title: Dementia in patients with atrial fibrillation and the value of the Hachinski ischemic score.
abstract: OBJECTIVE
  To assess the prevalence of vascular dementia, mixed dementia and Alzheimer's disease in patients with atrial fibrillation, and to evaluate the accuracy of the Hachinski ischemic score for these subtypes of dementia.
  
  
  METHODS
  A nested case-control study was carried out. A total of 103 of 784 consecutive patients evaluated for cognitive status at the Ambulatory Geriatric Clinic had a diagnosis of atrial fibrillation. Controls without atrial fibrillation were randomly selected from the remaining 681 patients using a 1:2 matching for sex, age and education.
  
  
  RESULTS
  The prevalence of vascular dementia was twofold in patients with atrial fibrillation compared with controls (21.4% vs 10.7%, P = 0.024). Alzheimer's disease was also more frequent in the group with atrial fibrillation (12.6% vs 7.3%, P = 0.046), whereas mixed dementia had a similar distribution. The Hachinski ischemic score poorly discriminated between dementia subtypes, with misclassification rates between 46% (95% CI 28-66) and 70% (95% CI 55-83). In patients with atrial fibrillation, these rates ranged from 55% (95% CI 32-77) to 69% (95% CI 39-91%). In patients in whom the diagnosis of dementia was excluded, the Hachinski ischemic score suggested the presence of vascular dementia in 11% and mixed dementia in 30%.
  
  
  CONCLUSIONS
  Vascular dementia and Alzheimer's disease, but not mixed dementia, are more prevalent in patients with atrial fibrillation. The discriminative accuracy of the Hachinski ischemic score for dementia subtypes in atrial fibrillation is poor, with a significant proportion of misclassifications.
authors.affiliation: Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy.|Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Marcello
authors.initials: M
authors.lastname: Di Nisio
authors.affiliation: Department of Medicine and Aging, Center for Aging Sciences (Ce.S.I.), Internal Medicine Unit, "University G. D'Annunzio" Foundation, Chieti, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Prisciandaro
authors.affiliation: Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Anne W S
authors.initials: AW
authors.lastname: Rutjes
authors.affiliation: Department of Medicine and Aging, Center for Aging Sciences (Ce.S.I.), Internal Medicine Unit, "University G. D'Annunzio" Foundation, Chieti, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Russi
authors.affiliation: Department of Medicine and Aging, Center for Aging Sciences (Ce.S.I.), Internal Medicine Unit, "University G. D'Annunzio" Foundation, Chieti, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Maiorini
authors.affiliation: Department of Medicine and Aging, Center for Aging Sciences (Ce.S.I.), Internal Medicine Unit, "University G. D'Annunzio" Foundation, Chieti, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Porreca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002545:Brain Ischemia / Q000145:classification; D016022:Case-Control Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology*; D015140:Dementia, Vascular / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence
keywords: Hachinski ischemic score; atrial fibrillation; dementia