Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: the atherosclerosis risk in communities study

Lin Y Chen¹, Faye L Lopez², Rebecca F Gottesman², Rachel R Huxley², Sunil K Agarwal², Laura Loehr², Thomas Mosley², Alvaro Alonso²

Affiliations

¹ From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.). chenx484@umn.edu.
² From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.).

PMID: 25052319
PMCID: PMC4146651
DOI: 10.1161/STROKEAHA.114.005243

Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: the atherosclerosis risk in communities study

Lin Y Chen et al. Stroke. 2014 Sep.

. 2014 Sep;45(9):2568-74.

doi: 10.1161/STROKEAHA.114.005243. Epub 2014 Jul 22.

Authors

Lin Y Chen¹, Faye L Lopez², Rebecca F Gottesman², Rachel R Huxley², Sunil K Agarwal², Laura Loehr², Thomas Mosley², Alvaro Alonso²

Affiliations

¹ From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.). chenx484@umn.edu.
² From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.).

PMID: 25052319
PMCID: PMC4146651
DOI: 10.1161/STROKEAHA.114.005243

Abstract

Background and purpose: The mechanism underlying the association of atrial fibrillation (AF) with cognitive decline in stroke-free individuals is unclear. We examined the association of incident AF with cognitive decline in stroke-free individuals, stratified by subclinical cerebral infarcts (SCIs) on brain MRI scans.

Methods: We analyzed data from 935 stroke-free participants (mean age±SD, 61.5±4.3 years; 62% women; and 51% black) from 1993 to 1995 through 2004 to 2006 in the Atherosclerosis Risk in Communities Study, a biracial community-based prospective cohort study. Cognitive testing (including the digit symbol substitution and the word fluency tests) was performed in 1993 to 1995, 1996 to 1998, and 2004 to 2006 and brain MRI scans in 1993 to 1995 and 2004 to 2006.

Results: During follow-up, there were 48 incident AF events. Incident AF was associated with greater annual average rate of decline in digit symbol substitution (-0.77; 95% confidence interval, -1.55 to 0.01; P=0.054) and word fluency (-0.80; 95% confidence interval, -1.60 to -0.01; P=0.048). Among participants without SCIs on brain MRI scans, incident AF was not associated with cognitive decline. In contrast, incident AF was associated with greater annual average rate of decline in word fluency (-2.65; 95% confidence interval, -4.26 to -1.03; P=0.002) among participants with prevalent SCIs in 1993 to 1995. Among participants who developed SCIs during follow-up, incident AF was associated with a greater annual average rate of decline in digit symbol substitution (-1.51; 95% confidence interval, -3.02 to -0.01; P=0.049).

Conclusions: The association of incident AF with cognitive decline in stroke-free individuals can be explained by the presence or development of SCIs, raising the possibility of anticoagulation as a strategy to prevent cognitive decline in AF.

Keywords: atrial fibrillation; cognition; epidemiology.

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References

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Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: the atherosclerosis risk in communities study

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Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: the atherosclerosis risk in communities study

Authors

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Abstract

References

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Grants and funding

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Full Text Sources

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Medical