Atrial Fibrillation, Stroke, and Cognition

Abstract

Background and Purpose— The aim of this study was to investigate the association between atrial fibrillation (AF), stroke, dementia, and their correlation with brain pathology in subjects aged 85 years or older. Methods— This is a prospective 9-year follow-up population based study in Vantaa, a town in Southern Finland; 553 subjects (92% of the total population) aged 85 years or older were clinically examined by a neurologist. The presence of AF was collected from the medical records or examined by ECG or ambulatory ECG. Neuropathological examination was conducted in more than half of the clinically examined subjects. Results— AF was significantly associated with stroke at baseline; 32% of patients with AF had clinical evidence of stroke compared with 16.7% of those without such evidence ( P <0.001). Dementia at baseline was significantly associated with age, clinical stroke, and the presence of apolipoprotein E ε4 allele, but not with sex, education, or vascular risk factors. Multiple regression analysis including neuropathological results showed that dementia was significantly associated with education (OR, 0.89; 95% CI, 0.80 to 0.98; P =0.019), the β-amyloid load in the brain (OR, 1.26; 95% CI, 1.13 to 1.39; P <0.001) and with the vascular pathology (OR, 2.03; 95% CI, 1.14 to 3.62; P =0.016), but not with sex, age at death, apolipoprotein E ε4 allele, or vascular risk factors. Conclusions— AF is a significant and preventable risk factor for stroke but not for dementia in the very old. The etiology of dementia syndrome in the very old is multifactorial. Both Alzheimer disease pathology and vascular pathology, particularly multiple small infarcts, contribute to cognitive decline.