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Ren QW, Katherine Teng TH, Tse YK, Wei Tsang CT, Yu SY, Wu MZ, Li XL, Hung D, Tse HF, Lam CS, Yiu KH. Statins and risks of dementia among patients with heart failure: a population-based retrospective cohort study in Hong Kong. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:101006. [PMID: 38298909 PMCID: PMC10827582 DOI: 10.1016/j.lanwpc.2023.101006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
Background Heart failure (HF) and dementia frequently co-exist with shared pathological mechanisms and risk factors. Our study aims to investigate the association between statin therapy and the risks of dementia and its subtypes among patients with HF. Methods The Hong Kong Clinical Data Analysis and Reporting System database was interrogated to identify patients with incident HF diagnosis from 2004 to 2018, using ICD 9/ICD 10 codes. Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates between statin users (N = 54,004) and non-users (N = 50,291). The primary outcomes were incident all-cause dementia, including subtypes of Alzheimer's disease, vascular dementia, and unspecified dementia. Cox proportional-hazard model with competing risk regression was performed to estimate the sub-distribution hazards ratio (SHR) with corresponding 95% confidence intervals (CI) of the risks of all-cause dementia and its subtypes that are associated with statin use. Findings Of all eligible patients with HF (N = 104,295), the mean age was 74.2 ± 13.6 years old and 52,511 (50.3%) were male. Over a median follow-up of 9.9 years (interquartile range [IQR]: 6.4-13.0), 10,031 (9.6%) patients were diagnosed with dementia, among which Alzheimer's disease (N = 2250), vascular dementia (N = 1831), and unspecified dementia (N = 5950) were quantified separately. After IPTW, statin use was associated with a 20% lower risk of incident dementia compared with non-use (multivariable-adjusted SHR 0.80, 95% CI 0.76-0.84). Stratified by subtypes of dementia, statin use was associated with a 28% lower risk of Alzheimer's disease (SHR 0.72, 95% CI 0.63-0.82), 18% lower risk of vascular dementia (SHR 0.82, 95% CI 0.70-0.95), and a 20% lower risk of unspecified dementia (SHR 0.80, 95% CI 0.75-0.85). Interpretation In patients with HF, statin use was associated with a significantly lower risk of all-cause dementia and its subtypes, including Alzheimer's disease, vascular dementia, and unspecified dementia. Both randomized trials and experimental studies to validate the potential neuroprotective effect of statin are warranted. Funding No funding was provided for this study.
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Affiliation(s)
- Qing-wen Ren
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Tiew-Hwa Katherine Teng
- National Heart Center Singapore, Singapore
- Duke-NUS Medical School, Singapore
- School of Allied Health, University of Western Australia, Australia
| | - Yi-Kei Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Christopher Tze Wei Tsang
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Si-Yeung Yu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Xin-li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Denise Hung
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Carolyn S.P. Lam
- National Heart Center Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Feldman DR, Zeitler EP. Neurologic impact of atrial fibrillation. Curr Opin Cardiol 2024; 39:33-38. [PMID: 37678332 DOI: 10.1097/hco.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW Cognitive dysfunction is a complex condition that is becoming increasingly more prevalent. There has been growing acknowledgement that individuals with atrial fibrillation are at an increased risk of cognitive dysfunction beyond the association of age with both disorders. The purpose of this review is to explore the potential underlying mechanisms connecting atrial fibrillation and cognitive dysfunction and to examine the existing evidence for potential treatment options. RECENT FINDINGS Many mechanisms have been proposed for the association between cognitive dysfunction and atrial fibrillation. These include cerebral infarction (both micro and macro embolic events), cerebral microbleeds including those secondary to therapeutic anticoagulation, an increased inflammatory state, cerebral hypoperfusion, and a genetic predisposition to both diseases. Treatments designed to target each of these mechanisms have led to mixed results and there are no specific interventions that have definitively led to a reduction in the incidence of cognitive dysfunction. SUMMARY The relationship between cognitive dysfunction and atrial fibrillation remains poorly understood. Standard of care currently focuses on reducing risk factors, managing stroke risk, and maintaining sinus rhythm in appropriately selected patients. Further work needs to be conducted in this area to limit the progression of cognitive dysfunction in patients with atrial fibrillation.
