The Study On Risk Factors Of Cognitive Impairment In Patients With Atrial Fibrillation

Objective To explore the incidence and risk factors of vascular cognitive impairment(VCI)in patients with atrial fibrillation.Methods Three hundred and three patients with atrial fibrillation were selected from the second hospital of lanzhou university and were divided into no VCI(n=216)and VCI(n=87)according to their MMSE score.To evaluate the incidence of VCI in hospitalized patients with atrial fibrillation and analyze different cognitive functions by univariate analysis and multivariate analysis respectively.Results Compared with no VCI group,VCI group is older and higher in the proportion of CHA2DS2-VASC score?2,persistent and permanent atrial fibrillation,heart failure and diabetes mellitus,and it is higher in systolic blood pressure,mean arterial pressure,pulse pressure,left atrium diameter and serum creatinine,and it is low in the proportion of male and left ventricular end-diastolic diameter.The above index were statistically significant differet(P < 0.05,P < 0.001).The incidence of VCI in hospitalized patients with atrial fibrillation is 28.7 percent.With the increase of age and CHA2DS2-VASC score,the incidence of VCI increase.The incidence of VCI in female is more than in male,in persistent and permanent atrial fibrillation is higher than paroxysmal atrial fibrillation.Multiple linear regression analysis show that age(OR=0.1135,95%CI: 0.1708~0.0562,P=0.0001),female(OR=1.2528,95%CI: 2.2056 ~ 0.3000,P=0.0105),lever of culture(With primary education OR=3.2193,95%CI: 1.844 ~ 4.5940,P<0.0001;With junior middle school education and above OR=5.9104,95%CI: 4.6055 ~ 7.2154,P<0.0001),heart failure(OR=1.9357,95%CI: 3.5522~0.3192,P=0.0196),stroke(OR=1.6349,95%CI: 2.7517~0.5181,P=0.0044)and left atrium diameter(OR=0.1252,95%CI: 0.1962 ~ 0.0541,P=0.0006)are associated with VCI in hospitalized patients with atrial fibrillation.Conclusion The incidence of VCI in patients with atrial fibrillation is high.Eld,female,lower cultural level,heart failure and stroke,left atrial diameter expanding are risk factors for VCI in patients with atrial fibrillation.Objective Left atrial(LA)size is an independent predictor of cardiovascular events.In patients with atrial fibrillation(AF),LA enlargement is also associated with the occurrence and recurrence of AF,but the relationship between LA size and cognitive function in patients with AF has not been reported.Methods 297 patients with AF were selected from the second hospital of lanzhou university,the age average was 67.6±8.4.According to the tertiles of left atrial diameter(LAD),they were divided into three groups(LAD?33.8mm group included 99 patients;LAD 33.9-39.7mm group included 98 patients;LAD?39.8 mm group included 100 patients),and then according to the MMSE score they were divided into no cognitive impairment group(n=213)and cognitive impairment group(n=84).LAD was obtained by echocardiography.To evaluate the effect of different LAD on cognitive impairment of AF patients by multivariate linear regression.Results According to the tertiles of LAD,LAD?39.8 mm groups is older and higher in BMI,CHA2DS2-VASC score and the proportion of persistent AF,heart failure,diuretics and warfarin,DBP and mean arterial pressure are medium level,average ventricular rate is faster,LAD and left ventricular end-diastolic diameter are larger,left ventricular ejection fraction and triglycerides are lower,serum creatinine and blood uric acid are higher(P < 0.05,P < 0.001).According to with or without cognitive impairment,cognitive impairment group is older and more women,CHA2DS2-VASC score is higher,the proportion of persistent AF,heart failure and diabetes is higher,SBP,mean arterial pressure and pulse pressure is higher too,LAD is larger and the left ventricular enddiastolic diameter is smaller(P < 0.05,P < 0.001).There are 84 patients of cognitive impairment with AF,accounting for 28.3%.With the increase of LAD,the incidence of cognitive impairment increased.When LAD ? 39.8 mm,the incidence of cognitive impairment is 39%(P< 0.05).Moreover,with the increase of LAD,the language ability,attention and computing power,and the directive force are significantly reduced,and the difference is statistically significant(P < 0.05,P < 0.001).The factors which are significant in univariate analysis,such as gender,age,culture level,CHA2DS2 VASC score,AF type,chronic heart failure,diabetes and stroke,diuretic use,DBP,mean arterial pressure,fasting blood sugar and serum creatinine are adjustment of variables for the multiple linear regression analysis.When LAD is used as a continuous variable,LAD was significantly associated with cognitive impairment(OR =-0.0893,95%CI:-0.1570~0.0216,P= 0.01),and the LAD could independently increase the risk of cognitive impairment in patients with AF;Compared with LAD?33.8 mm group,LAD 33.9-39.7 mm group failed to show the correlation of LAD and cognitive impairment in patients with AF(OR =-0.1906,95% CI: 0.1906~0.7817,P = 0.701),while in the LAD?39.8 mm group,LAD significantly related with cognitive impairment,LAD can independently increases the risk of cognitive impairment in patients with AF(OR =-1.3729,95% CI: 2.4796~0.2662,P = 0.016).When the LAD is two categories variables,LAD?35 mm in women or LAD?38 mm in male can increase the risk of cognitive impairment in patients with AF independently,and significantly be related with cognitive impairment(OR =-0.9598,95% CI: 1.8238~0.0958,P = 0.03).Conclusion LAD is an independent risk factor for cognitive impairment in AF patients.The incidence of cognitive impairment in AF patients increased with the enlargement of the LAD,especially language ability,concentration and computing power,and directional ability have been significantly reduced.Background Antihypertensive drug use is inconsistently associated with the risk of dementia,Alzheimer's disease,cognitive impairment,and cognitive decline.Therefore,we conducted a metaanalysis of available prospective cohort studies to summarize the evidence on the strength of these relationships.Methods Three electronic databases including Med Line,Em Base,and the Cochrane Library were searched to identify studies from inception to April 2017.Only prospective cohort studies that reported effect estimates with corresponding 95% confidence intervals(CIs)of dementia,Alzheimer's disease,cognitive impairment,and cognitive decline for antihypertensive drug use versus without antihypertensive drugs were included.Results We included 10 prospective cohort studies reporting data on 30895 individuals.Overall,participants who received antihypertensive drugs had lower incidence of dementia(relative risk [RR]: 0.86,95% CI: 0.75~0.99,P=0.033),while there was no significant effect on the incidence of Alzheimer's disease(RR: 0.83,95% CI: 0.64~1.09,P =0.154),cognitive impairment(RR: 0.89,95% CI: 0.57~1.38,P=0.596),and cognitive decline(RR: 1.11,95% CI: 0.86~1.43,P=0.415).Further,the incidence of Alzheimer's disease might be affected by antihypertensive drug use in participants with specific characteristics.Conclusions Antihypertensive drug use was associated with a significantly reduced risk of dementia,but not with the risk of Alzheimer's disease,cognitive impairment,and cognitive decline.