Abstract：
BACKGROUND: We investigated the association between atrial fibrillation (AF) and dementia, and its subtypes (vascular-VaD, Alzheimer, mixed and rare dementia), and identified predictors for dementia in AF patients.
METHODS: The analysis was based on 183,610 patients with new-onset AF and 367,220 non-AF controls in the United Kingdom between 1998 and 2016, identified in three prospectively collected, linked electronic health records sources. Time-to-event (dementia or subtypes) analyses were performed using Cox proportional hazards and weighted Cox. Sub-analyses performed: including & censoring stroke and age (median used as cut-off).
RESULTS: Over a median follow-up of 2.67 years (IQR .65-6.02) for AF patients and 5.84 years for non-AF patients (IQR 2.26-11.80), incidence of dementia in the AF cohort was 2.65 per 100 person-years, compared to 2.02 in the non-AF cohort. After adjustment, a significant association was observed between AF and all-cause dementia (HR = 1.38, 95% CI: 1.31-1.45), driven by a strong association with VaD (HR = 1.55, 95% CI: 1.41-1.70). AF was also associated with mixed dementia (HR = 1.26, 95% CI: 1.01-1.56), but we could not confirm an association with Alzheimer (HR = 1.05, 95% CI: .94-1.16) and rare dementia forms (HR = 1.19, 95% CI: .90-1.56). Ischemic stroke (HR = 1.40, 95% CI: 1.26-1.56), subarachnoid haemorrhage (HR = 2.08, 95% CI: 1.47-2.96), intracerebral haemorrhage (HR = 1.95, 95% CI: 1.54-2.48) and diabetes (HR = 1.32, 95% CI: 1.24-1.41) were identified as the strongest predictors of dementia in AF patients.
CONCLUSIONS: AF patients have an increased risk of dementia, independent of stroke, with highest risk of VaD. Management and prevention of the identified risk factors could be crucial to reduce the increasing burden of dementia.
METHODS: The analysis was based on 183,610 patients with new-onset AF and 367,220 non-AF controls in the United Kingdom between 1998 and 2016, identified in three prospectively collected, linked electronic health records sources. Time-to-event (dementia or subtypes) analyses were performed using Cox proportional hazards and weighted Cox. Sub-analyses performed: including & censoring stroke and age (median used as cut-off).
RESULTS: Over a median follow-up of 2.67 years (IQR .65-6.02) for AF patients and 5.84 years for non-AF patients (IQR 2.26-11.80), incidence of dementia in the AF cohort was 2.65 per 100 person-years, compared to 2.02 in the non-AF cohort. After adjustment, a significant association was observed between AF and all-cause dementia (HR = 1.38, 95% CI: 1.31-1.45), driven by a strong association with VaD (HR = 1.55, 95% CI: 1.41-1.70). AF was also associated with mixed dementia (HR = 1.26, 95% CI: 1.01-1.56), but we could not confirm an association with Alzheimer (HR = 1.05, 95% CI: .94-1.16) and rare dementia forms (HR = 1.19, 95% CI: .90-1.56). Ischemic stroke (HR = 1.40, 95% CI: 1.26-1.56), subarachnoid haemorrhage (HR = 2.08, 95% CI: 1.47-2.96), intracerebral haemorrhage (HR = 1.95, 95% CI: 1.54-2.48) and diabetes (HR = 1.32, 95% CI: 1.24-1.41) were identified as the strongest predictors of dementia in AF patients.
CONCLUSIONS: AF patients have an increased risk of dementia, independent of stroke, with highest risk of VaD. Management and prevention of the identified risk factors could be crucial to reduce the increasing burden of dementia.
摘要：
背景：我们研究了心房颤动（AF）与痴呆之间的关系，及其亚型(血管VaD，老年痴呆症,混合和罕见的痴呆症)，并确定了房颤患者痴呆的预测因素。
方法：分析基于1998年至2016年在英国的183,610例新发房颤患者和367,220例非房颤对照，在三个前瞻性收集中确定。链接的电子健康记录来源。使用Cox比例风险和加权Cox进行事件发生时间（痴呆或亚型）分析。进行的子分析：包括并审查中风和年龄（中位数用作截止值）。
结果：房颤患者的中位随访时间为2.67年（IQR.65-6.02），非房颤患者为5.84年（IQR2.26-11.80），房颤队列中痴呆的发病率为2.65/100人年,相比于非AF队列中的2.02。调整后,房颤与全因痴呆之间存在显著关联(HR=1.38,95%CI:1.31-1.45),受与VaD强关联的驱动(HR=1.55，95%CI：1.41-1.70)。房颤也与混合型痴呆相关(HR=1.26,95%CI:1.01-1.56),但我们无法确认与阿尔茨海默病(HR=1.05,95%CI:.94-1.16)和罕见痴呆形式(HR=1.19,95%CI:.90-1.56)的相关性.缺血性卒中（HR=1.40，95%CI：1.26-1.56），蛛网膜下腔出血(HR=2.08,95%CI:1.47-2.96),脑出血(HR=1.95,95%CI:1.54~2.48)和糖尿病(HR=1.32,95%CI:1.24~1.41)是房颤患者痴呆的最强预测因子.
结论：房颤患者患痴呆的风险增加，独立于中风，VaD风险最高。管理和预防已确定的风险因素对于减轻痴呆症日益增加的负担至关重要。
方法：分析基于1998年至2016年在英国的183,610例新发房颤患者和367,220例非房颤对照，在三个前瞻性收集中确定。链接的电子健康记录来源。使用Cox比例风险和加权Cox进行事件发生时间（痴呆或亚型）分析。进行的子分析：包括并审查中风和年龄（中位数用作截止值）。
结果：房颤患者的中位随访时间为2.67年（IQR.65-6.02），非房颤患者为5.84年（IQR2.26-11.80），房颤队列中痴呆的发病率为2.65/100人年,相比于非AF队列中的2.02。调整后,房颤与全因痴呆之间存在显著关联(HR=1.38,95%CI:1.31-1.45),受与VaD强关联的驱动(HR=1.55，95%CI：1.41-1.70)。房颤也与混合型痴呆相关(HR=1.26,95%CI:1.01-1.56),但我们无法确认与阿尔茨海默病(HR=1.05,95%CI:.94-1.16)和罕见痴呆形式(HR=1.19,95%CI:.90-1.56)的相关性.缺血性卒中（HR=1.40，95%CI：1.26-1.56），蛛网膜下腔出血(HR=2.08,95%CI:1.47-2.96),脑出血(HR=1.95,95%CI:1.54~2.48)和糖尿病(HR=1.32,95%CI:1.24~1.41)是房颤患者痴呆的最强预测因子.
结论：房颤患者患痴呆的风险增加，独立于中风，VaD风险最高。管理和预防已确定的风险因素对于减轻痴呆症日益增加的负担至关重要。
