Analysis Of Cognitive Impairment And Its Influencing Factors In Patients With Atrial Fibrillation

Objective:we aimed to explore the influencing factors of cognitive dysfunction in patients with atrial fibrillation,and to provide a theoretical basis for the protection of cognitive function in patients with atrial fibrillation.Methods:The 150 cases of patients with atrial fibrillation were analyzed in the first affiliated hospital of Nanchang University who were treated in the the cardiovascular department,gerontology department and General medicine department from August 2018 to June 2019.we used Mini-Mental State Examination(MMSE)to evaluate cognitive function of all patients with atrial fibrillation.According to the level of education and MMSE score,patients with atrial fibrillation were divided into three groups:normal cognitive function group,mild cognitive impairment group and dementia group.Inpatient data of all patients were collected as observational indicators,which included demographic date,clinical data,and laboratory data.Data analysis was performed using SPSS 21.0 statistical software.Multiple sets of quantitative date with homogeneous variances were analyzed by one-way ANOVA,and LSD test was used to compare the date between groups.Multiple sets of quantitative date with unequal variances were analyzed by Welch's ANOVA,and games-howell test was used to compare the date between groups.The enumeration data were analyzed by chi-square test.For two sets of continuous variable data with normal distribution,Pearson correlation analysis was used.And for two sets of continuous variable data with non-normally distributed data,the spearman rank correlation analysis were used.The risk factors with statistical significance in monofactor analysis were analyzed by ordinal and multinomial logistic regression.We adopted a significance level of P<0.05 in all analyses.Results:1.The basic situation of research object:a total of 150 patients with atrial fibrillation were enrolled in this study,and the average age of these patients was 65.05±8.74 years old.All patients with atrial fibrillation included 78 males(52%)and 72 females(48%),and the mean of MMSE score was 23.6±4.69 points.There were 86 cases(57.3%)of cognitive dysfunction in patients with atrial fibrillation,which included 41 cases(27.3%)of mild cognitive impairment and 45 cases(30%)of dementia.2.The comparison of cognitive function scores:There were significant differences in the total MMSE score,directionality,memory,attention and computational power,recall ability and language ability between the three groups.Except for there were no significant differences in attention and numeracy between the mild cognitive impairment group and the dementia group,other indicators of cognitive function were significantly different in pairwise comparison among the three groups.3.The comparison of clinical data:there were significant differences in daily smoking,age,the level of education,type of atrial fibrillation,duration from AF were diagnosed,hypertension,type 2 diabetes,COPD,stroke,history of radiofrequency ablation surgery,previous use of taking warfarin,dabigatran and statins,CHDS2-VASc score,NYHA classification,left ventricular ejection fraction,left atrial diameter,D-dimer,fibrinogen,homocysteine and blood platelet(P<0.05).4.In this study,the results of linear correlation analysis showed that left ventricular ejection fraction,left atrial diameter,homocysteine,low density lipoprotein,blood platelet,duration from AF were diagnosed,BMI,CHDS2-VASc score,NT-proBNP,and D-dimer were correlated with MMSE score.5.The results of risk factors with statistical significance in monofactor analysis analyzed by Multifactor analysis showed that age(OR=1.174,95%CI:0.091?0.231),CHDS2-VASc score(OR=1.379,95%CI:-0.013?0.657),the level of education(illiterate OR=4.162,95%CI:-0.032?2.955,primary school OR=2.751,95%CI:-0.172?2.197,junior high school OR=3.539,95%CI:-0.048?2.577,high school and special secondary school OR=1.332,95%CI:-1.080?1.655),no hypertension(OR=0.419,95%CI:-1.812?0.074),no type 2 diabetes(OR=0.300,95%CI:-2.123?-0.279),no stroke(OR=0.405,95%CI:-1.750?0.053),no history of radiofrequency ablation surgery(OR=0.292,95%CI:-2.292?-0.171),no CCB(OR=1.174,95%CI:0.091?0.231),no warfarin(OR=13.749,95%CI:1.480?3.762),no dabigatran etexilate(OR=16.395,95%CI:1.462?4.131),NYHA 1-2 grade(OR=0.151,95%CI:-2.863?0.908),type of atrial fibrillation(primary AF OR=0.058,95%CI:-6.020?0.334,paroxysmal AF OR=0.081,95%CI:-4.788?-0.222,persistent AF OR=0.083,95%CI:-4.420?-0.541,long-term persistent AF OR=0.109,95%CI:-4.052?-0.376),D-dimer(OR=2.745,95%CI:-0.611?2.631),fibrinogen(OR=3.228,95%CI:0.399?1.946).Conclusions:1.Patients with atrial fibrillation had a high risk of cognitive dysfunction(The incidence of 57.4%).When patients with atrial fibrillation were in the stage of mild cognitive impairment,they had impairment in five cognitive fields,namely,directional ability,memory,attention and computational ability,recall ability and language ability.However,in the stage of dementia,except for attention and computational ability,the impairment in other cognitive fields was significantly aggravated.2.Left ventricular ejection fraction was positively correlated with MMSE score,but age,left atrial diameter,homocysteine,LDL,blood platelet,duration from AF were diagnosed,BMI,CHDS2-VASc score,NT-proBNP and D-dimer were negatively correlated with MMSE score.3.High level of education,the previous use of taking warfarin and dabigatran were protective factors for cognitive functionin in patients with AF;but age,CHDS2-VASc scor,hypertension,type 2 diabetes,stroke,the history of radiofrequency ablation surgery,the previous use of taking CCB,NYHA 3-4 grade,D-dimer and fibrinogen were the risk factors for cognitive function.The risk of cognitive impairment in patients with primary AF to permanent AF are increasing.Early anticoagulant therapy,intervention of risk factors and control of atrial fibrillation are helpful for the protection of cognitive function.