Ott A, Breteler M M, de Bruyne M C, van Harskamp F, Grobbee D E, Hofman A
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
Stroke. 1997 Feb;28(2):316-21. doi: 10.1161/01.str.28.2.316.
Atrial fibrillation is a frequent disorder in the elderly and a known risk factor for cerebrovascular stroke. We investigated the association of atrial fibrillation with dementia and cognitive impairment in a large cross-sectional, population-based study in the elderly.
Of the 6584 participants in the Rotterdam Study aged 55 to 106 years, detailed information on dementia status and ECG abnormalities was available. Dementia was diagnosed in three phases. First, participants were screened. Screen-positive subjects were tested further. Those with possible dementia underwent an extensive diagnostic workup. Dementia and dementia subtypes were diagnosed according to prevailing criteria. Cognitive impairment was defined as a Mini-Mental State Examination test score of < 26 points for a nondemented subject.
Atrial fibrillation was diagnosed in 195, dementia in 276, and cognitive impairment in 635 subjects. We found significant positive associations of atrial fibrillation with both dementia and impaired cognitive function (age- and sex-adjusted odds ratios, 2.3 [95% confidence interval, 1.4 to 3.7] and 1.7 [95% confidence interval, 1.2 to 2.5]), respectively). The strongest association was found not for vascular dementia but rather for Alzheimer's disease with cerebrovascular disease. The associations were stronger in women, and the relation with dementia was more pronounced in the relatively younger elderly. A history of stroke in subjects with atrial fibrillation could not account for these associations.
Dementia and subtypes Alzheimer's disease and vascular dementia may be related to atrial fibrillation even if no clinical stokes have occurred.
心房颤动是老年人常见的病症，也是已知的脑血管卒中风险因素。我们在一项针对老年人的大型横断面、基于人群的研究中，调查了心房颤动与痴呆及认知障碍之间的关联。
鹿特丹研究中有6584名年龄在55至106岁的参与者，可获取有关痴呆状态和心电图异常的详细信息。痴呆诊断分三个阶段进行。首先，对参与者进行筛查。筛查呈阳性的受试者会接受进一步检测。那些可能患有痴呆的人要接受全面的诊断检查。根据现行标准诊断痴呆及其亚型。认知障碍定义为非痴呆受试者的简易精神状态检查表测试得分<26分。
195名受试者被诊断为心房颤动，276名患有痴呆，635名存在认知障碍。我们发现心房颤动与痴呆及认知功能受损均存在显著正相关（年龄和性别调整后的优势比分别为2.3[95%置信区间，1.4至3.7]和1.7[95%置信区间，1.2至2.5]）。关联最强的并非血管性痴呆，而是伴有脑血管疾病的阿尔茨海默病。女性中的关联更强，且与痴呆的关系在相对年轻的老年人中更为明显。心房颤动患者的卒中病史无法解释这些关联。
即使未发生临床卒中，痴呆及其亚型阿尔茨海默病和血管性痴呆也可能与心房颤动有关。