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Affiliation(s)
| | - Emily P Zeitler
- Dartmouth Health and Dartmouth-Hitchcock Medical Center
- The Dartmouth Institute, Lebanon, New Hampshire, USA
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Gao YF, Jin TY, Chen Y, Ding YH. No causal genetic relationships between atrial fibrillation and vascular dementia: A bidirectional Mendelian randomization study. Front Cardiovasc Med 2023; 10:1071574. [PMID: 37456823 PMCID: PMC10347408 DOI: 10.3389/fcvm.2023.1071574] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/20/2023] [Indexed: 07/18/2023] Open
Abstract
Background Numerous observational studies have suggested that atrial fibrillation (AF) was associated with an increased risk of vascular dementia (VaD). However, the causal genetic relationships between AF and VaD remains unclear. To evaluate the effect of AF on VaD, we performed the Mendelian randomization (MR) analysis to investigate the causal genetic relationships between AF and VaD. Methods The bidirectional MR analysis was conducted to explore the causal relationships between exposure and disease. We applied a series of quality assessments to select significantly and independently single nucleotide polymorphisms (SNPs) from publicly available large-scale genome-wide association studies (GWAS) databases. Three methods [Inverse variance weighted method (IVW), MR-Egger method, and weighted median (WM)method] were used to derive MR estimates. In order to ensure reliable MR results, sensitivity analyses were performed to evaluate the horizontal pleiotropy and heterogeneity. Results Our MR analyses revealed no significant genetic relationships between AF and the risk of VaD (IVW: OR = 1.10, 95%CI = 0.95-1.28, P = 0.20). In the reverse direction analysis, there was no evidence to support a significant genetic relationship of VaD with AF risk (IVW: OR = 1.00, 95% CI = 0.99-1.01, P = 0.52). Consistent results were obtained using different MR methods. Sensitivity analyses suggested no significant horizontal pleiotropy and heterogeneity in the study. Conclusion This MR analysis did not provide evidence to support the causal genetic relationships between AF on VaD risk and the causal effect of VaD on AF risk.
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Affiliation(s)
- Ya-fang Gao
- Department of Cardiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Tian-yu Jin
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- Department of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yan Chen
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Ya-hui Ding
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
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Olmastroni E, Molari G, De Beni N, Colpani O, Galimberti F, Gazzotti M, Zambon A, Catapano AL, Casula M. Statin use and risk of dementia or Alzheimer's disease: a systematic review and meta-analysis of observational studies. Eur J Prev Cardiol 2021; 29:804-814. [PMID: 34871380 DOI: 10.1093/eurjpc/zwab208] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 11/24/2021] [Indexed: 12/16/2022]
Abstract
AIMS As the potential impact of statins on cognitive decline and dementia is still debated, we conducted a meta-analysis of observational studies to examine the effect of statin use on the risk of Alzheimer's disease (AD) and dementia. METHODS AND RESULTS PubMed, Cochrane, and EMBASE were searched since inception to January 2021. Inclusion criteria were: (i) cohort or case-control studies; (ii) statin users compared to non-users; and (iii) AD and/or dementia risk as outcome. Estimates from original studies were pooled using restricted maximum-likelihood random-effect model. Measure of effects were reported as odds ratio (OR) and 95% confidence intervals (CIs). In the pooled analyses, statins were associated with a decreased risk of dementia [36 studies, OR 0.80 (CI 0.75-0.86)] and of AD [21 studies, OR 0.68 (CI 0.56-0.81)]. In the stratified analysis by sex, no difference was observed in the risk reduction of dementia between men [OR 0.86 (CI 0.81-0.92)] and women [OR 0.86 (CI 0.81-0.92)]. Similar risks were observed for lipophilic and hydrophilic statins for both dementia and AD, while high-potency statins showed a 20% reduction of dementia risk compared with a 16% risk reduction associated with low-potency statins, suggesting a greater efficacy of the former, although a borderline statistical significance (P = 0.05) for the heterogeneity between estimates. CONCLUSION These results confirm the absence of a neurocognitive risk associated with statin treatment and suggest a potential favourable role of statins. Randomized clinical trials with an ad hoc design are needed to explore this potential neuroprotective effect.
