title: Role of ventricular rate response on dementia in cognitively impaired elderly subjects with atrial fibrillation: a 10-year study.
abstract: BACKGROUND
  The role of ventricular rate response (VRr) on the incidence of dementia in elderly subjects with cognitive impairment and atrial fibrillation (AF) is not known. Thus, we examined the ability of VRr to predict dementia in cognitively impaired elderly subjects with and without AF.
  
  
  METHODS
  A total of 358 cognitively impaired elderly subjects (MMSE <24) with and without AF were stratified in low/high (<50/>90) and moderate (>50/<90 bpm) VRr. A 10-year follow-up was performed.
  
  
  RESULTS
  Cognitively impaired subjects with dementia at the end of the follow-up were 135 (37.7%): 33 in the presence (75.0%) and 102 (32.5%) in the absence of AF (p < 0.001). Multivariate analysis shows that AF is a strong predictor of dementia (hazard ratio, HR = 4.10; 95% confidence interval, CI = 1.80-9.30, p < 0.001). More importantly, low/high VRr (<50/>90 bpm) is predictive of dementia in the presence (HR = 7.70, 95% CI = 1.10-14.20, p = 0.03) but not in the absence (HR = 1.85; 95% CI = 0.78-4.47; p = 0.152) of AF.
  
  
  CONCLUSIONS
  This study demonstrates that AF predicts dementia in elderly subjects with cognitive impairment. Moreover, VRr seems to play a key role in the incidence of dementia in cognitively impaired elderly subjects with AF.
authors.affiliation: Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Cattedra di Geriatria, Università di Napoli Federico II, Napoli, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cacciatore
authors.forename: Gianluca
authors.initials: G
authors.lastname: Testa
authors.forename: Assunta
authors.initials: A
authors.lastname: Langellotto
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Galizia
authors.forename: David
authors.initials: D
authors.lastname: Della-Morte
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gargiulo
authors.forename: Agnese
authors.initials: A
authors.lastname: Bevilacqua
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Del Genio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Canonico
authors.forename: Franco
authors.initials: F
authors.lastname: Rengo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Abete
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D003704:Dementia / Q000453:epidemiology / Q000209:etiology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis