Advertisement

Risk Factors for Dementia in Patients With Atrial Fibrillation

      Although dementia and atrial fibrillation (AF) are common in older adults, risk factors for dementia have not been sufficiently characterized in patients with AF. We studied 621,773 patients with AF without dementia at the time of AF diagnosis who were enrolled in the MarketScan Commercial and Medicare Supplemental databases from 2007 to 2015. Dementia incidence and presence of predictors at the time of AF diagnosis (cardiometabolic conditions, mental and neurologic disorders, and other chronic conditions) were based on International Classification of Diseases, Ninth Revision, Clinical Modification codes in outpatient and inpatient claims, whereas medication usage was based on outpatient pharmacy claims. A frailty score was calculated using a previously established algorithm. The associations between the predictors of interest and dementia were assessed with multivariable Cox models. Patients had a mean age of 68 years (SD 14 years) and 41% were women. During a mean follow-up of 2.0 years, there were 16,073 cases of dementia. The strongest predictors of dementia were frailty (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.40 to 1.45, per 1-SD increase in the score), cognitive impairment (HR 1.50, 95% CI 1.36 to 1.65), mood disorders (HR 1.49, 95% CI 1.32 to 1.70), schizophrenia (HR 1.86, 95% CI 1.75 to 1.98), and substance abuse (HR 1.58, 95% CI 1.39 to 1.80). Among cardiometabolic conditions, only stroke (HR 1.17, 95% CI 1.13 to 1.22) and diabetes mellitus (HR 1.14, 95% CI 1.11 to 1.18) were associated with small increases in dementia risk after adjusting for demographics, frailty, co-morbidities, and medications. We have identified several risk factors for dementia in patients with AF.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Staerk L
        • Sherer JA
        • Ko D
        • Benjamin EJ
        • Helm RH.
        Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes.
        Circ Res. 2017; 120: 1501-1517
        • Chugh SS
        • Havmoeller R
        • Narayanan K
        • Singh D
        • Rienstra M
        • Benjamin EJ
        • Gillum RF
        • Kim YH
        • McAnulty Jr, JH
        • Zheng ZJ
        • Forouzanfar MH
        • Naghavi M
        • Mensah GA
        • Ezzati M
        • Murray CJ.
        Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study.
        Circulation. 2014; 129: 837-847
        • Marzona I
        • O'Donnell M
        • Teo K
        • Gao P
        • Anderson C
        • Bosch J
        • Yusuf S.
        Increased risk of cognitive and functional decline in patients with atrial fibrillation: results of the ONTARGET and TRANSCEND studies.
        CMAJ. 2012; 184: E329-E336
        • Kim D
        • Yang PS
        • Yu HT
        • Kim TH
        • Jang E
        • Sung JH
        • Pak HN
        • Lee MY
        • Lee MH
        • Lip GYH
        • Joung B.
        Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort.
        Eur Heart J. 2019; 40: 2313-2323
        • Alonso A
        • Arenas de Larriva AP
        Atrial fibrillation, cognitive decline and dementia.
        Eur Cardiol. 2016; 11: 49-53
      1. IBM Watson Health. IBM MarketScan Research Databases for life sciences researchers–White Paper. Available at: https://www.ibm.com/downloads/cas/0NKLE57Y. Accessed on January 7, 2022.