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Affiliation(s)
- Elena Olmastroni
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP), University of Milan, Via Balzaretti 9, 20133 Milan, Italy
| | - Giulia Molari
- IRCCS MultiMedica, Via Milanese 300, 20099 Sesto S. Giovanni (MI), Italy; and
| | - Noemi De Beni
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP), University of Milan, Via Balzaretti 9, 20133 Milan, Italy
| | - Ornella Colpani
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP), University of Milan, Via Balzaretti 9, 20133 Milan, Italy
| | - Federica Galimberti
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP), University of Milan, Via Balzaretti 9, 20133 Milan, Italy.,IRCCS MultiMedica, Via Milanese 300, 20099 Sesto S. Giovanni (MI), Italy; and
| | - Marta Gazzotti
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP), University of Milan, Via Balzaretti 9, 20133 Milan, Italy
| | - Alberto Zambon
- IRCCS MultiMedica, Via Milanese 300, 20099 Sesto S. Giovanni (MI), Italy; and.,Department of Medicine-DIMED, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP), University of Milan, Via Balzaretti 9, 20133 Milan, Italy.,IRCCS MultiMedica, Via Milanese 300, 20099 Sesto S. Giovanni (MI), Italy; and
| | - Manuela Casula
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP), University of Milan, Via Balzaretti 9, 20133 Milan, Italy.,IRCCS MultiMedica, Via Milanese 300, 20099 Sesto S. Giovanni (MI), Italy; and
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Dutta S, Rahman S, Ahmad R, Kumar T, Dutta G, Banerjee S, Abubakar AR, Rowaiye AB, Dhingra S, Ravichandiran V, Kumar S, Sharma P, Haque M, Charan J. An evidence-based review of neuronal cholesterol role in dementia and statins as a pharmacotherapy in reducing risk of dementia. Expert Rev Neurother 2021; 21:1455-1472. [PMID: 34756134 DOI: 10.1080/14737175.2021.2003705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Dementia is a progressive neurodegenerative disorder impairing memory and cognition. Alzheimer's Disease, followed by vascular dementia - the most typical form. Risk factors for vascular dementia include diabetes, cardiovascular disease, hyperlipidemia. Lipids' levels are significantly associated with vascular changes in the brain. AREAS COVERED The present article reviews the cholesterol metabolism in the brain, which includes: the synthesis, transport, storage, and elimination process. Additionally, it reviews the role of cholesterol in the pathogenesis of dementia and statin as a therapeutic intervention in dementia. In addition to the above, it further reviews evidence in support of as well as against statin therapy in dementia, recent updates of statin pharmacology, and demerits of use of statin pharmacotherapy. EXPERT OPINION Amyloid-β peptides and intraneuronal neurofibrillary tangles are markers of Alzheimer's disease. Evidence shows cholesterol modulates the functioning of enzymes associated with Amyloid-β peptide processing and synthesis. Lowering cholesterol using statin may help prevent or delay the progression of dementia. This paper reviews the role of statin in dementia and recommends extensive future studies, including genetic research, to obtain a precise medication approach for patients with dementia.
