title: Atrial fibrillation, stroke, and cognition: a longitudinal population-based study of people aged 85 and older.
abstract: OBJECTIVE
  The aim of this study was to investigate the association between atrial fibrillation (AF), stroke, dementia, and their correlation with brain pathology in subjects aged 85 years or older.
  
  
  METHODS
  This is a prospective 9-year follow-up population based study in Vantaa, a town in Southern Finland; 553 subjects (92% of the total population) aged 85 years or older were clinically examined by a neurologist. The presence of AF was collected from the medical records or examined by ECG or ambulatory ECG. Neuropathological examination was conducted in more than half of the clinically examined subjects.
  
  
  RESULTS
  AF was significantly associated with stroke at baseline; 32% of patients with AF had clinical evidence of stroke compared with 16.7% of those without such evidence (P<0.001). Dementia at baseline was significantly associated with age, clinical stroke, and the presence of apolipoprotein E epsilon4 allele, but not with sex, education, or vascular risk factors. Multiple regression analysis including neuropathological results showed that dementia was significantly associated with education (OR, 0.89; 95% CI, 0.80 to 0.98; P=0.019), the beta-amyloid load in the brain (OR, 1.26; 95% CI, 1.13 to 1.39; P<0.001) and with the vascular pathology (OR, 2.03; 95% CI, 1.14 to 3.62; P=0.016), but not with sex, age at death, apolipoprotein E epsilon4 allele, or vascular risk factors.
  
  
  CONCLUSIONS
  AF is a significant and preventable risk factor for stroke but not for dementia in the very old. The etiology of dementia syndrome in the very old is multifactorial. Both Alzheimer disease pathology and vascular pathology, particularly multiple small infarcts, contribute to cognitive decline.
authors: Department of Neurology, University of Kuopio, Kuopio, Finland.
authors: Sari
authors: S
authors: Rastas
authors: Auli
authors: A
authors: Verkkoniemi
authors: Tuomo
authors: T
authors: Polvikoski
authors: Kati
authors: K
authors: Juva
authors: Leena
authors: L
authors: Niinistö
authors: Kimmo
authors: K
authors: Mattila
authors: Esko
authors: E
authors: Länsimies
authors: Tuula
authors: T
authors: Pirttilä
authors: Raimo
authors: R
authors: Sulkava
mesh_terms: D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications*; D001921:Brain / Q000473:pathology*; D003704:Dementia / Q000209:etiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000473:pathology*