Atrial fibrillation and the risk of incident dementia

A meta-analysis

Pasquale Santangeli, Luigi Di Biase, Rong Bai, Sanghamitra Mohanty, Agnes Pump, Mauricio Cereceda Brantes, Rodney Horton, J. David Burkhardt, Dhanunjaya Lakkireddy, Yeruva Madhu Reddy, Michela Casella, Antonio Dello Russo, Claudio Tondo, Andrea Natale

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Background: The risk of cerebrovascular embolic events with atrial fibrillation (AF) is potentially linked to an increased risk of cognitive decline and dementia. However, epidemiologic studies exploring the association between AF and incident dementia have reported conflicting results. Objective: The purpose of this study was to perform a meta-analysis of observational studies specifically designed to evaluate the prospective relationship between AF and incident dementia. Methods: We searched PubMed, CENTRAL, BioMedCentral, Embase, Cardiosource, clinicaltrials.gov, and ISI Web of Science (January 1980 to May 2012). No language restriction was applied. Two independent reviewers screened titles and abstracts to identify population-based studies that prospectively evaluated the association between AF and the incidence of dementia in patients not suffering an acute stroke and with normal cognitive function at baseline, providing the hazard ratio (HR) obtained in multiple Cox regression analyses, and adjusted for all confounding variables. Two independent reviewers assessed risk of bias according to the Cochrane Collaboration, and extracted patient and study characteristics and the adjusted HR of incident dementia with its 95% confidence interval (CI) of patients with AF vs those without AF. Results: Eight studies with 77,668 patients were included in the analysis. All studies had a prospective observational design and included elderly patients (mean age range 61-84 years) with normal cognitive function at baseline, of whom 11,700 (15%) had AF. After a mean follow-up of 7.7 ± 9.1 years (range 1.8-30 years), 4773 of 73,321 (6.5%) patients developed dementia. Two studies did not report the rates of dementia at follow-up but reported the adjusted HR and were included in the pooled analysis. At pooled analysis adjusted for baseline confounders and covariates, AF was independently associated with increased risk of incident dementia (HR = 1.42 [95% CI 1.17-1.72], P <.001). Conclusion: AF is independently associated with increased risk of dementia. Patients with AF should be periodically screened for dementia, which should be included among the outcomes assessed in AF treatment trials.

Original languageEnglish (US)
JournalHeart Rhythm
Volume9
Issue number11
DOIs
StatePublished - Nov 2012
Externally publishedYes

Fingerprint

Atrial Fibrillation
Dementia
Meta-Analysis
Cognition
Confidence Intervals
Confounding Factors (Epidemiology)
PubMed
Observational Studies
Epidemiologic Studies
Language
Stroke
Regression Analysis
Incidence

Keywords

  • Atrial fibrillation
  • Dementia
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Santangeli, P., Di Biase, L., Bai, R., Mohanty, S., Pump, A., Cereceda Brantes, M., ... Natale, A. (2012). Atrial fibrillation and the risk of incident dementia: A meta-analysis. Heart Rhythm, 9(11). https://doi.org/10.1016/j.hrthm.2012.07.026

Atrial fibrillation and the risk of incident dementia : A meta-analysis. / Santangeli, Pasquale; Di Biase, Luigi; Bai, Rong; Mohanty, Sanghamitra; Pump, Agnes; Cereceda Brantes, Mauricio; Horton, Rodney; Burkhardt, J. David; Lakkireddy, Dhanunjaya; Reddy, Yeruva Madhu; Casella, Michela; Dello Russo, Antonio; Tondo, Claudio; Natale, Andrea.

In: Heart Rhythm, Vol. 9, No. 11, 11.2012.

