Group Health Research Institute, Seattle, Washington, USA.
J Am Geriatr Soc. 2011 Aug;59(8):1369-75. doi: 10.1111/j.1532-5415.2011.03508.x. Epub 2011 Aug 1.
To determine whether atrial fibrillation (AF) is associated with risk of incident dementia or Alzheimer's disease (AD), beyond its effect on stroke.
Prospective cohort study.
An integrated healthcare delivery system.
A population-based sample of 3,045 community-dwelling adults aged 65 and older without dementia or clinical stroke followed from 1994 to 2008.
AF was identified from health plan electronic data using International Classification of Diseases, Ninth Revision, codes from inpatient and outpatient encounters. Covariates came from self-report, study measures, and health plan data. Participants were screened every 2 years using the Cognitive Abilities Screening Instrument (range 0-100), with detailed neuropsychological and clinical assessment of those scoring less than 86. A multidisciplinary consensus committee determined diagnoses of all-cause dementia and possible or probable AD using standard research criteria.
AF was present in 132 (4.3%) participants at baseline and was diagnosed in 370 (12.2%) more over a mean of 6.8 years of follow-up; 572 participants (18.8%) developed dementia (449 with AD). The adjusted hazard ratio associated with AF was 1.38 (95% confidence interval (CI)=1.10-1.73) for all-cause dementia and 1.50 (95% CI=1.16-1.94) for possible or probable AD. Results were similar for participants with and without clinically recognized stroke during follow-up and in sensitivity analyses examining only probable AD.
AF is associated with higher risk of developing AD and dementia. Future studies should examine whether specific treatments, including optimal anticoagulation, can decrease this risk.
确定心房颤动（房颤）是否与痴呆或阿尔茨海默病（AD）的发病风险相关，而不仅仅是其对中风的影响。
前瞻性队列研究。
一个综合医疗服务系统。
1994 年至 2008 年期间，一项基于人群的、年龄在 65 岁及以上、无痴呆或临床中风的、居住在社区的 3045 名成年人的样本。
使用国际疾病分类，第九版，门诊和住院患者就诊的代码，从健康计划电子数据中确定房颤。协变量来自自我报告、研究测量和健康计划数据。参与者每 2 年使用认知能力筛查工具（范围 0-100）进行筛查，对得分低于 86 的参与者进行详细的神经心理学和临床评估。一个多学科共识委员会使用标准研究标准确定所有原因痴呆和可能或可能的 AD 的诊断。
在基线时有 132 名（4.3%）参与者存在房颤，在平均 6.8 年的随访中又有 370 名（12.2%）参与者被诊断为房颤；572 名参与者（18.8%）发生痴呆（449 名患有 AD）。与房颤相关的调整后风险比为 1.38（95%置信区间[CI]=1.10-1.73），用于全因痴呆，为 1.50（95% CI=1.16-1.94），用于可能或可能的 AD。在随访期间有和没有临床确认中风的参与者以及仅检查可能 AD 的敏感性分析中，结果相似。
房颤与更高的 AD 和痴呆发病风险相关。未来的研究应研究是否特定的治疗方法，包括最佳抗凝治疗，能否降低这种风险。
