RESUMO
Objectives The aim of this study was to study the relationship between silent cerebral ischemia (SCI) and mild cognitive impairment(MCI)in inpatients with nonvalvula atrial fibrillation (NAF) and those with sinus rhythm (SR) older than sixty. Methods Ninety-eight inpatients were enrolled from November 2014 to November 2015 in Hui?zhou Municipal Central Hospital: 45 patients with NAF and 53 with SR. All general clinical data was collected. The Montreal Cognitive Assessment (MoCA) and brain MRI were used to assess the cognitive performance of patients within 1 weeks of admission. Results The MoCA scores were lower in patients with NAF than in those with SR[16(10,20) vs. 20 (15,23),P=0.006]. At least one foci of SCI was present in patients 80%with NAF and 52.8%with SR (NAF vs. SR, P=0.018).The rates of SCIs in the cortex/subcortex were higher in the NAF group than in the SR group (25.2%vs. 12.4%, P=0.017). Multivariate analysis showed that MoCA score were related to the degree of education in NAF patients and were related to age and education level in SR patients. Conclusions NAF is an independent risk factor for cognitive impair?ment in NAF patient and associated with the SCI present. Educational level is a factor affecting the cognitive function with elderly patients.
RESUMO
La fibrilación auricular (FA) es la arritmia más frecuente en la población adulta. Es sabido que la FA se asocia con un aumento del riesgo de presentar muchos eventos adversos, entre los que se incluyen accidente cerebrovascular, insuficiencia cardíaca, muerte por todas las causas, así como muerte súbita cardíaca. Más recientemente también ha habido un creciente interés en la asociación de FA con deterioro cognitivo y demencia. En esta revisión narrativa describimos la actual evidencia a favor de la relación entre la FA y la declinación cognitiva, el deterioro cognitivo o la demencia en pacientes sin antecedentes de accidente cerebrovascular. Aun cuando no queda muy claro cuáles son los mecanismos exactos que explican la asociación entre la FA y la declinación cognitiva, los mecanismos propuestos incluyen isquemia silente, estado pro inflamatorio, microsangrados cerebrales e hipoperfusión cerebral. Se necesitan más estudios para dilucidar los mecanismos de base que faciliten el descubrimiento de alguna estrategia de prevención.
Atrial fibrillation (AF) is the most common arrhythmia in the adult population. AF is widely known to be associated with an increased risk of many adverse outcomes including stroke, heart failure, all-cause death, as well as sudden cardiac death. More recently, there has also been growing interest in the association of AF with cognitive impairment and dementia. In this narrative review, we describe the current evidence that supports the relationship of AF to cognitive decline, cognitive impairment, or dementia in patients without a history of stroke. The exact mechanisms underlying the association of AF with cognitive decline are unclear; however, proposed mechanisms include silent ischemia, pro-inflammatory state, cerebral microbleeds, and cerebral hypoperfusion. Further research is needed to elucidate the underlying mechanisms to facilitate discovery of prevention strategies.