Kilander L, Andrén B, Nyman H, Lind L, Boberg M, Lithell H
Department of Public Health and Social Sciences/Geriatrics, Uppsala University, Sweden.
Stroke. 1998 Sep;29(9):1816-20. doi: 10.1161/01.str.29.9.1816.
Cerebrovascular disease is increasingly recognized as a cause of dementia and cognitive decline. We have previously reported an association between hypertension and diabetes and low cognitive function in the elderly. Atrial fibrillation is another main risk factor for cerebrovascular disease. The aim of this study was to investigate whether atrial fibrillation is associated with low cognitive function in elderly men with and without previous manifest stroke.
This was a cross-sectional study based on a cohort of 952 community-living men, aged 69 to 75 years, in Uppsala, Sweden. Cognitive functions were assessed by the Mini-Mental State Examination and the Trail Making Tests, and a composite z score was calculated. The relation between atrial fibrillation and cognitive z score was analyzed, with stroke and other vascular risk factors taken into account.
All analyses were adjusted for age, education, and occupational level. Men with atrial fibrillation (n=44) had lower mean adjusted cognitive z scores (-0.26+/-0.11) than men without atrial fibrillation (+0.14+/-0.03; P=0.0003). The exclusion of stroke patients did not alter this relationship; the mean cognitive z score was -0.24+/-0.12 in the 36 men with atrial fibrillation and +0.17+/-0.03 in those without atrial fibrillation (P=0.0004), corresponding to a difference of 0.4 SDs between groups. Adjustments for 24-hour diastolic blood pressure and heart rate, diabetes, and ejection fraction did not change this relationship. Men with atrial fibrillation who were treated with digoxin (n=27) performed markedly better (-0.05+/-0.21) than those without treatment (n=9; -1.14+/-0.34; adjusted P=0.0005). Previous myocardial infarction was not associated with impaired cognitive results.
In these community-living elderly men, we found an association between atrial fibrillation and low cognitive function independent of stroke, high blood pressure, and diabetes. Interventional studies are needed to answer the question of whether optimal treatment of atrial fibrillation may prevent or postpone cognitive decline and dementia.
脑血管疾病日益被认为是痴呆和认知功能衰退的一个病因。我们之前曾报道过高血压、糖尿病与老年人认知功能低下之间的关联。心房颤动是脑血管疾病的另一个主要危险因素。本研究的目的是调查心房颤动是否与既往有或无明显卒中的老年男性认知功能低下有关。
这是一项基于瑞典乌普萨拉952名年龄在69至75岁之间的社区居住男性队列的横断面研究。通过简易精神状态检查表和连线测验评估认知功能，并计算综合z评分。分析心房颤动与认知z评分之间的关系，同时考虑卒中及其他血管危险因素。
所有分析均对年龄、教育程度和职业水平进行了校正。有心房颤动的男性（n = 44）经校正后的平均认知z评分（-0.26±0.11）低于无心房颤动的男性（+0.14±0.03；P = 0.0003）。排除卒中患者后这种关系未改变；36名有心房颤动的男性平均认知z评分为-0.24±0.12，无心房颤动的男性为+0.17±0.03（P = 0.0004），两组间相差0.4个标准差。对24小时舒张压、心率、糖尿病和射血分数进行校正后，这种关系未改变。接受地高辛治疗的有心房颤动男性（n = 27）表现明显更好（-0.05±0.21），优于未接受治疗的男性（n = 9；-1.14±0.34；校正后P = 0.0005）。既往心肌梗死与认知结果受损无关。
在这些社区居住的老年男性中，我们发现心房颤动与认知功能低下之间存在关联，且独立于卒中、高血压和糖尿病。需要进行干预性研究来回答优化心房颤动治疗是否可预防或延缓认知衰退和痴呆这一问题。
