| アブストラクト | INTRODUCTION: Atrial fibrillation (AF) is associated with dementia. Anticoagulation may modify this relationship, but it is unclear if this is due to stroke reduction alone. METHODS: Age- and sex-matched individuals from the U.K. Clinical Practice Research Datalink (2008-2016) with and without an incident diagnosis of AF were followed for a new dementia diagnosis. We estimated adjusted hazard ratios (aHRs) for incident dementia diagnosis in the AF cohort, overall and stratified by anticoagulation status, using the matched non-AF cohorts as reference. We performed a sensitivity analysis excluding individuals with stroke/transient ischaemic attack (TIA) before the observation period. RESULTS: Over 193,082 person-years (mean follow-up 25.7 +/- 0.1 months), 347/15,276 AF (2.3%) and 1,085/76,096 non-AF (1.4%) were newly diagnosed with dementia (aHR, 1.31, 95% confidence interval, 1.15-1.49). The AF group had more co-morbidity and higher rates of dementia, both with and without anticoagulation, than non-AF. When those with history of stroke/ TIA before the observation period were excluded and those with incident stroke/TIA during the observation period were censored, AF individuals not on anticoagulation had significantly higher rates of dementia compared with non-AF, aHR 1.30 (1.06-1.58). CONCLUSION: Our findings support the hypothesis that AF is a distinct risk factor for dementia, independent of stroke/TIA and other vascular risk factors. In those without stroke/TIA, risk of dementia is increased only in those who are not on anticoagulation, suggesting anticoagulation is protective presumably through reduction of sub-clinical embolic events. Further prospective research is needed to better ascertain the role of anticoagulation amongst targeted therapeutic strategies to reduce cognitive decline in AF. |
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| 投稿日 | 2019/3/29 |
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| 投稿者 | Field, Thalia S; Weijs, Bob; Curcio, Antonio; Giustozzi, Michela; Sudikas, Saulius; Katholing, Anja; Wallenhorst, Christopher; Weitz, Jeffrey I; Cohen, Alexander T; Martinez, Carlos |
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| ジャーナル名 | Thrombosis and haemostasis |
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| 組織名 | Division of Neurology, Vancouver Stroke Program, Djavad Mowafaghian Centre for;Brain Health, University of British Columbia, Vancouver, Canada.;Department of Cardiology, Cardiovascular Research Institute Maastricht,;Maastricht University Medical Center, Maastricht University, Maastricht, The;Netherlands.;Division of Cardiology, Department of Medical and Surgical Sciences, Magna;Graecia University, Catanzaro, Italy.;Department of Internal Medicine, Universita degli Studi di Perugia, Perugia,;Italy.;Department of Surgery, Kantonsspital Winterthur, Zurich, Switzerland.;Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany.;Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton,;Ontario, Canada.;Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, King's;College London, London, United Kingdom. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30919384/ |
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