Mid-term changes in cognitive functions in patients with atrial fibrillation: a longitudinal analysis of the Swiss-AF cohort

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Rebecca E. Paladini¹  Stefan Osswald¹  Michael Kuhne¹  Philipp Krisai¹  Michael Coslovsky²  Anne Springer³  Tobias Reichlin⁴  Andreas S. Mueller⁵  Annina Stauber⁵  Nikki Rommers⁶  Juerg H. Beer⁷  Leo H. Bonati⁸  Giorgio Moschovitis⁹  Maria Luisa De Perna⁹  Priska Zuber^1,10  Baris Gencer^1,11  Nicolas Rodondi^1,12  David Conen^1,13  Andreas U. Monsch^1,14  Alexandra S. Wueest^1,15 

[1]Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland

[2]Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland

[3]Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland

[4]Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland

[5]Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland

[6]Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland

[7]Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland

[8]Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

[9]Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland

[10]Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland

[11]Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland

[12]Department of Neurology, University of Basel, University Hospital Basel, Basel, Switzerland

[13]Department of Research, Reha Rheinfelden, Rheinfelden, Switzerland

[14]Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Cardiocentro Ticino Institute, Regional Hospital of Lugano, Lugano, Switzerland

[15]Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland

[16]Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

[17]Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland

[18]Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

[19]Population Health Research Institute, McMaster University, Hamilton, ON, Canada

[20]University Department of Geriatric Medicine FELIX PLATTER, Memory Clinic, Basel, Switzerland

[21]University Department of Geriatric Medicine FELIX PLATTER, Memory Clinic, Basel, Switzerland

[22]Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland

关键词: atrial fibrillation;    cognitive function;    longitudinal cohort study;    Swiss-AF;    practice effect;   

DOI  :  10.3389/fcvm.2023.1212587

 received in 2023-04-27, accepted in 2023-07-18,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundLongitudinal association studies of atrial fibrillation (AF) and cognitive functions have shown an unclear role of AF-type and often differ in methodological aspects. We therefore aim to investigate longitudinal changes in cognitive functions in association with AF-type (non-paroxysmal vs. paroxysmal) and comorbidities in the Swiss-AF cohort.MethodsSeven cognitive measures were administered up to five times between 2014 and 2022. Age-education standardized scores were calculated and association between longitudinal change in scores and baseline AF-type investigated using linear mixed-effects models. Associations between AF-type and time to cognitive drop, an observed score of at least one standard deviation below individual's age-education standardized cognitive scores at baseline, were studied using Cox proportional hazard models of each cognitive test, censoring patients at their last measurement. Models were adjusted for baseline covariates.Results2,415 AF patients (mean age 73.2 years; 1,080 paroxysmal, 1,335 non-paroxysmal AF) participated in this Swiss multicenter prospective cohort study. Mean cognitive scores increased longitudinally (median follow-up 3.97 years). Non-paroxysmal AF patients showed smaller longitudinal increases in Digit Symbol Substitution Test (DSST), Cognitive Construct Score (CoCo)and Trail Making Test part B (TMT-B) scores vs. paroxysmal AF patients. Diabetes, history of stroke/TIA and depression were associated with worse performance on all cognitive tests. No differences in time to cognitive drop were observed between AF-types in any cognitive test.ConclusionThis study indicated preserved cognitive functioning in AF patients, best explained by practice effects. Smaller practice effects were found in non-paroxysmal AF patients in the DSST, TMT-B and the CoCo and could indicate a marker of subtle cognitive decline. As diabetes, history of stroke/TIA and depression—but not AF-type—were associated with cognitive drop, more attention should be given to risk factors and underlying mechanisms of AF.

【 授权许可】

Unknown   
© 2023 Wueest, Zuber, Coslovsky, Rommers, Rodondi, Gencer, Moschovitis, De Perna, Beer, Reichlin, Krisai, Springer, Conen, Stauber, Mueller, Paladini, Kuhne, Osswald, Monsch and Bonati.