We read with interest the article by Hachinski et al1 on their efforts to consolidate and further validate the Hachinski Ischemic Score in a community-based large-scale cohort study.
We suppose many readers like us would like to read comments from Hachinski and his co-authors on whether the presence of atrial fibrillation (AF), if included in the scoring system, could further improve the power of the scale in identifying vascular dementia. In a recent study, Marzona et al2 sought to determine the association of AF with cognitive and physical impairment in a large group of patients at high cardiovascular risk through a posthoc analysis of 2 randomized controlled trials (ONTARGET [Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial] and TRANSCEND [Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease]). Among the population studied (N = 31 546; mean age, 66.5 years; mean [SD] Mini-Mental State Examination score, 27.7 [2.9]), 1016 participants (3.3%) had AF at baseline, with the condition developing in an additional 2052 participants (6.5%) during a median follow-up of 56 months. They found that participants with AF at baseline had lower Mini-Mental State Examination scores; were older; and were more likely to have a history of stroke, myocardial infarction, hypertension, diabetes mellitus, smoking, renal impairment, a sedentary lifestyle, and not adhering to their medications. During follow-up, a decrease in Mini-Mental State Examination score by 3 points or more, dementia, admission to a long-term care facility, and loss of independence in performing activities of daily living occurred in 7269 patients (26.1%) without AF and in 1050 patients (34.2%) with AF. On multivariable analysis, AF (baseline and follow-up) was associated with an increased risk for cognitive loss (hazard ratio [HR], 1.14), new dementia (HR, 1.30), loss of independence (HR, 1.35), and admission to a long-term care facility (HR, 1.53). The results were also consistent for patients with AF at baseline and those in whom AF developed during follow-up. Moreover, subgroup analysis for patients with and without stroke (baseline and follow-up) did not reveal any difference regarding the study outcomes, suggesting that the presence of AF was an important risk factor for cognitive and functional decline, independent of previous or incident clinical stroke as well as treatment with antihypertensive drugs.