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Affiliation(s)
- Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Rajkot, Gujrat, India
| | - Sayeeda Rahman
- School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, Bangladesh
| | - Tarun Kumar
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Gitashree Dutta
- Department of Community Medicine, Neigrihms, Shillong, India
| | | | - Abdullahi Rabiu Abubakar
- Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University, Kano, Nigeria
| | - Adekunle Babajide Rowaiye
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
| | - Velayutham Ravichandiran
- Department of Natural Products, National Institute of Pharmaceutical Education and Research-Kolkata, Kolkata, India
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Paras Sharma
- Department of Pharmacognosy, BVM College of Pharmacy, Gwalior, India
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur, Malaysia
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Rajkot, Gujrat, India
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Abstract
Elevated cholesterol is a major risk factor in the development of cardiovascular disease. Statins have proven to be effective in lowering low-density lipoprotein cholesterol as well as the incidence of cardiovascular events. As a result, statins are widely prescribed in the United States, with an estimated 35 million patients on statins. Many of these patients are older than age 65 and suffer from various comorbidities, including mild to severe cognitive impairment. Early studies looking at the effects of statins on cognition have shown that statin use may lead to mild reversible cognitive decline, although long-term studies have shown inconclusive findings. In recent years, studies have shown that the use of statins in certain groups of patients may lead to a reduction in the rate of cognitive decline. One hypothesis for this finding is that statin use can reduce the risk of cerebrovascular disease which may, in turn, reduce the risk of mild cognitive decline and dementia. With numerous patients currently prescribed statins and the likelihood that more patients will be prescribed the medication in the coming years, it is important to review the current literature to determine the association between statin use and cognitive decline, as well as determine how statins may be beneficial in preventing cognitive decline.
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Affiliation(s)
- Bhawneet Chadha
- From the Department of Medicine, Tufts Medical Center, Boston, MA
| | - William H Frishman
- Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
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7
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Junejo RT, Lip GYH, Fisher JP. Cerebrovascular Dysfunction in Atrial Fibrillation. Front Physiol 2020; 11:1066. [PMID: 33013456 PMCID: PMC7509200 DOI: 10.3389/fphys.2020.01066] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/04/2020] [Indexed: 01/13/2023] Open
Abstract
It is now well established that besides being the most common sustained arrhythmia, atrial fibrillation (AF) is a major healthcare burden. Risk of debilitating stroke is increased in AF patients, but even in the absence of stroke, this population is at heightened risk of cognitive decline, depression, and dementia. The reasons for this are complex, multifactorial, and incompletely understood. One potential contributing mechanism is cerebrovascular dysfunction. Cerebral blood flow is regulated by chemical, metabolic, autoregulatory, neurogenic, and systemic factors. The dysfunction in one or more of these mechanisms may contribute to the elevated risk of cognitive decline and cerebrovascular events in AF. This short review presents the evidence for diminished cerebral blood flow, cerebrovascular carbon dioxide reactivity (i.e., cerebrovascular vasodilatory reserve), cerebral autoregulation, and neurovascular coupling in AF patients when compared to control participants in sinus rhythm. Further work is needed to understand the physiological mechanisms underpinning these observations and their clinical significance in atrial fibrillation patients.
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Affiliation(s)
- Rehan T. Junejo
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom
| | - James P. Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Hsieh YC, Chen YY, Chien KL, Chung FP, Lo LW, Chang SL, Chao TF, Hu YF, Lin CY, Tuan TC, Liao JN, Lin YJ, Chen SA. Catheter ablation of atrial fibrillation reduces the risk of dementia and hospitalization during a very long-term follow-up. Int J Cardiol 2020; 304:75-81. [DOI: 10.1016/j.ijcard.2019.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
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Manolis TA, Manolis AA, Apostolopoulos EJ, Melita H, Manolis AS. Atrial Fibrillation and Cognitive Impairment: An Associated Burden or Burden by Association? Angiology 2020; 71:498-519. [DOI: 10.1177/0003319720910669] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Growing evidence suggests that atrial fibrillation (AF), in addition to its thromboembolic risk, is a risk factor for cognitive impairment (CI) via several pathways and mechanisms, further contributing to morbidity/mortality. Prior stroke is a contributor to CI, but AF is also associated with CI independently from prior stroke. Silent brain infarctions, microemboli and microbleeds, brain atrophy, cerebral hypoperfusion from widely fluctuating ventricular rates, altered hemostatic function, vascular oxidative stress, and inflammation may all exacerbate CI, particularly in patients with persistent/permanent rather than paroxysmal AF and with increased duration/burden of the arrhythmia. Brain magnetic resonance imaging is an important screening tool in eliciting and monitoring vascular and nonvascular lesions contributing to CI. Evidence is also emerging about the role of genetics in CI development. Anticoagulation and rhythm/rate control strategies may protect against CI preventing or slowing its progression or conversion to dementia, particularly at the early stages when CI may still be a treatable condition. Importantly, AF and CI share many common risk factors. Thus, screening for these 2 conditions and searching for and managing modifiable risk factors and potentially reversible causes for both AF and CI remains an important step toward prevention or amelioration of the impact incurred by these 2 conditions.
