Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, WA, USA.
Neurology. 2013 Jul 9;81(2):119-25. doi: 10.1212/WNL.0b013e31829a33d1. Epub 2013 Jun 5.
We sought to determine whether in the absence of clinical stroke, people with atrial fibrillation experience faster cognitive decline than people without atrial fibrillation.
We conducted a longitudinal analysis in the Cardiovascular Health Study, a community-based study of 5,888 men and women aged 65 years and older, enrolled in 1989/1990 or 1992/1993. Participants did not have atrial fibrillation or a history of stroke at baseline. Participants were censored when they experienced incident clinical stroke. Incident atrial fibrillation was identified by hospital discharge diagnosis codes and annual study ECGs. The main outcome was rate of decline in mean scores on the 100-point Modified Mini-Mental State Examination (3MSE), administered annually up to 9 times.
Analyses included 5,150 participants, of whom 552 (10.7%) developed incident atrial fibrillation during a mean of 7 years of follow-up. Mean 3MSE scores declined faster after incident atrial fibrillation compared with no prior atrial fibrillation. For example, the predicted 5-year decline in mean 3MSE score from age 80 to age 85 was -6.4 points (95% confidence interval [CI]: -7.0, -5.9) for participants without a history of atrial fibrillation, but was -10.3 points (95% CI: -11.8, -8.9) for participants experiencing incident atrial fibrillation at age 80, a 5-year difference of -3.9 points (95% CI: -5.3, -2.5).
In the absence of clinical stroke, people with incident atrial fibrillation are likely to reach thresholds of cognitive impairment or dementia at earlier ages than people with no history of atrial fibrillation.
我们旨在确定在没有临床中风的情况下，患有心房颤动的人群是否比没有心房颤动的人群认知衰退更快。
我们对心血管健康研究（一项针对 5888 名年龄在 65 岁及以上的男性和女性的基于社区的研究）进行了纵向分析，这些参与者于 1989/1990 年或 1992/1993 年入组。基线时，参与者没有心房颤动或中风病史。当参与者发生临床中风时，将其作为截尾事件。通过医院出院诊断代码和年度研究心电图来确定新发心房颤动。主要结局是每年进行一次的 100 分改良简易精神状态检查（3MSE）的平均得分下降率，共进行了 9 次。
分析纳入了 5150 名参与者，其中 552 名（10.7%）在平均 7 年的随访期间发生了新发心房颤动。与没有既往心房颤动相比，发生心房颤动后 3MSE 得分下降更快。例如，无心房颤动病史的参与者从 80 岁到 85 岁的 5 年平均 3MSE 得分下降预测值为-6.4 分（95%置信区间[CI]：-7.0，-5.9），但在 80 岁时发生新发心房颤动的参与者的 5 年平均 3MSE 得分下降预测值为-10.3 分（95% CI：-11.8，-8.9），5 年差异为-3.9 分（95% CI：-5.3，-2.5）。
在没有临床中风的情况下，与没有心房颤动病史的人群相比，新发心房颤动的人群可能更早达到认知障碍或痴呆的阈值。
