title: Atrial fibrillation and cognitive decline: a longitudinal cohort study.
abstract: OBJECTIVE
  We sought to determine whether in the absence of clinical stroke, people with atrial fibrillation experience faster cognitive decline than people without atrial fibrillation.
  
  
  METHODS
  We conducted a longitudinal analysis in the Cardiovascular Health Study, a community-based study of 5,888 men and women aged 65 years and older, enrolled in 1989/1990 or 1992/1993. Participants did not have atrial fibrillation or a history of stroke at baseline. Participants were censored when they experienced incident clinical stroke. Incident atrial fibrillation was identified by hospital discharge diagnosis codes and annual study ECGs. The main outcome was rate of decline in mean scores on the 100-point Modified Mini-Mental State Examination (3MSE), administered annually up to 9 times.
  
  
  RESULTS
  Analyses included 5,150 participants, of whom 552 (10.7%) developed incident atrial fibrillation during a mean of 7 years of follow-up. Mean 3MSE scores declined faster after incident atrial fibrillation compared with no prior atrial fibrillation. For example, the predicted 5-year decline in mean 3MSE score from age 80 to age 85 was -6.4 points (95% confidence interval [CI]: -7.0, -5.9) for participants without a history of atrial fibrillation, but was -10.3 points (95% CI: -11.8, -8.9) for participants experiencing incident atrial fibrillation at age 80, a 5-year difference of -3.9 points (95% CI: -5.3, -2.5).
  
  
  CONCLUSIONS
  In the absence of clinical stroke, people with incident atrial fibrillation are likely to reach thresholds of cognitive impairment or dementia at earlier ages than people with no history of atrial fibrillation.
authors.affiliation: Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, WA, USA. elt@uab.edu
authors.forename: Evan L
authors.initials: EL
authors.lastname: Thacker
authors.forename: Barbara
authors.initials: B
authors.lastname: McKnight
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Sitlani
authors.forename: Sascha
authors.initials: S
authors.lastname: Dublin
authors.forename: Alice M
authors.initials: AM
authors.lastname: Arnold
authors.forename: Annette L
authors.initials: AL
authors.lastname: Fitzpatrick
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008182:Luria-Nebraska Neuropsychological Battery; D008297:Male; D011237:Predictive Value of Tests