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Affiliation(s)
| | | | | | | | - Antonis S. Manolis
- First and Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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10
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Mongkhon P, Naser AY, Fanning L, Tse G, Lau WC, Wong IC, Kongkaew C. Oral anticoagulants and risk of dementia: A systematic review and meta-analysis of observational studies and randomized controlled trials. Neurosci Biobehav Rev 2019; 96:1-9. [DOI: 10.1016/j.neubiorev.2018.10.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/03/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023]
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Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications. Am J Med 2018; 131:1408-1417. [PMID: 30076825 DOI: 10.1016/j.amjmed.2018.06.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 11/23/2022]
Abstract
Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors such as age or hypertension. Critical appraisal of studies evaluating the association between atrial fibrillation and dementia in stroke-free patients reveals that several suffer from methodological issues, such as not including silent stroke or anticoagulation therapy in multivariate analyses. Some studies show a close relationship between atrial fibrillation and dementia due to silent stroke, in the absence of overt stroke. Evidence is accumulating that anticoagulation may be effective to decrease the risk of dementia in atrial fibrillation patients. Overall, the pathogenesis linking atrial fibrillation to dementia is likely multifactorial. Cerebral infarctions, including silent stroke, play a central role. These findings underscore the importance of stroke prevention measures in atrial fibrillation patients.
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Zhu XC, Dai WZ, Ma T. Overview the effect of statin therapy on dementia risk, cognitive changes and its pathologic change: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:435. [PMID: 30596065 DOI: 10.21037/atm.2018.06.43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Many studies have reported on the role of statin therapy in dementia, but its efficacy remains controversial. We aimed to search for reliable and meaningful articles to assess the efficacy of statin therapy for dementia risk, cognitive items, and pathologic markers. Methods Related literature for this study was published in the period from January 1, 1987 to January 1, 2018. Odds ratio (OR) and 95% confidence interval (95% CI) estimates were pooled in either fixed or random effects models. Results A total of 23 relevant studies were included after the application of the search strategy. The pooled results showed that statin therapy would downregulate dementia risk according to an analysis of 1,314,431 dementia patients and 1,836,539 healthy controls (OR: 0.64, 95% CI: 0.50, 0.81). In addition, specific changes in mini-mental state examination (MMSE) score were observed in individuals with dementia with statin therapy (OR: 0.46, 95% CI: 0.17, 0.74). However, the results of this meta-analysis showed that statin therapy did not significantly modify the Alzheimer's Disease Assessment Scale (ADAS-cog) score (OR: -0.26, 95% CI: -1.13, 0.62). No significant association was found between statin therapy and activities of daily living performance (OR: -0.69, 95% CI: -4.12, 2.74). When investigating pathological markers, our results indicated a significant influence of statin therapy on plasma amyloid β40 (Aβ40) (OR: 9.27, 95% CI: 0.71, 17.84), plasma Aβ42 (OR: 2.60, 95% CI: 1.07, 4.13), plasma low-density lipoprotein (LDL) cholesterol (OR: -16.95, 95% CI: -25.54, -8.37), plasma lathosterol (OR: -0.11, 95% CI: -0.14, -0.07), plasma 24s-hydroxycholesterol (OR: -10.41, 95% CI: -15.57, -5.25), and cerebrospinal fluid (CSF) lathosterol (OR: -0.07, 95% CI: -0.12, -0.01). Conclusions The available data indicate that statin therapy may reduce dementia risk, altering cognitive items and pathologic markers.
