Association Between Atrial Fibrillation and Cognitive Impairment in Individuals With Prior Stroke

Author:

Kokkinidis Damianos G.1ORCID,Zareifopoulos Nikos23,Theochari Christina A.4,Arfaras-Melainis Angelos1,Papanastasiou Christos A.5,Uppal Dipan1,Giannakoulas George5,Kalogeropoulos Andreas P.6,Fontes Joao Daniel T.7

Affiliation:

1. From the Department of Medicine, Jacobi Medical Center (D.G.K., A.A.-M., D.U.), Albert Einstein College of Medicine, New York, NY

2. School of Medicine, University of Patras, Greece (N.Z.)

3. School of Medicine, University of Athens, Greece (N.Z.)

4. Department of Internal Medicine, Sotiria General Hospital for Chest Diseases, National and Kapodistrian University of Athens, Greece (C.A.T.)

5. Division of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (C.A.P., G.G.)

6. Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook University Medical Center, Health Sciences Center, NY (A.P.K.).

7. Division of Cardiology, Montefiore Medical Center (J.D.T.F.), Albert Einstein College of Medicine, New York, NY

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

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