65 - 75 Yaş Arası Hastalarda Atriyal Fibrilasyonun Kognitif Fonksiyonlar Üzerine Etkileri

Öz

Amaç: Yaşlı popülasyonda en sık görülen aritmi olan atriyal fibrilasyon (AF), aynı zamanda iskemik inmenin de en sık nedenidir. İskemik inme bilişsel gerilemeyle doğrudan ilişkilidir. Atriyal fibrilasyon ile bilişsel gerileme arasındaki ilişki yıllardır inme ile ilişkilendirilmiştir. Bu çalışma, inmeden bağımsız olarak sadece atriyal fibrilasyon varlığının bilişsel işlevler üzerinde olumsuz etkilerinin olup olmadığını ortaya koymayı amaçlamıştır. Gereç ve Yöntem: Çalışmaya bilinen hipertansiyon dışında kronik hastalığı olmayan, 65-75 yaş arası erkek ve kadın hastalar dahil edildi. Elektrokardiyografi bulgularına göre hastalar yeni tanı alan AF grubu ve normal sinüs ritmi (NSR) grubu olmak üzere ikiye ayrıldı. Bilişsel işlevleri değerlendirmek amacıyla her iki gruba da Montreal Bilişsel Değerlendirme (MoCA) uygulandı ve gruplar sonuçlar açısından karşılaştırıldı. Bulgular: Gruplar arasında yaş, hasta özellikleri, eğitim durumu ve laboratuvar bulguları açısından istatistiksel olarak anlamlı fark yoktu. MoCA skoru AF grubunda NSR grubuna göre anlamlı derecede düşüktü (p=0,001). Çok değişkenli doğrusal regresyon analizi, düşük yaş ve yüksek eğitim durumunun bağımsız olarak yüksek MoCA puanıyla ilişkili olduğunu gösterdi (β: 3,392, %95 GA: 2,375- 4,410, p<0,001 / β: -0,478, %95 GA: -0,664 - -0,292, p<0,001, sırasıyla). Ayrıca AF, yaş ve eğitim durumundan bağımsız olarak düşük MoCA puanıyla ilişkili bulundu (β:-2,463, %95 GA: -3,448 - -1,478, p<0,001). Sonuç: AF, iskemik inmenin varlığından bağımsız olarak bilişsel gerileme için bir risk faktörüdür.

Anahtar Kelimeler

• Aritmi
• Atriyal fibrilasyon
• Bilişsel gerileme

Effects of Atrial Fibrıllation on Cognitive Functions in Patients Between 65-75 Years of Age

Öz

Objective: Atrial fibrillation (AF) is the most common arrhythmia in the elderly population and also the most common cause of ischemic stroke. Ischemic stroke is directly related to cognitive decline. The relationship between atrial fibrillation and cognitive decline has long been associated with stroke. This study aimed to reveal whether the mere presence of atrial fibrillation, independent of stroke, has negative effects on cognitive functions. Material and Method: Male and female patients between the ages of 65 and 75 with no chronic diseases other than known hypertension were included in the study. They were divided into two groups according to electrocardiography findings: the group with newly diagnosed atrial fibrillation and the group with normal sinus rhythm (NSR). To evaluate cognitive functions, the Montreal Cognitive Assessment (MoCA) was applied to both groups and then the groups were compared in terms of scores. Results: No statistically significant difference was observed between the groups in terms of age, patient characteristics, educational status, or laboratory findings. MoCA scores were significantly lower in the AF group than in the NSR group (p=0.001). Multivariable linear regression analysis demonstrated lower age and higher education status were independently associated with high MoCA scores (β: 3.392, 95% CI: 2.375 - 4.410, p<0.001 / β: -0.478, 95% CI: -0.664 - -0.292, p<0.001, respectively). In addition, AF was independently associated with low MoCA scores after adjustments by age and education status (β:-2.463, 95% CI: -3.448 - -1.478, p<0.001). Conclusion: AF is a risk factor for cognitive decline regardless of the presence of ischemic stroke.

