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Original Investigation |

Association Between Atrial Fibrillation and Dementia in the General Population

Renée F. A. G. de Bruijn, MD1,2; Jan Heeringa, MD, PhD1; Frank J. Wolters, MD1,2; Oscar H. Franco, MD, PhD1; Bruno H. C. Stricker, MD, PhD1; Albert Hofman, MD, PhD1; Peter J. Koudstaal, MD, PhD2; M. Arfan Ikram, MD, PhD1,3
[+] Author Affiliations
1Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
2Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
3Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
JAMA Neurol. 2015;72(11):1288-1294. doi:10.1001/jamaneurol.2015.2161.
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Importance  Atrial fibrillation (AF) has been suggested as a risk factor for dementia since it may lead to chronic cerebral hypoperfusion and stroke. However, longitudinal studies assessing the association between AF and dementia have shown inconsistent results.

Objective  To determine the effect of AF on the risk of developing dementia during 20 years of follow-up.

Design, Setting, and Participants  The association of prevalent and incident AF with incident dementia was assessed from July 6, 1989, to February 4, 2010, in 6514 dementia-free participants in the prospective population-based Rotterdam Study. Data analysis was conducted from September 18, 2014, to April 17, 2015. Cox proportional hazards regression models adjusting for age, sex, and cardiovascular risk factors; censored for stroke; and stratified by median age were used. In addition, we investigated whether the association between incident AF and dementia varied according to the duration of exposure, categorized in 6-year time bands.

Exposures  Prevalent and incident AF.

Main Outcomes and Measures  Incident dementia, determined according to the Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised) and the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association criteria.

Results  At baseline, 318 of 6514 participants (4.9%) had prevalent AF, and during 81 483 person-years of follow-up, 994 participants (15.3%) developed incident dementia. With findings presented as adjusted hazard ratio (95% CI), prevalent AF was related to an increased risk of dementia (1.33; 1.02-1.73). Among 6196 participants without prevalent AF during 79 003 person-years of follow-up, 723 participants (11.7%) developed incident AF and 932 individuals (15.0%) developed incident dementia. Incident AF was associated with an increased risk of dementia in younger participants (<67 years: 1.81; 1.11-2.94 vs ≥67 years: 1.12; 0.85-1.46; P = .02 for interaction). The risk of dementia was strongly associated with duration of exposure to AF in the younger participants (in the highest stratum: 3.30; 1.16-9.38; P = .003 for trend) but not in the elder participants (0.25; 0.04-1.86; P = .94 for trend).

Conclusions and Relevance  Atrial fibrillation is associated with an increased risk of dementia, independent of clinical stroke. This association was strongest for younger participants with the longest duration of AF. Future studies should investigate whether optimal treatment of AF can prevent or postpone dementia.

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Figure.
Hazard Ratios for Dementia per Category of Follow-up of Time With Atrial Fibrillation

A, Younger participant cohort. B, Older participant cohort. Cutoff times for categories were greater than 0 and 6 years or less, greater than 6 and 12 years or less, and greater than 12 years until the end of the follow-up time. Bullets indicate hazard ratio; limit lines, 95% CI; and the horizontal line (at hazard ratio 1) indicates no difference in hazard between exposure and nonexposure.

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