Research output: Contribution to journalArticle

Santangeli, P, Di Biase, L, Bai, R, Mohanty, S, Pump, A, Cereceda Brantes, M, Horton, R, Burkhardt, JD, Lakkireddy, D, Reddy, YM, Casella, M, Dello Russo, A, Tondo, C & Natale, A 2012, 'Atrial fibrillation and the risk of incident dementia: A meta-analysis', Heart Rhythm, vol. 9, no. 11. https://doi.org/10.1016/j.hrthm.2012.07.026
Santangeli, Pasquale ; Di Biase, Luigi ; Bai, Rong ; Mohanty, Sanghamitra ; Pump, Agnes ; Cereceda Brantes, Mauricio ; Horton, Rodney ; Burkhardt, J. David ; Lakkireddy, Dhanunjaya ; Reddy, Yeruva Madhu ; Casella, Michela ; Dello Russo, Antonio ; Tondo, Claudio ; Natale, Andrea. / Atrial fibrillation and the risk of incident dementia : A meta-analysis. In: Heart Rhythm. 2012 ; Vol. 9, No. 11.
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abstract = "Background: The risk of cerebrovascular embolic events with atrial fibrillation (AF) is potentially linked to an increased risk of cognitive decline and dementia. However, epidemiologic studies exploring the association between AF and incident dementia have reported conflicting results. Objective: The purpose of this study was to perform a meta-analysis of observational studies specifically designed to evaluate the prospective relationship between AF and incident dementia. Methods: We searched PubMed, CENTRAL, BioMedCentral, Embase, Cardiosource, clinicaltrials.gov, and ISI Web of Science (January 1980 to May 2012). No language restriction was applied. Two independent reviewers screened titles and abstracts to identify population-based studies that prospectively evaluated the association between AF and the incidence of dementia in patients not suffering an acute stroke and with normal cognitive function at baseline, providing the hazard ratio (HR) obtained in multiple Cox regression analyses, and adjusted for all confounding variables. Two independent reviewers assessed risk of bias according to the Cochrane Collaboration, and extracted patient and study characteristics and the adjusted HR of incident dementia with its 95{\%} confidence interval (CI) of patients with AF vs those without AF. Results: Eight studies with 77,668 patients were included in the analysis. All studies had a prospective observational design and included elderly patients (mean age range 61-84 years) with normal cognitive function at baseline, of whom 11,700 (15{\%}) had AF. After a mean follow-up of 7.7 ± 9.1 years (range 1.8-30 years), 4773 of 73,321 (6.5{\%}) patients developed dementia. Two studies did not report the rates of dementia at follow-up but reported the adjusted HR and were included in the pooled analysis. At pooled analysis adjusted for baseline confounders and covariates, AF was independently associated with increased risk of incident dementia (HR = 1.42 [95{\%} CI 1.17-1.72], P <.001). Conclusion: AF is independently associated with increased risk of dementia. Patients with AF should be periodically screened for dementia, which should be included among the outcomes assessed in AF treatment trials.",
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AU - Pump, Agnes

AU - Cereceda Brantes, Mauricio

AU - Horton, Rodney

AU - Burkhardt, J. David

AU - Lakkireddy, Dhanunjaya

AU - Reddy, Yeruva Madhu

AU - Casella, Michela

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AU - Tondo, Claudio

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N2 - Background: The risk of cerebrovascular embolic events with atrial fibrillation (AF) is potentially linked to an increased risk of cognitive decline and dementia. However, epidemiologic studies exploring the association between AF and incident dementia have reported conflicting results. Objective: The purpose of this study was to perform a meta-analysis of observational studies specifically designed to evaluate the prospective relationship between AF and incident dementia. Methods: We searched PubMed, CENTRAL, BioMedCentral, Embase, Cardiosource, clinicaltrials.gov, and ISI Web of Science (January 1980 to May 2012). No language restriction was applied. Two independent reviewers screened titles and abstracts to identify population-based studies that prospectively evaluated the association between AF and the incidence of dementia in patients not suffering an acute stroke and with normal cognitive function at baseline, providing the hazard ratio (HR) obtained in multiple Cox regression analyses, and adjusted for all confounding variables. Two independent reviewers assessed risk of bias according to the Cochrane Collaboration, and extracted patient and study characteristics and the adjusted HR of incident dementia with its 95% confidence interval (CI) of patients with AF vs those without AF. Results: Eight studies with 77,668 patients were included in the analysis. All studies had a prospective observational design and included elderly patients (mean age range 61-84 years) with normal cognitive function at baseline, of whom 11,700 (15%) had AF. After a mean follow-up of 7.7 ± 9.1 years (range 1.8-30 years), 4773 of 73,321 (6.5%) patients developed dementia. Two studies did not report the rates of dementia at follow-up but reported the adjusted HR and were included in the pooled analysis. At pooled analysis adjusted for baseline confounders and covariates, AF was independently associated with increased risk of incident dementia (HR = 1.42 [95% CI 1.17-1.72], P <.001). Conclusion: AF is independently associated with increased risk of dementia. Patients with AF should be periodically screened for dementia, which should be included among the outcomes assessed in AF treatment trials.

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