Mild cognitive impairment in high-risk patients with chronic atrial fibrillation: a forgotten component of clinical management?

作者：Ball Jocasta; Carrington Melinda Jane; Stewart Simon^*

来源：Heart, 2013, 99(8): 542-547.

DOI：10.1136/heartjnl-2012-303182

Objective We examined cognitive function in older hospitalised patients with chronic atrial fibrillation (AF). %26lt;br%26gt;Design A prospective substudy of a multicentre randomised trial of an AF-specific disease management intervention (the Standard versus Atrial Fibrillation spEcific managmenT studY; SAFETY). %26lt;br%26gt;Setting Three tertiary referral hospitals within Australia. %26lt;br%26gt;Patients A total of 260 patients with chronic AF: mean age 72 +/- 11 years, 53% men, mean CHA(2)DS(2)-VASc score 4 +/- 2. %26lt;br%26gt;Interventions Cognitive function was assessed at baseline (during inpatient stay) using the Montreal Cognitive Assessment (MoCA). %26lt;br%26gt;Main Outcome Measures The extent of mild cognitive impairment (MCI-defined as a MoCA score %26lt;26) in AF patients and identification of independent predictors of MCI. %26lt;br%26gt;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; %26lt;8 years school education OR 5.29, 95% CI 1.95 to 14.36 vs 8-13 years), higher CHA(2)DS(2)-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). %26lt;br%26gt;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.

• 出版日期2013-4