Key result
AF linked to ~360% higher dementia risk in patients with mild cognitive impairment.
Why the study?
Mild cognitive impairment is a precursor to dementia but not all patients progress; the impact of atrial fibrillation on dementia risk in MCI subtypes is unclear.
Does atrial fibrillation increase the risk of conversion to dementia in elderly subjects with and without mild cognitive impairment?
Cohort (n=611)
Does atrial fibrillation increase the risk of conversion to dementia in elderly subjects with and without mild cognitive impairment?
Hazard Ratio: 4.63 (95% CI 1.72–12.46)
Atrial fibrillation significantly increases the risk of conversion to dementia in elderly patients with mild cognitive impairment, but not in those with normal baseline cognition.
AF may hasten dementia conversion in elderly MCI patients; hypothesis-generating and requires prospective trials before practice change.
OBJECTIVES: Mild cognitive impairment (MCI) is regarded as a precursor to dementia, but not all patients with MCI actually develop dementia. As Alzheimer and vascular dementia are thought to share many common etiopathogenetic mechanisms, we investigated whether the vascular risk factor atrial fibrillation affects the risk of conversion to dementia for different MCI subtypes diagnosed according to international criteria. METHODS: One hundred and eighty elderly outpatients with MCI and 431 elderly outpatients with a normal cognition were followed up for a mean of 3 and 4 years, respectively. The risk of conversion to dementia associated with atrial fibrillation was studied in both samples using a Cox proportional hazards model adjusted for socio-demographic and medical variables. RESULTS: Overall conversion rate to dementia was 10.5 (8.0-13.8 per 100 person-years) in the MCI group and 2.2 (1.5-3.1 per 100 person-years) in the normal cognition group. Atrial fibrillation was significantly associated with conversion to dementia [hazard ratio (HR): 4.63; 95% confidence interval: 1.72-12.46] in the MCI group but not in the cognitively normal group (HR: 1.10; 95% confidence interval: 0.40-3.03). DISCUSSION: Current diagnostic criteria for MCI subtypes define heterogeneous populations, but atrial fibrillation can be useful in identifying people with increased risk of conversion to dementia.
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Forti et al. (2006) conducted a cohort in Mild cognitive impairment and normal cognition (n=611). Atrial fibrillation vs. Absence of atrial fibrillation was evaluated on Conversion to dementia (HR 4.63, 95% CI 1.72-12.46). Atrial fibrillation was significantly associated with conversion to dementia in elderly patients with mild cognitive impairment (HR 4.63; 95% CI 1.72-12.46), but not in those with normal cognition.
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