0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Atrial Fibrillation and the Hachinski Ischemic Scale

Ilker Tasci, MD; Huseyin Doruk, MD
Arch Neurol. 2012;69(8):1084-1085. doi:10.1001/archneurol.2012.1129.
Text Size: A A A
Published online

Extract

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.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Tables

References

Correspondence

August 1, 2012
Vladimir Hachinski, MD, DSc; Shahram Oveisgharan, MD; William R. Shankle, MS, MD
Arch Neurol. 2012;69(8):1084-1085. doi:10.1001/archneurol.2012.1524.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

89 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have a Hemorrhagic Stroke?

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have a Hemorrhagic Stroke?

brightcove.createExperiences();