title: Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: the atherosclerosis risk in communities study.
abstract: OBJECTIVE
  The mechanism underlying the association of atrial fibrillation (AF) with cognitive decline in stroke-free individuals is unclear. We examined the association of incident AF with cognitive decline in stroke-free individuals, stratified by subclinical cerebral infarcts (SCIs) on brain MRI scans.
  
  
  METHODS
  We analyzed data from 935 stroke-free participants (mean age±SD, 61.5±4.3 years; 62% women; and 51% black) from 1993 to 1995 through 2004 to 2006 in the Atherosclerosis Risk in Communities Study, a biracial community-based prospective cohort study. Cognitive testing (including the digit symbol substitution and the word fluency tests) was performed in 1993 to 1995, 1996 to 1998, and 2004 to 2006 and brain MRI scans in 1993 to 1995 and 2004 to 2006.
  
  
  RESULTS
  During follow-up, there were 48 incident AF events. Incident AF was associated with greater annual average rate of decline in digit symbol substitution (-0.77; 95% confidence interval, -1.55 to 0.01; P=0.054) and word fluency (-0.80; 95% confidence interval, -1.60 to -0.01; P=0.048). Among participants without SCIs on brain MRI scans, incident AF was not associated with cognitive decline. In contrast, incident AF was associated with greater annual average rate of decline in word fluency (-2.65; 95% confidence interval, -4.26 to -1.03; P=0.002) among participants with prevalent SCIs in 1993 to 1995. Among participants who developed SCIs during follow-up, incident AF was associated with a greater annual average rate of decline in digit symbol substitution (-1.51; 95% confidence interval, -3.02 to -0.01; P=0.049).
  
  
  CONCLUSIONS
  The association of incident AF with cognitive decline in stroke-free individuals can be explained by the presence or development of SCIs, raising the possibility of anticoagulation as a strategy to prevent cognitive decline in AF.
authors: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.). chenx484@umn.edu.
authors: Lin Y
authors: LY
authors: Chen
authors: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.).
authors: Faye L
authors: FL
authors: Lopez
authors: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.).
authors: Rebecca F
authors: RF
authors: Gottesman
authors: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.).
authors: Rachel R
authors: RR
authors: Huxley
authors: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.).
authors: Sunil K
authors: SK
authors: Agarwal
authors: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.).
authors: Laura
authors: L
authors: Loehr
authors: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.).
authors: Thomas
authors: T
authors: Mosley
authors: From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.L., A.A.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Queensland Clinical Trials and Biostatistics Center, School of Population Health, University of Queensland, Queensland, Australia (R.R.H.); Division of Medicine, Johns Hopkins University, Baltimore, MD (S.K.A.); Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.L.); and University of Mississippi School of Medicine, Jackson (T.M.).
authors: Alvaro
authors: A
authors: Alonso
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications*; D001281:Atrial Fibrillation / Q000150:complications*; D001921:Brain / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications* / Q000473:pathology; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
keywords: atrial fibrillation; cognition; epidemiology