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July 09, 2013; 81 (2) Article

Atrial fibrillation and cognitive decline

A longitudinal cohort study

Evan L. Thacker, Barbara McKnight, Bruce M. Psaty, W.T. Longstreth, Colleen M. Sitlani, Sascha Dublin, Alice M. Arnold, Annette L. Fitzpatrick, Rebecca F. Gottesman, Susan R. Heckbert
First published June 5, 2013, DOI: https://doi.org/10.1212/WNL.0b013e31829a33d1
Evan L. Thacker
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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Barbara McKnight
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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Bruce M. Psaty
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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W.T. Longstreth Jr
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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Colleen M. Sitlani
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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Sascha Dublin
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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Alice M. Arnold
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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Annette L. Fitzpatrick
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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Rebecca F. Gottesman
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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Susan R. Heckbert
From the Cardiovascular Health Research Unit (E.L.T., B.M., B.M.P., C.M.S., S.R.H.) and Departments of Epidemiology (E.L.T., B.M.P., W.T.L., S.D., A.L.F., S.R.H.), Biostatistics (B.M., A.M.A.), Medicine (B.M.P., W.T.L., C.M.S.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington; Group Health Research Institute (B.M.P., S.D., S.R.H.), Seattle, WA; Department of Neurology (R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (E.L.T.), University of Alabama at Birmingham, AL.
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Full PDF
Citation
Atrial fibrillation and cognitive decline
A longitudinal cohort study
Evan L. Thacker, Barbara McKnight, Bruce M. Psaty, W.T. Longstreth, Colleen M. Sitlani, Sascha Dublin, Alice M. Arnold, Annette L. Fitzpatrick, Rebecca F. Gottesman, Susan R. Heckbert
Neurology Jul 2013, 81 (2) 119-125; DOI: 10.1212/WNL.0b013e31829a33d1

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Abstract

Objective: We sought to determine whether in the absence of clinical stroke, people with atrial fibrillation experience faster cognitive decline than people without atrial fibrillation.

Methods: We conducted a longitudinal analysis in the Cardiovascular Health Study, a community-based study of 5,888 men and women aged 65 years and older, enrolled in 1989/1990 or 1992/1993. Participants did not have atrial fibrillation or a history of stroke at baseline. Participants were censored when they experienced incident clinical stroke. Incident atrial fibrillation was identified by hospital discharge diagnosis codes and annual study ECGs. The main outcome was rate of decline in mean scores on the 100-point Modified Mini-Mental State Examination (3MSE), administered annually up to 9 times.

Results: Analyses included 5,150 participants, of whom 552 (10.7%) developed incident atrial fibrillation during a mean of 7 years of follow-up. Mean 3MSE scores declined faster after incident atrial fibrillation compared with no prior atrial fibrillation. For example, the predicted 5-year decline in mean 3MSE score from age 80 to age 85 was −6.4 points (95% confidence interval [CI]: −7.0, −5.9) for participants without a history of atrial fibrillation, but was −10.3 points (95% CI: −11.8, −8.9) for participants experiencing incident atrial fibrillation at age 80, a 5-year difference of −3.9 points (95% CI: −5.3, −2.5).

Conclusions: In the absence of clinical stroke, people with incident atrial fibrillation are likely to reach thresholds of cognitive impairment or dementia at earlier ages than people with no history of atrial fibrillation.

GLOSSARY

CI=
confidence interval;
DSST=
Digit Symbol Substitution Test;
ICD-9=
International Classification of Diseases, ninth revision;
3MSE=
Modified Mini-Mental State Examination

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received November 15, 2012.
  • Accepted in final form March 23, 2013.
  • © 2013 American Academy of Neurology
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