Document Detail

Cognitive impairment associated with atrial fibrillation: a meta-analysis.
MedLine Citation:
PMID:  23460057     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Atrial fibrillation (AF) has been linked with an increased risk for cognitive impairment and dementia.
PURPOSE: To complete a meta-analysis of studies examining the association between AF and cognitive impairment.
DATA SOURCES: Search of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE databases and hand search of article references.
STUDY SELECTION: Prospective and nonprospective studies reporting adjusted risk estimates for the association between AF and cognitive impairment.
DATA EXTRACTION: Two abstracters independently extracted data on study characteristics, risk estimates, methods of AF and outcome ascertainment, and methodological quality.
DATA SYNTHESIS: Twenty-one studies were included in the meta-analysis. Atrial fibrillation was significantly associated with a higher risk for cognitive impairment in patients with first-ever or recurrent stroke (relative risk [RR], 2.70 [95% CI, 1.82 to 4.00]) and in a broader population including patients with or without a history of stroke (RR, 1.40 [CI, 1.19 to 1.64]). The association in the latter group remained significant independent proof of clinical stroke history (RR, 1.34 [CI, 1.13 to 1.58]). However, there was significant heterogeneity among studies of the broader population (I2 = 69.4%). Limiting the analysis to prospective studies yielded similar results (RR, 1.36 [CI, 1.12 to 1.65]). Restricting the analysis to studies of dementia eliminated the significant heterogeneity (P = 0.137) but did not alter the pooled estimate substantially (RR, 1.38 [CI, 1.22 to 1.56]).
LIMITATIONS: There is an inherent bias because of confounding variables in observational studies. There was significant heterogeneity among included studies.
CONCLUSION: Evidence suggests that AF is associated with a higher risk for cognitive impairment and dementia, with or without a history of clinical stroke. Further studies are required to elucidate the association between AF and subtypes of dementia as well as the cause of cognitive impairment.
Shadi Kalantarian; Theodore A Stern; Moussa Mansour; Jeremy N Ruskin
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-05     Completed Date:  2013-05-06     Revised Date:  2014-03-05    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  338-46     Citation Subset:  AIM; IM    
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MeSH Terms
Atrial Fibrillation / complications*
Cognition Disorders / complications*
Dementia / complications
Publication Bias
Risk Factors
Sensitivity and Specificity
Stroke / complications
Grant Support
Comment In:
Evid Based Med. 2014 Feb;19(1):e3   [PMID:  23708205 ]
Ann Intern Med. 2013 Jun 4;158(11):849-50   [PMID:  23732722 ]
Ann Intern Med. 2013 Jun 4;158(11):849   [PMID:  23732721 ]
Ann Intern Med. 2013 Jun 4;158(11):849   [PMID:  23732720 ]

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