Affiliation:
1. NEUROFARBA Department University of Florence Florence Italy
2. Atherothrombotic Diseases Centre Careggi University Hospital Florence Italy
3. Health Physics Unit Careggi University Hospital Florence Italy
4. Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi” University of Bologna Bologna Italy
5. Department of Experimental and Clinical Medicine University of Florence Florence Italy
6. Institute of Applied Physics “Nello Carrara” (IFAC) National Research Council of Italy (CNR) Florence Italy
7. Stroke Unit Careggi University Hospital Florence Italy
8. Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences University of Florence, Careggi University Hospital Florence Italy
9. Don Carlo Gnocchi Foundation Florence Italy
Abstract
AbstractBackground and purposeThe multifactorial relationship between atrial fibrillation (AF) and cognitive impairment needs to be elucidated. The aim of this study was to assess, in AF patients on oral anticoagulants (OACs), the prevalence of cognitive impairment, defined according to clinical criteria or data‐driven phenotypes, the prevalence of cognitive worsening, and factors associated with cognitive outcomes.MethodsThe observational prospective Strat‐AF study enrolled AF patients aged ≥ 65 years who were receiving OACs. The baseline and 18‐month protocol included clinical, functional, and cognitive assessment, and brain magnetic resonance imaging. Cognitive outcomes were: empirically derived cognitive phenotypes; clinical diagnosis of cognitive impairment; and longitudinal cognitive worsening.ResultsOut of 182 patients (mean age 77.7 ± 6.7 years, 63% males), 82 (45%) received a cognitive impairment diagnosis, which was associated with lower education level and functional status, and higher level of atrophy. Cluster analysis identified three cognitive profiles: dysexecutive (17%); amnestic (25%); and normal (58%). Compared to the normal group, the dysexecutive group was older, and had higher CHA2DS2‐VASc scores, while the amnestic group had worse cognitive and functional abilities, and medial temporal lobe atrophy (MTA). Out of 128 followed‐up patients, 35 (27%) had cognitive worsening that was associated with lower education level, worse cognitive efficiency, CHA2DS2‐VASc score, timing of OAC intake, history of stroke, diabetes, non‐lacunar infarcts, white matter hyperintensities and MTA. In multivariate models, belonging to the dysexecutive or amnestic group was a main predictor of cognitive worsening.ConclusionsIn our cohort of older AF patients, CHA2DS2‐VASc score, timing of OAC intake, and history of stroke influenced presence, type and progression of cognitive impairment. Empirically derived cognitive classification identified three groups with different clinical profiles and better predictive ability for cognitive worsening compared to conventional clinical diagnosis.
Subject
Neurology (clinical),Neurology
Cited by
2 articles.
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