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      Atrial fibrillation as a risk factor for cognitive decline and dementia

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          Abstract

          Aims

          To assess whether AF is a risk factor for cognitive dysfunction we used prospective data on AF, repeat cognitive scores, and dementia incidence in adults followed over 45 to 85 years.

          Methods and results

          Data are drawn from the Whitehall II study, N = 10 308 at study recruitment in 1985. A battery of cognitive tests was administered four times (1997–2013) to 7428 participants (414 cases of AF), aged 45–69 years in 1997. Compared with AF-free participants, those with longer exposure to AF (5, 10, or 15 years) experienced faster cognitive decline after adjustment for sociodemographic, behavioural, and chronic diseases ( P for trend = 0.01). Incident stroke or coronary heart disease individually did not explain the excess cognitive decline; however, this relationship was impacted when considering them together ( P for trend 0.09). Analysis of incident dementia ( N = 274/9302 without AF; N = 50/912 with AF) showed AF was associated with higher risk of dementia in Cox regression adjusted for sociodemographic factors, health behaviours and chronic diseases [hazard ratio (HR): 1.87; 95% confidence interval (CI): 1.37, 2.55]. Multistate models showed AF to increase risk of dementia in those free of stroke (HR: 1.67; 95% CI: 1.17, 2.38) but not those free of stroke and coronary heart disease (HR: 1.29; 95% CI: 0.74, 2.24) over the follow-up.

          Conclusion

          In adults aged 45–85 years AF is associated with accelerated cognitive decline and higher risk of dementia even at ages when AF incidence is low. At least in part, this was explained by incident cardiovascular disease in patients with AF.

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          Most cited references33

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          2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.

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            Tracking pathophysiological processes in Alzheimer's disease: an updated hypothetical model of dynamic biomarkers.

            In 2010, we put forward a hypothetical model of the major biomarkers of Alzheimer's disease (AD). The model was received with interest because we described the temporal evolution of AD biomarkers in relation to each other and to the onset and progression of clinical symptoms. Since then, evidence has accumulated that supports the major assumptions of this model. Evidence has also appeared that challenges some of our assumptions, which has allowed us to modify our original model. Refinements to our model include indexing of individuals by time rather than clinical symptom severity; incorporation of interindividual variability in cognitive impairment associated with progression of AD pathophysiology; modifications of the specific temporal ordering of some biomarkers; and recognition that the two major proteinopathies underlying AD biomarker changes, amyloid β (Aβ) and tau, might be initiated independently in sporadic AD, in which we hypothesise that an incident Aβ pathophysiology can accelerate antecedent limbic and brainstem tauopathy. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              Atrial fibrillation as an independent risk factor for stroke: the Framingham Study

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                Author and article information

                Journal
                Eur Heart J
                Eur. Heart J
                eurheartj
                European Heart Journal
                Oxford University Press
                0195-668X
                1522-9645
                07 September 2017
                29 April 2017
                29 April 2017
                : 38
                : 34 , Focus Issue on Atrial fibrillation
                : 2612-2618
                Affiliations
                [1 ]INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
                [2 ]Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
                Author notes
                [* ] Corresponding author. Tel: +33 (0)1 77 74 74 10, Email: Archana.Singh-Manoux@ 123456inserm.fr

                See page 2619 for the editorial comment on this article (doi: [Related article:]10.1093/eurheartj/ehx320)

                Article
                ehx208
                10.1093/eurheartj/ehx208
                5837240
                28460139
                0b1c00fc-441e-4905-bf27-7190483badff
                © The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 November 2016
                : 08 March 2017
                : 24 April 2017
                Page count
                Pages: 7
                Categories
                Clinical Research
                Atrial Fibrillation
                Editor's Choice

                Cardiovascular Medicine
                atrial fibrillation,cognitive decline,dementia,ageing
                Cardiovascular Medicine
                atrial fibrillation, cognitive decline, dementia, ageing

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