title: Mild cognitive impairment in high-risk patients with chronic atrial fibrillation: a forgotten component of clinical management?
abstract: OBJECTIVE
  We examined cognitive function in older hospitalised patients with chronic atrial fibrillation (AF).
  
  
  METHODS
  A prospective substudy of a multicentre randomised trial of an AF-specific disease management intervention (the Standard versus Atrial Fibrillation spEcific managemenT studY; SAFETY).
  
  
  METHODS
  Three tertiary referral hospitals within Australia.
  
  
  METHODS
  A total of 260 patients with chronic AF: mean age 72±11 years, 53% men, mean CHA2DS2-VASc score 4±2.
  
  
  METHODS
  Cognitive function was assessed at baseline (during inpatient stay) using the Montreal Cognitive Assessment (MoCA).
  
  
  METHODS
  The extent of mild cognitive impairment (MCI-defined as a MoCA score <26) in AF patients and identification of independent predictors of MCI.
  
  
  RESULTS
  Overall, 169 patients (65%, 95% CI 59% to 71%) were found to have MCI at baseline (mean MoCA score 21±3). Multiple deficits in cognitive domains were identified, most notably in executive functioning, visuospatial abilities and short-term memory. Predictors of MCI (age and sex-adjusted) were lower education level (technical/trade school level OR 6.00, 95% CI 2.07 to 17.42; <8 years school education OR 5.29, 95% CI 1.95 to 14.36 vs 8-13 years), higher CHA2DS2-VASc score (OR 1.46, 95% CI 1.23 to 1.74) and prescribed digoxin (OR 2.19, 95% CI 1.17 to 4.10).
  
  
  CONCLUSIONS
  MCI is highly prevalent amongst typically older high-risk patients hospitalised with AF. Routine assessment of cognitive function with adjustment of clinical management is indicated for this patient group.
authors: National Health and Medical Research Council of Australia, Centre of Research Excellence to Reduce Inequality in Heart Disease/Preventative Health, Baker IDI Heart and Diabetes Institute, St Kilda Road Central, Melbourne, VIC 8008, Australia.
authors: Jocasta
authors: J
authors: Ball
authors: Melinda Jane
authors: MJ
authors: Carrington
authors: Simon
authors: S
authors: Stewart
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D001288:Attention; D001315:Australia / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D004077:Digoxin / Q000627:therapeutic use; D004522:Educational Status; D056344:Executive Function; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016017:Odds Ratio; D009949:Orientation; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin