Abstract 022: Atrial Fibrillation and Cognitive Decline: The Cardiovascular Health Study
Objective. We sought to determine whether atrial fibrillation (AF) was associated with cognitive decline in the absence of stroke.
Methods. We included Cardiovascular Health Study participants aged 65+ who did not have AF or prior stroke at baseline and had at least one Modified Mini-Mental State Examination (3MSE) during the study. AF was identified by hospital discharge diagnoses and annual study ECGs. The 3MSE (score range 0–100) was administered annually up to nine times from 1990/91 to 1998/99. Mixed effects linear regression was used to characterize the relationship of cognitive decline with AF and age, adjusted for birth year, sex, race, education, smoking, alcohol use, diabetes, hypertension, systolic blood pressure, coronary heart disease, and heart failure. Interaction terms for AF and age variables with incident clinical stroke were used to allow estimation of cognitive decline in the absence of stroke.
Results. Analyses included 5,199 participants with a mean of 6.7 3MSE scores. During follow-up 11% of participants (554 of 5,199) had AF identified. Panel A of the Figure shows mean 3MSE score trajectories for participants without AF (solid line) and after AF was identified at ages 70, 75, 80, and 85 (dashed lines). Panel B shows the trajectory for participants without AF set to zero (solid horizontal line) and differences in mean trajectories after AF was identified relative to participants without AF (dashed lines). Gray shading shows 95% CIs. Having newly-identified AF was not associated with a difference in 3MSE score relative to participants of the same age without AF. However, after AF was identified, 3MSE scores declined 2.3 points faster per five years, relative to participants without AF. For example, after AF was identified at age 80, mean 3MSE score declined 9.1 points by age 85, versus 6.8 points for participants without AF.
Conclusions. In older adults without clinical stroke, the average rate of cognitive decline was greater after AF was identified.
- © 2012 by American Heart Association, Inc.