INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France.
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
Eur Heart J. 2017 Sep 7;38(34):2612-2618. doi: 10.1093/eurheartj/ehx208.
To assess whether AF is a risk factor for cognitive dysfunction we used prospective data on AF, repeat cognitive scores, and dementia incidence in adults followed over 45 to 85 years.
Data are drawn from the Whitehall II study, N = 10 308 at study recruitment in 1985. A battery of cognitive tests was administered four times (1997-2013) to 7428 participants (414 cases of AF), aged 45-69 years in 1997. Compared with AF-free participants, those with longer exposure to AF (5, 10, or 15 years) experienced faster cognitive decline after adjustment for sociodemographic, behavioural, and chronic diseases (P for trend = 0.01). Incident stroke or coronary heart disease individually did not explain the excess cognitive decline; however, this relationship was impacted when considering them together (P for trend 0.09). Analysis of incident dementia (N = 274/9302 without AF; N = 50/912 with AF) showed AF was associated with higher risk of dementia in Cox regression adjusted for sociodemographic factors, health behaviours and chronic diseases [hazard ratio (HR): 1.87; 95% confidence interval (CI): 1.37, 2.55]. Multistate models showed AF to increase risk of dementia in those free of stroke (HR: 1.67; 95% CI: 1.17, 2.38) but not those free of stroke and coronary heart disease (HR: 1.29; 95% CI: 0.74, 2.24) over the follow-up.
In adults aged 45-85 years AF is associated with accelerated cognitive decline and higher risk of dementia even at ages when AF incidence is low. At least in part, this was explained by incident cardiovascular disease in patients with AF.
为了评估房颤是否是认知功能障碍的风险因素，我们使用了前瞻性的房颤数据、重复的认知评分和在 45 至 85 年内随访的成年人的痴呆发病率数据。
数据来自 1985 年招募的白厅 II 研究，共纳入 10308 名参与者。1997 年，年龄在 45-69 岁的 7428 名参与者接受了四次认知测试（1997-2013 年）。与无房颤的参与者相比，房颤暴露时间更长（5、10 或 15 年）的参与者，在调整社会人口统计学、行为和慢性疾病因素后，认知能力下降更快（趋势 P 值=0.01）。单独发生中风或冠心病并不能解释认知能力下降的增加；然而，当同时考虑这些因素时，这种关系受到影响（趋势 P 值=0.09）。对新发痴呆症（无房颤的 9302 例中有 274 例/9302 例；有房颤的 912 例中有 50 例/912 例）的分析显示，房颤与调整社会人口统计学因素、健康行为和慢性疾病后的 Cox 回归分析中痴呆症风险增加相关[危险比（HR）：1.87；95%置信区间（CI）：1.37，2.55]。多状态模型显示，在无中风的人群中，房颤会增加痴呆症的风险（HR：1.67；95% CI：1.17，2.38），但在无中风和冠心病的人群中则没有（HR：1.29；95% CI：0.74，2.24）。
在 45-85 岁的成年人中，即使在房颤发病率较低的年龄，房颤与认知能力下降加速和痴呆症风险增加相关。在患有房颤的患者中，至少部分原因是新发心血管疾病。
