Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Cattedra di Geriatria, Università di Napoli Federico II, Napoli, Italy.
Dement Geriatr Cogn Disord. 2012;34(3-4):143-8. doi: 10.1159/000342195. Epub 2012 Sep 12.
The role of ventricular rate response (VRr) on the incidence of dementia in elderly subjects with cognitive impairment and atrial fibrillation (AF) is not known. Thus, we examined the ability of VRr to predict dementia in cognitively impaired elderly subjects with and without AF.
A total of 358 cognitively impaired elderly subjects (MMSE <24) with and without AF were stratified in low/high (<50/>90) and moderate (>50/<90 bpm) VRr. A 10-year follow-up was performed.
Cognitively impaired subjects with dementia at the end of the follow-up were 135 (37.7%): 33 in the presence (75.0%) and 102 (32.5%) in the absence of AF (p < 0.001). Multivariate analysis shows that AF is a strong predictor of dementia (hazard ratio, HR = 4.10; 95% confidence interval, CI = 1.80-9.30, p < 0.001). More importantly, low/high VRr (<50/>90 bpm) is predictive of dementia in the presence (HR = 7.70, 95% CI = 1.10-14.20, p = 0.03) but not in the absence (HR = 1.85; 95% CI = 0.78-4.47; p = 0.152) of AF.
This study demonstrates that AF predicts dementia in elderly subjects with cognitive impairment. Moreover, VRr seems to play a key role in the incidence of dementia in cognitively impaired elderly subjects with AF.
心室率反应（VRr）在伴有认知障碍和心房颤动（AF）的老年患者中对痴呆的发生的作用尚不清楚。因此，我们研究了 VRr 在伴有和不伴有 AF 的认知障碍老年患者中预测痴呆的能力。
共有 358 名认知障碍老年患者（MMSE<24）被分为低/高（<50/>90）和中（>50/<90bpm）VRr 组。进行了 10 年的随访。
在随访结束时有痴呆的认知障碍患者为 135 例（37.7%）：33 例在 AF 存在时（75.0%），102 例在 AF 不存在时（32.5%）（p<0.001）。多变量分析显示，AF 是痴呆的一个强有力的预测因素（危险比，HR=4.10；95%置信区间，CI=1.80-9.30，p<0.001）。更重要的是，低/高 VRr（<50/>90bpm）在 AF 存在时预测痴呆（HR=7.70，95% CI=1.10-14.20，p=0.03），而在 AF 不存在时则没有预测作用（HR=1.85；95% CI=0.78-4.47；p=0.152）。
本研究表明，AF 可预测认知障碍老年患者的痴呆。此外，VRr 似乎在伴有认知障碍和 AF 的老年患者中痴呆的发生中起关键作用。
