between patients with or without AF could not be pooled. Meta-analysis of the remaining 14 studies showed that AF was associated with a significant increase in dementia overall (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.4 to 2.7, p < 0.0001), with substantial heterogeneity (I(2) = 75%). When stratified by participants, the association was significant (with little heterogeneity) in studies focusing solely on patients with stroke (7 studies, OR 2.4, 95% CI 1.7 to 3.5, p < 0.001, I(2) = 10%), and of borderline significance (with substantial heterogeneity) for studies in broader populations (7 studies, OR 1.6, 95% CI 1.0 to 2.7, p = 0.05, I(2) = 87%). For conversion of mild cognitive impairment to dementia, one study showed a significant association with AF (OR 4.6, 95% CI 1.7 to 12.5).
There is consistent evidence supporting an association between AF and increased incidence of dementia in patients with stroke whereas there remains considerable uncertainty about any link in the broader population. The potential association between AF and incident dementia in mild cognitive impairment merits further investigation.
先前检查心房颤动（AF）是否与痴呆相关的系统评价依赖于不同的研究设计（包括回顾性研究），并未使用荟萃分析评估风险。
我们于 2010 年 9 月检索了 Medline、Embase 和 PsychINFO，以查找关于基线 AF 与新发痴呆之间关联的已发表前瞻性研究。使用随机效应模型计算 AF 和痴呆的合并优势比，并使用 I²评估异质性。
我们确定了 15 项相关研究，共纳入 46637 名参与者，平均年龄 71.7 岁。有一项研究报告称，在有无 AF 的患者之间，简易精神状态检查评分无显著差异，因此无法进行合并。对其余 14 项研究的荟萃分析表明，AF 与痴呆的总体发生风险显著增加相关（优势比 [OR] 2.0，95%置信区间 [CI] 1.4 至 2.7，p<0.0001），存在较大的异质性（I²=75%）。按参与者分层，仅关注卒中患者的研究中该关联具有显著性（异质性较小）（7 项研究，OR 2.4，95%CI 1.7 至 3.5，p<0.001，I²=10%），而在更广泛的人群中该关联具有边缘显著性（异质性较大）（7 项研究，OR 1.6，95%CI 1.0 至 2.7，p=0.05，I²=87%）。对于从轻度认知障碍转化为痴呆，有一项研究显示与 AF 存在显著关联（OR 4.6，95%CI 1.7 至 12.5）。
有一致的证据支持 AF 与卒中患者痴呆发生率增加之间存在关联，而在更广泛的人群中是否存在任何关联仍存在较大的不确定性。AF 与轻度认知障碍患者新发痴呆之间的潜在关联值得进一步研究。
