Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden.
Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
J Intern Med. 2019 Jul;286(1):101-110. doi: 10.1111/joim.12902. Epub 2019 Apr 22.
Atrial fibrillation increases risk of stroke, and thus risk of cognitive impairment and dementia. Emerging evidence suggests an association also in the absence of stroke. We aimed to examine the association between atrial fibrillation and incident dementia, with and without exclusion of individuals with stroke, and if sex and genetic factors modify the possible association.
In 2000-2001, a population-based sample of 70-year-olds (N = 561) underwent comprehensive somatic and neuropsychiatric examinations, as part of the Gothenburg H70 Birth Cohort Studies. Participants were followed up at age 75 and 79. Atrial fibrillation at baseline was identified through ECG, proxy-reports and the National Patient Register (NPR). Stroke at baseline and follow-up was identified through self-reports, proxy-reports and the NPR. Dementia at baseline and follow-up was diagnosed according to the DSM-III-R criteria based on neuropsychiatric examinations, proxy-reports and the NPR.
Individuals with atrial fibrillation had an almost threefold increased risk of dementia during 12-year follow-up (HR 2.8; 95% CI 1.3-5.7; P = 0.004), and this risk remained after excluding individuals with stroke at baseline and follow-up. After stratification for sex, the association was only found amongst men (HR 4.6; 95% CI 1.9-11.2; P < 0.001, interaction sexatrial fibrillation; P = 0.047) and noncarriers of the APOE ε4 allele (HR 4.2; 95% CI 1.8-9.7; P < 0.001, interaction APOEatrial fibrillation; P = 0.128). Population attributable risk for dementia resulting from atrial fibrillation was 13%.
The relevance for atrial fibrillation as an indicator of subclinical brain vascular risk needs to be further explored. In addition, patients with atrial fibrillation should be screened for cognitive symptoms.
心房颤动会增加中风的风险，进而增加认知障碍和痴呆的风险。新出现的证据表明，即使没有中风，这种关联也存在。我们旨在研究心房颤动与痴呆的发病风险之间的关联，包括排除有中风的个体和不排除有中风的个体，并研究性别和遗传因素是否会影响这种可能的关联。
在 2000-2001 年，一项基于人群的 70 岁样本（N=561）接受了全面的躯体和神经心理检查，作为哥德堡 H70 出生队列研究的一部分。参与者在 75 岁和 79 岁时接受了随访。基线时的心房颤动通过心电图、代理报告和国家患者登记处（NPR）确定。基线和随访时的中风通过自我报告、代理报告和 NPR 确定。基线和随访时的痴呆根据 DSM-III-R 标准，通过神经心理检查、代理报告和 NPR 诊断。
在 12 年的随访中，患有心房颤动的个体患痴呆的风险增加了近三倍（HR 2.8；95%CI 1.3-5.7；P=0.004），并且在排除了基线和随访时患有中风的个体后，这种风险仍然存在。在按性别分层后，这种关联仅在男性中发现（HR 4.6；95%CI 1.9-11.2；P<0.001，性别心房颤动交互作用；P=0.047）和非 APOE ε4 等位基因携带者（HR 4.2；95%CI 1.8-9.7；P<0.001，APOE心房颤动交互作用；P=0.128）。由于心房颤动导致的痴呆的人群归因风险为 13%。
心房颤动作为亚临床脑血管风险的指标的相关性需要进一步探讨。此外，应该对患有心房颤动的患者进行认知症状筛查。