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Affiliation(s)
- Xi-Chen Zhu
- Department of Neurology, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Wen-Zhuo Dai
- Department of Neurology, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi 214002, China
| | - Tao Ma
- Department of Neurology, the Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi 214002, China
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13
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Abstract
As the worldwide prevalence of dementia increases, there is a greater and more urgent need for all health care providers to understand how to evaluate and manage cognitive impairment. Many people presenting with a dementing illness have one or more reversible underlying conditions that worsen prognosis and, if treated, can improve cognitive function. This article reviews the major potentially reversible dementias, including the basic workup and management of each condition.
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Affiliation(s)
- Milta O Little
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University Health Center, 1402 South Grand Boulevard Room M238, St Louis, MO 63104, USA.
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14
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Abstract
PURPOSE OF REVIEW Atrial fibrillation (AF) and dementia are both prevalent diseases in aging societies, which exert a great economic burden worldwide. Although a handful of epidemiologic studies have indicated that AF is independently associated with faster cognitive decline and a higher risk of dementia, there is still a lack of comprehensive understanding of the observed association. In this review, we summarize evidence from major epidemiologic studies concerning AF-related cognitive decline and dementia, the potential mechanisms underlying their association, and the cognitive benefits of treatment options. RECENT FINDINGS A large majority of population-based longitudinal studies have consistently shown an independent association of AF with cognitive decline and dementia with varying effect sizes, depending on the age of the study population and the presence of clinical stroke. The underlying pathways linking AF to cognitive phenotypes may involve systemic inflammation, cerebral hypoperfusion, and cerebral small vessel disease and microemboli. However, current evidence is insufficient to support the potential benefits of AF treatment in reducing risk of cognitive decline and dementia. SUMMARY Current epidemiologic research suggests that AF contributes to cognitive decline and dementia, independent of a history of stroke. Further work is warranted to elucidate the potential mechanisms underlying this association, and more well-designed studies are needed to explore the possible cognitive benefits of different therapeutic options in patients with AF.
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Affiliation(s)
- Mozhu Ding
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Widerströmska Huset, Karolinska Institutet and Stockholm University, Tomtebodavägen 18A, 171 65 Solna, Sweden
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Widerströmska Huset, Karolinska Institutet and Stockholm University, Tomtebodavägen 18A, 171 65 Solna, Sweden
- Department of Neurology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong China
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15
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Yan XH, Wu YQ. Study Progress of the Influence of Atrial Fibrillation Treatment on Dementia. Chin Med J (Engl) 2018; 131:859-861. [PMID: 29578132 PMCID: PMC5887747 DOI: 10.4103/0366-6999.228248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Use of statins and adverse outcomes in patients with atrial fibrillation: An analysis from the EURObservational Research Programme Atrial Fibrillation (EORP-AF) general registry pilot phase. Int J Cardiol 2017; 248:166-172. [DOI: 10.1016/j.ijcard.2017.08.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 01/19/2023]
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17
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Mechanisms, Clinical Significance, and Prevention of Cognitive Impairment in Patients With Atrial Fibrillation. Can J Cardiol 2017; 33:1556-1564. [DOI: 10.1016/j.cjca.2017.09.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/21/2017] [Accepted: 09/24/2017] [Indexed: 11/18/2022] Open
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18
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Banerjee G, Carare R, Cordonnier C, Greenberg SM, Schneider JA, Smith EE, Buchem MV, Grond JVD, Verbeek MM, Werring DJ. The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice. J Neurol Neurosurg Psychiatry 2017; 88:982-994. [PMID: 28844070 PMCID: PMC5740546 DOI: 10.1136/jnnp-2016-314697] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/26/2017] [Accepted: 05/18/2017] [Indexed: 12/29/2022]
Abstract
