Risk and prediction of dementia in patients with atrial fibrillation — A nationwide population-based cohort study

• Published in: International journal of cardiology Vol. 199; pp. 25 - 30
• Main Authors: Liao, Jo-Nan, Chao, Tze-Fan, Liu, Chia-Jen, Wang, Kang-Ling, Chen, Su-Jung, Tuan, Ta-Chuan, Lin, Yenn-Jiang, Chang, Shih-Lin, Lo, Li-Wei, Hu, Yu-Feng, Chung, Fa-Po, Tsao, Hsuan-Ming, Chen, Tzeng-Ji, Lip, Gregory Y.H., Chen, Shih-Ann
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 15.11.2015
• Subjects: Aged; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - psychology; Cardiovascular; CHA2DS2-VASc score; CHADS2 score; Cognition - physiology; Dementia; Dementia - diagnosis; Dementia - epidemiology; Dementia - etiology; Disease Progression; Female; Follow-Up Studies; Humans; Incidence; Male; Population Surveillance - methods; Prognosis; Retrospective Studies; Risk Assessment - methods; Risk Factors; Taiwan - epidemiology; Time Factors; Taiwan; CHADS2 score; CHA2DS2-VASc score; Atrial fibrillation; Dementia; CHA 2DS 2-VASc score; CHADS 2 score; CHADS score; CHADS-VASc score
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2015.06.170

Atrial fibrillation (AF) is associated with an increased risk of cognitive impairment and functional decline, and may contribute to development of dementia. Data from a nationwide large-scale population-based cohort study are lacking. Besides, how best to predict the occurrence of incident dementia among AF subjects remains uncertain. A total of 332,665 AF subjects without dementia were identified as the study group from the “National Health Insurance Research Database” in Taiwan. For each study patient, one age- and sex-matched subject without AF and dementia was selected as the control group. The study end point was occurrence of dementia, and the usefulness of CHADS2 and CHA2DS2-VASc scores in predicting dementia was analyzed. During the follow-up, 29,012 AF patients experienced dementia with an annual incidence of 2.12%, higher than non-AF subjects (1.50%). Patients with AF possessed a higher risk of dementia with a hazard ratio (HR) of 1.420 after adjustments for age, gender, baseline differences and medication use. Among AF patients, the CHADS2 and CHA2DS2-VASc scores were significant predictors of dementia with an adjusted HR of 1.520 and 1.497 per 1 increment of the CHADS2 and CHA2DS2-VASc scores, respectively. The c-index for CHA2DS2-VASc in predicting dementia (0.611, 95% confidence interval [CI]=0.608–0.614) was significantly higher than the CHADS2 score (0.589, 95% CI=0.586–0.592) (DeLong test p<0.001). In this nationwide cohort study, AF was independently associated with a higher risk of dementia. The CHA2DS2-VASc score can be used to estimate the risk of dementia in AF patients.