Atrial fibrillation tied to higher dementia risk in older adults

  • Rydén L & al.
  • J Intern Med
  • 20 Mar 2019

  • International Clinical Digest
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Takeaway

  • Atrial fibrillation roughly triples the risk for dementia among older adults, even in the absence of stroke.

Why this matters

  • Isolated neurocognitive effect of atrial fibrillation is unclear.

Key results

  • With mean 10.4-year follow-up, atrial fibrillation conferred similarly elevated dementia risk:
    • In the cohort overall (adjusted HR, 2.8; P=.004).
    • In a subset stroke free at baseline and during follow-up (adjusted HR, 2.9; P=.013).
  • In stratified analyses, risk was significantly elevated by atrial fibrillation only among:
    • Men (adjusted HR, 4.6; P<.001 interaction sex by atrial fibrillation p=".047).</li">
    • Noncarriers of APOE ε4 allele (adjusted HR, 4.2; P<.001 interaction apoe by atrial fibrillation p=".128).</li">
  • Population attributable risk for dementia resulting from atrial fibrillation:
    • 12.9% in cohort overall.
    • 12.1% in stroke-free subset.

Study design

  • Swedish population-based cohort study of 561 adults aged 70 years having comprehensive physical and neuropsychiatric examinations in 2000-2001 and followed-up at ages 75 and 79 years.
  • Main outcome: dementia (DSM, Third Edition revised, criteria based on neuropsychiatric examinations, proxy reports, National Patient Register).
  • Funding: Swedish state.

Limitations

  • Atrial fibrillation history ascertained from proxies.
  • Milder strokes not captured.
  • Limited ability to perform subgroup analyses.
  • Possible attrition bias.

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