Cerebral amyloid angiopathy (CAA) has never been more relevant. The last 5 years have seen a rapid increase in publications and research in the field, with the development of new biomarkers for the disease, thanks to advances in MRI, amyloid positron emission tomography and cerebrospinal fluid biomarker analysis. The inadvertent development of CAA-like pathology in patients treated with amyloid-beta immunotherapy for Alzheimer's disease has highlighted the importance of establishing how and why CAA develops; without this information, the use of these treatments may be unnecessarily restricted. Our understanding of the clinical and radiological spectrum of CAA has continued to evolve, and there are new insights into the independent impact that CAA has on cognition in the context of ageing and intracerebral haemorrhage, as well as in Alzheimer's and other dementias. While the association between CAA and lobar intracerebral haemorrhage (with its high recurrence risk) is now well recognised, a number of management dilemmas remain, particularly when considering the use of antithrombotics, anticoagulants and statins. The Boston criteria for CAA, in use in one form or another for the last 20 years, are now being reviewed to reflect these new wide-ranging clinical and radiological findings. This review aims to provide a 5-year update on these recent advances, as well as a look towards future directions for CAA research and clinical practice.
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Affiliation(s)
- Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Roxana Carare
- Division of Clinical Neurosciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Charlotte Cordonnier
- Department of Neurology, Université de Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Steven M Greenberg
- J P Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie A Schneider
- Departments of Pathology and Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel M Verbeek
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Departments of Neurology and Laboratory Medicine, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
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19
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Aldrugh S, Sardana M, Henninger N, Saczynski JS, McManus DD. Atrial fibrillation, cognition and dementia: A review. J Cardiovasc Electrophysiol 2017; 28:958-965. [PMID: 28569383 DOI: 10.1111/jce.13261] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF) is one of the most common types of cardiac arrhythmia, particularly among older adults. AF confers a 5-fold risk for thromboembolic stroke as well as a 2-fold higher risk for congestive heart failure, morbidity, and mortality. Although stroke remains an important and impactful complication of AF, recent studies have shown that AF is independently associated with other neurological disorders, including cognitive impairment and dementia, even after adjusting for prior ischemic stroke. We performed a review of the published literature on the association between AF and cognitive status. Further, we reviewed studies investigating the underlying mechanisms for this association and/or reporting the impact of AF treatment on cognitive function. While most published studies demonstrate associations between AF and impaired cognition, no AF treatment has yet been associated with a reduced incidence of cognitive decline or dementia.
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Affiliation(s)
- Summer Aldrugh
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Mayank Sardana
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane S Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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20
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Dietzel J, Haeusler KG, Endres M. Does atrial fibrillation cause cognitive decline and dementia? Europace 2017; 20:408-419. [DOI: 10.1093/europace/eux031] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/07/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Joanna Dietzel
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
- German Center for Cardiovascular Research (DZHK)
- German Center for Neurodegenerative Disease (DZNE)
- ExcellenceCluster NeuroCure, Charité- Universitätsmedizin Berlin, Germany
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21
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Banach M, Jankowski P, Jóźwiak J, Cybulska B, Windak A, Guzik T, Mamcarz A, Broncel M, Tomasik T, Rysz J, Jankowska-Zduńczyk A, Hoffman P, Mastalerz-Migas A. PoLA/CFPiP/PCS Guidelines for the Management of Dyslipidaemias for Family Physicians 2016. Arch Med Sci 2017; 13:1-45. [PMID: 28144253 PMCID: PMC5206369 DOI: 10.5114/aoms.2017.64712] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Piotr Jankowski
- 1 Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Jóźwiak
- Institute of Health and Nutrition Sciences, Czestochowa University of Technology, Czestochowa, Poland
| | | | - Adam Windak
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Guzik