        • Kim DH
        • Schneeweiss S.
        Measuring frailty using claims data for pharmacoepidemiologic studies of mortality in older adults: evidence and recommendations.
        Pharmacoepidemiol Drug Saf. 2014; 23: 891-901
        • Ding M
        • Qiu C.
        Atrial fibrillation, cognitive decline, and dementia: an epidemiologic review.
        Curr Epidemiol Rep. 2018; 5: 252-261
        • Singh-Manoux A
        • Fayosse A
        • Sabia S
        • Canonico M
        • Bobak M
        • Elbaz A
        • Kivimäki M
        • Dugravot A.
        Atrial fibrillation as a risk factor for cognitive decline and dementia.
        Eur Heart J. 2017; 38: 2612-2618
        • Alonso A
        • Knopman DS
        • Gottesman RF
        • Soliman EZ
        • Shah AJ
        • O'Neal WT
        • Norby FL
        • Mosley TH
        • Chen LY
        Correlates of dementia and mild cognitive impairment in patients with atrial fibrillation: the atherosclerosis risk in communities neurocognitive study (ARIC-NCS).
        J Am Heart Assoc. 2017; 6 (e006014)
        • Friberg L
        • Rosenqvist M.
        Less dementia with oral anticoagulation in atrial fibrillation.
        Eur Heart J. 2018; 39: 453-460
        • Chen N
        • Lutsey PL
        • MacLehose RF
        • Claxton JS
        • Norby FL
        • Chamberlain AM
        • Bengtson LGS
        • O'Neal WT
        • Chen LY
        • Alonso A
        Association of oral anticoagulant type with risk of dementia among patients with nonvalvular atrial fibrillation.
        J Am Heart Assoc. 2018; 7 (e009561)
        • Lip GY
        • Nieuwlaat R
        • Pisters R
        • Lane DA
        • Crijns HJ.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.
        Chest. 2010; 137: 263-272
        • Rawlings AM
        • Sharrett AR
        • Albert MS
        • Coresh J
        • Windham BG
        • Power MC
        • Knopman DS
        • Walker K
        • Burgard S
        • Mosley TH
        • Gottesman RF
        • Selvin E.
        The association of late-life diabetes status and hyperglycemia with incident mild cognitive impairment and dementia: the ARIC study.
        Diabetes Care. 2019; 42: 1248-1254
        • Lee AK
        • Rawlings AM
        • Lee CJ
        • Gross AL
        • Huang ES
        • Sharrett AR
        • Coresh J
        • Selvin E.
        Severe hypoglycaemia, mild cognitive impairment, dementia and brain volumes in older adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) cohort study.
        Diabetologia. 2018; 61: 1956-1965
        • Wändell P
        • Carlsson AC
        • Li X
        • Sundquist J
        • Sundquist K.
        Association between relevant co-morbidities and dementia with atrial fibrillation-A national study.
        Arch Med Res. 2019; 50: 29-35
        • Grams J
        • Garvey WT.
        Weight loss and the prevention and treatment of Type 2 diabetes using lifestyle therapy, pharmacotherapy, and bariatric surgery: mechanisms of action.
        Curr Obes Rep. 2015; 4: 287-302
        • Aucott LS.
        Influences of weight loss on long-term diabetes outcomes.
        Proc Nutr Soc. 2008; 67: 54-59
        • Jamaly S
        • Carlsson L
        • Peltonen M
        • Jacobson P
        • Sjöström L
        • Karason K.
        Bariatric surgery and the risk of new-onset atrial fibrillation in Swedish obese subjects.
        J Am Coll Cardiol. 2016; 68: 2497-2504
        • Abed HS
        • Wittert GA
        • Leong DP
        • Shirazi MG
        • Bahrami B
        • Middeldorp ME
        • Lorimer MF
        • Lau DH
        • Antic NA
        • Brooks AG
        • Abhayaratna WP
        • Kalman JM
        • Sanders P.
        Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial.
        JAMA. 2013; 310: 2050-2060
        • Howren MB
        • Lamkin DM
        • Suls J.
        Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis.
        Psychosom Med. 2009; 71: 171-186
        • Fiedorowicz JG.
        Depression and cardiovascular disease: an update on how course of illness may influence risk.
        Curr Psychiatry Rep. 2014; 16: 492
        • Connolly MJ
        • Crowley JJ
        • Charan NB
        • Nielson CP
        • Vestal RE.
        Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale.
        Thorax. 1992; 47: 410-413
        • Goeman DP
        • O'Hehir RE
        • Jenkins C
        • Scharf SL
        • Douglass JA.
        You have to learn to live with it': a qualitative and quantitative study of older people with asthma.
        Clin Respir J. 2007; 1: 99-105
        • Walli-Attaei M
        • Joseph P
        • Rosengren A
        • Chow CK
        • Rangarajan S
        • Lear SA
        • AlHabib KF
        • Davletov K
        • Dans A
        • Lanas F
        • Yeates K
        • Poirier P
        • Teo KK
        • Bahonar A
        • Camilo F
        • Chifamba J
        • Diaz R
        • Didkowska JA
        • Irazola V
        • Ismail R
        • Kaur M
        • Khatib R
        • Liu X
        • Mańczuk M
        • Miranda JJ
        • Oguz A
        • Perez-Mayorga M
        • Szuba A
        • Tsolekile LP
        • Prasad Varma R
        • Yusufali A
        • Yusuf R
        • Wei L
        • Anand SS
        • Yusuf S
        Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study.
        Lancet. 2020; 396: 97-109
        • Centers for Disease Control and Prevention (CDC)
        Current cigarette smoking among adults - United States, 2011.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 889-894
        • Toppila-Salmi S
        • Lemmetyinen R
        • Chanoine S
        • Karjalainen J
        • Pekkanen J
        • Bousquet J
        • Siroux V.
        Risk factors for severe adult-onset asthma: a multi-factor approach.
        BMC Pulm Med. 2021; 21: 214
        • Suanrueang P
        • Shen YJ
        • Lin HF
        • Er TK
        • Suen MW
        • Shieh FA.
        Gender differences in geriatric syndromes as mental illness and nervous system diseases in hospitalized Thai older patients.
        Psychogeriatrics. 2021; 21: 453-465
        • Li R
        • Ma X
        • Wang G
        • Yang J
        • Wang C.
        Why sex differences in schizophrenia?.
        J Transl Neurosci (Beijing). 2016; 1: 37-42