Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas 78705, USA.
Heart Rhythm. 2012 Nov;9(11):1761-8. doi: 10.1016/j.hrthm.2012.07.026. Epub 2012 Aug 2.
The risk of cerebrovascular embolic events with atrial fibrillation (AF) is potentially linked to an increased risk of cognitive decline and dementia. However, epidemiologic studies exploring the association between AF and incident dementia have reported conflicting results.
The purpose of this study was to perform a meta-analysis of observational studies specifically designed to evaluate the prospective relationship between AF and incident dementia.
We searched PubMed, CENTRAL, BioMedCentral, Embase, Cardiosource, clinicaltrials.gov, and ISI Web of Science (January 1980 to May 2012). No language restriction was applied. Two independent reviewers screened titles and abstracts to identify population-based studies that prospectively evaluated the association between AF and the incidence of dementia in patients not suffering an acute stroke and with normal cognitive function at baseline, providing the hazard ratio (HR) obtained in multiple Cox regression analyses, and adjusted for all confounding variables. Two independent reviewers assessed risk of bias according to the Cochrane Collaboration, and extracted patient and study characteristics and the adjusted HR of incident dementia with its 95% confidence interval (CI) of patients with AF vs those without AF.
Eight studies with 77,668 patients were included in the analysis. All studies had a prospective observational design and included elderly patients (mean age range 61-84 years) with normal cognitive function at baseline, of whom 11,700 (15%) had AF. After a mean follow-up of 7.7 ± 9.1 years (range 1.8-30 years), 4773 of 73,321 (6.5%) patients developed dementia. Two studies did not report the rates of dementia at follow-up but reported the adjusted HR and were included in the pooled analysis. At pooled analysis adjusted for baseline confounders and covariates, AF was independently associated with increased risk of incident dementia (HR = 1.42 [95% CI 1.17-1.72], P <.001).
AF is independently associated with increased risk of dementia. Patients with AF should be periodically screened for dementia, which should be included among the outcomes assessed in AF treatment trials.
心房颤动（AF）患者发生脑血管栓塞事件的风险可能与认知能力下降和痴呆的风险增加有关。然而，探索 AF 与痴呆发病之间关联的流行病学研究结果存在冲突。
本研究旨在对专门设计用于评估 AF 与痴呆发病之间前瞻性关系的观察性研究进行荟萃分析。
我们检索了 PubMed、CENTRAL、BioMedCentral、Embase、Cardiosource、clinicaltrials.gov 和 ISI Web of Science（1980 年 1 月至 2012 年 5 月）。未限制语言。两名独立审查员筛选标题和摘要，以确定基于人群的研究，这些研究前瞻性评估了 AF 与基线时未发生急性脑卒中且认知功能正常的患者发生痴呆的相关性，提供了在多 Cox 回归分析中获得的风险比（HR），并根据所有混杂变量进行了调整。两名独立审查员根据 Cochrane 协作组评估了偏倚风险，并提取了患者和研究特征以及调整后的 HR，包括 AF 患者与无 AF 患者发生痴呆的风险比及其 95%置信区间（CI）。
共纳入了 8 项包含 77668 名患者的研究。所有研究均为前瞻性观察性设计，纳入了基线时认知功能正常的老年患者（平均年龄范围 61-84 岁），其中 11700 名（15%）患有 AF。在平均 7.7±9.1 年（范围 1.8-30 年）的随访后，73321 名患者中有 4773 名（6.5%）发生了痴呆。有两项研究未报告随访时的痴呆发生率，但报告了调整后的 HR，并纳入了汇总分析。在对基线混杂因素和协变量进行调整的汇总分析中，AF 与痴呆发病风险增加独立相关（HR=1.42[95%CI 1.17-1.72]，P<0.001）。
AF 与痴呆风险增加独立相关。应定期对 AF 患者进行痴呆筛查，并将其纳入 AF 治疗试验的评估结果中。