- Department of Internal Diseases and Rural Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Mamcarz
- 3 Department of Internal Diseases and Cardiology, 2 Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marlena Broncel
- Department of Internal Diseases and Clinical Pharmacology, Medical University of Lodz, Lodz, Poland
| | - Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | | | - Piotr Hoffman
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland
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22
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Mancini GJ, Baker S, Bergeron J, Fitchett D, Frohlich J, Genest J, Gupta M, Hegele RA, Ng D, Pearson GJ, Pope J, Tashakkor AY. Diagnosis, Prevention, and Management of Statin Adverse Effects and Intolerance: Canadian Consensus Working Group Update (2016). Can J Cardiol 2016; 32:S35-65. [DOI: 10.1016/j.cjca.2016.01.003] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 12/24/2022] Open
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23
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Wen YH, Wu SS, Lin CHR, Tsai JH, Yang P, Chang YP, Tseng KH. A Bayesian Approach to Identifying New Risk Factors for Dementia: A Nationwide Population-Based Study. Medicine (Baltimore) 2016; 95:e3658. [PMID: 27227925 PMCID: PMC4902349 DOI: 10.1097/md.0000000000003658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dementia is one of the most disabling and burdensome health conditions worldwide. In this study, we identified new potential risk factors for dementia from nationwide longitudinal population-based data by using Bayesian statistics.We first tested the consistency of the results obtained using Bayesian statistics with those obtained using classical frequentist probability for 4 recognized risk factors for dementia, namely severe head injury, depression, diabetes mellitus, and vascular diseases. Then, we used Bayesian statistics to verify 2 new potential risk factors for dementia, namely hearing loss and senile cataract, determined from the Taiwan's National Health Insurance Research Database.We included a total of 6546 (6.0%) patients diagnosed with dementia. We observed older age, female sex, and lower income as independent risk factors for dementia. Moreover, we verified the 4 recognized risk factors for dementia in the older Taiwanese population; their odds ratios (ORs) ranged from 3.469 to 1.207. Furthermore, we observed that hearing loss (OR = 1.577) and senile cataract (OR = 1.549) were associated with an increased risk of dementia.We found that the results obtained using Bayesian statistics for assessing risk factors for dementia, such as head injury, depression, DM, and vascular diseases, were consistent with those obtained using classical frequentist probability. Moreover, hearing loss and senile cataract were found to be potential risk factors for dementia in the older Taiwanese population. Bayesian statistics could help clinicians explore other potential risk factors for dementia and for developing appropriate treatment strategies for these patients.
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Affiliation(s)
- Yen-Hsia Wen
- From the School of Pharmacy, College of Pharmacy, Kaohsiung Medical University (Y-HW, S-SW); Department of Psychiatry (J-HT) and Department of Neurology (Y-PC), Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University (PY); and Department of Computer Science and Engineering, National Sun Yat-sen University (C-HRL, K-HT), Kaohsiung, Taiwan
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24
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Shah AD, Merchant FM, Delurgio DB. Atrial Fibrillation and Risk of Dementia/Cognitive Decline. J Atr Fibrillation 2016; 8:1353. [PMID: 27909476 DOI: 10.4022/jafib.1353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/14/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022]
Abstract
Emerging evidence suggests a link between atrial fibrillation and subsequent development of dementia. While a majority of risk can be attributed to cardioembolic stroke secondary to atrial fibrillation, additional risk is apparent, and may be driven by vascular inflammation and changes in cerebral perfusion. Medical therapies including anticoagulation, statin therapy, and angiotensin-renin-aldosterone axis antagonists may reduce dementia risk. Procedural therapies such as atrial fibrillation catheter ablation and left atrial appendage closure may also prove to be important mediators of acute and long-term risk. In this paper, we review the data supporting a link between atrial fibrillation and dementia syndromes, pathophysiologic mechanisms and the potential roles of medical and procedural therapies at reducing such risk.
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Affiliation(s)
- Anand D Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Faisal M Merchant
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - David B Delurgio
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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