From the Department of Public Health and Social Sciences/Geriatrics
(L.K., M.B., H.L.) and Department of Clinical Physiology, Uppsala University,
Uppsala (B.A.); Department of Clinical Neurosciences, Karolinska Institute,
Stockholm (H.N.); and Department of Internal Medicine, Uppsala (L.L.)
(Sweden).
Correspondence to Dr Lena Kilander, Department of Public Health and Caring Sciences/Geriatrics, PO Box 609, SE-751 25 Uppsala, Sweden.
Background and
Purpose—Cerebrovascular disease is increasingly recognized as a
cause of dementia and cognitive decline. We have previously reported an
association between hypertension and diabetes and low cognitive
function in the elderly. Atrial fibrillation is another main risk
factor for cerebrovascular disease. The aim of this study was to
investigate whether atrial fibrillation is associated with low
cognitive function in elderly men with and without previous
manifest stroke.
Methods—This was a cross-sectional study based on a cohort of 952
community-living men, aged 69 to 75 years, in Uppsala, Sweden.
Cognitive functions were assessed by the Mini–Mental State Examination
and the Trail Making Tests, and a composite z score was
calculated. The relation between atrial fibrillation and cognitive
z score was analyzed, with stroke and other
vascular risk factors taken into account.
Results—All analyses were adjusted for age, education,
and occupational level. Men with atrial fibrillation (n=44) had lower
mean adjusted cognitive z scores (-0.26±0.11) than men
without atrial fibrillation (+0.14±0.03; P=0.0003). The
exclusion of stroke patients did not alter this relationship; the mean
cognitive z score was -0.24±0.12 in the 36 men with
atrial fibrillation and +0.17±0.03 in those without atrial
fibrillation (P=0.0004), corresponding to a difference
of 0.4 SDs between groups. Adjustments for 24-hour
diastolic blood pressure and heart rate, diabetes, and
ejection fraction did not change this relationship. Men with atrial
fibrillation who were treated with digoxin (n=27) performed markedly
better (-0.05±0.21) than those without treatment (n=9; -1.14±0.34;
adjusted P=0.0005). Previous myocardial infarction was
not associated with impaired cognitive results.
Conclusions—In these community-living elderly men, we found an
association between atrial fibrillation and low cognitive function
independent of stroke, high blood pressure, and diabetes.
Interventional studies are needed to answer the question of whether
optimal treatment of atrial fibrillation may prevent or postpone
cognitive decline and dementia.
© 1998 American Heart Association, Inc.
Original Contributions
Atrial Fibrillation Is an Independent Determinant of Low Cognitive Function
A Cross-Sectional Study in Elderly Men
Key Words: atrial fibrillation • cognition • risk factors • stroke
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