Association Between Atrial Fibrillation and Cognitive Impairment in Individuals With Prior Stroke
- 1 June 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 51 (6), 1662-1666
- https://doi.org/10.1161/strokeaha.119.027815
Abstract
Background and Purpose— Atrial fibrillation (AF) is the most common chronic arrhythmia. Dementia and cognitive impairment (CI) are major burdens to public health. The prevalence of all 3 entities is projected to increase due to population aging. Previous reports have linked AF with a higher risk of CI and dementia in patients without prior stroke. Stroke is known to increase the risk for dementia and CI. It is unclear if AF in patients with history of stroke can further increase the risk for dementia or CI. Our purpose was to evaluate the impact of AF on risk for dementia or CI among patients with history of stroke. Methods— Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Pubmed, Scopus, and Cochrane central were searched. The outcomes of interest were dementia, CI, and the composite end point of dementia or CI. A random-effect model meta-analysis was performed. Meta-regression analysis was also performed. Publication bias was assessed with the Egger test and with funnel plots. Results— Fourteen studies and 14 360 patients (1363 with AF) were included in the meta-analysis. In the meta-analysis of adjusted odds ratio, AF was associated with increased risk of CI (odds ratio, 1.60 [95% CI, 1.20–2.14]), dementia (odds ratio, 3.11 [95% CI, 2.05–4.73]), and the composite end point of CI or dementia (odds ratio, 2.26 [95% CI, 1.61–3.19]). The heterogeneity for the composite end point of dementia or CI was moderate (adjusted analysis). The heterogeneity for the analysis of the end point of CI only was substantial in the unadjusted analysis and moderate in the adjusted analysis. The heterogeneity for the end point of dementia only was moderate in the unadjusted analysis and zero in the adjusted analysis. Conclusions— Our results indicate that an association between AF and CI or dementia is patients with prior strokes is possible given the persistent positive associations we noticed in the unadjusted and adjusted analyses. The heterogeneity levels limit the certainty of our findings.This publication has 30 references indexed in Scilit:
- Long-Term Effects of Secondary Prevention on Cognitive Function in Stroke PatientsCirculation, 2013
- Functional, cognitive and psychological outcomes, and recurrent vascular events in Pakistani stroke survivors: a cross sectional studyBMC Research Notes, 2012
- Patients Treated with Catheter Ablation for Atrial Fibrillation Have Long‐Term Rates of Death, Stroke, and Dementia Similar to Patients Without Atrial FibrillationJournal of Cardiovascular Electrophysiology, 2011
- Association of Atrial Fibrillation and Focal Neurologic Deficits With Impaired Cognitive Function in Hospitalized Patients ≥65 Years of AgeThe American Journal of Cardiology, 2006
- Frequency and Clinical Determinants of Poststroke Cognitive Impairment in Nondemented Stroke PatientsJournal of Geriatric Psychiatry and Neurology, 2006
- Patients at High Risk with Atrial Fibrillation: A Prospective and Serial Follow-up During 12 Months with Transesophageal Echocardiography and Cerebral Magnetic Resonance ImagingJournal of the American Society of Echocardiography, 2005
- Study on frequency and predictors of dementia after ischemic strokeZeitschrift für Neurologie, 2004
- Meta-analysis of Observational Studies in EpidemiologyA Proposal for ReportingJAMA, 2000
- Risk of Dementia after a First-Ever Ischemic Stroke: A 3-Year Longitudinal StudyCerebrovascular Diseases, 1997