Anahtar Kelimeler

• Arrhythmia
• Atrial fibrillation
• Cognitive decline

Kaynakça

1. Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res 2017;120:1501-1517.
2. Zhang J, Johnsen SP, Guo Y, Lip GYH. Epidemiology of atrial fibrillation: geographic/ecological risk factors, age, sex, genetics. Card Electrophysiol Clin 2021;13:1-23.
3. Sepehri Shamloo A, Dagres N, Müssigbrodt A, et al. Atrial fibrillation and cognitive impairment: new insights and future directions. Heart Lung Circ 2020;29:69-85.
4. Bunch TJ, Weiss JP, Crandall BG, et al. Atrial fibrillation is independently associated with senile, vascular, and Alzheimer’s dementia. Heart Rhythm 2010;7:433-437.
5. Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol 2007;6:611-619.
6. Farina E, Magni E, Ambrosini F, et al. Neuropsychological deficits in asymptomatic atrial fibrillation. Acta Neurol Scand 1997;96:310-316.
7. Washida K, Ihara M, Tachibana H, et al. Association of the ASCO classification with the executive function subscores of the Montreal cognitive assessment in patients with postischemic stroke. J Stroke Cerebrovasc Dis 2014;23:2250-2255.
8. Nasreddine ZS, Phillips NA, Bédirian V, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695-699.

9. Dautzenberg G, Lijmer J, Beekman A. Clinical value of the montreal cognitive assessment (MoCA) in patients suspected of cognitive impairment in old age psychiatry. Using the MoCA for triaging to a memory clinic. Cogn Neuropsychiatry 2021; 26:1–17.
10. Kumral E, Balkir K, Uzuner N, Evyapan D, Nalbantgil S. Microembolic signal detection in patients with symptomatic and asymptomatic lone atrial fibrillation. Cerebrovasc Dis 2001;12:192-196.
11. Udompanich S, Lip GY, Apostolakis S, Lane DA. Atrial fibrillation as a risk factor for cognitive impairment: a semi-systematic review. QJM 2013;106:795-802.
12. Ding M, Qiu C. Atrial fibrillation, cognitive decline, and dementia: an epidemiologic review. Curr Epidemiol Rep 2018;5:252-261.
13. Ömür SE, Zorlu Ç, Yılmaz M. Comparison of the relationship between inflammatory markers and atrial fibrillation burden. Anatol J Cardiol 2023;27:486-493.
14. Turan B. Value of CHADS-VASc score in diverse cardiovascular conditions. Turk Kardiyol Dern Ars 2023;51:83-84.
15. Conway DS, Pearce LA, Chin BS, Hart RG, Lip GY. Prognostic value of plasma von Willebrand factor and soluble P-selectin as indices of endothelial damage and platelet activation in 994 patients with nonvalvular atrial fibrillation. Circulation 2003;107:3141-3145.
16. Liu DS, Chen J, Jian WM, Zhang GR, Liu ZR. The association of atrial fibrillation and dementia incidence: a meta-analysis of prospective cohort studies. J Geriatr Cardiol 2019;16:298-306.
17. Kilander L, Andrén B, Nyman H, Lind L, Boberg M, Lithell H. Atrial fibrillation is an independent determinant of low cognitive function: a cross-sectional study in elderly men. Stroke 1998;29:1816-1820.
18. Park H, Hildreth A, Thomson R, O’Connell J. Non-valvular atrial fibrillation and cognitive decline: a longitudinal cohort study. Age Ageing 2007;36:157-163.
19. O’Connell JE, Gray CS, French JM, Robertson IH. Atrial fibrillation and cognitive function: case-control study. J Neurol Neurosurg Psychiatry 1998;65:386-389.
20. Rastas S, Verkkoniemi A, Polvikoski T, et al. Atrial fibrillation, stroke, and cognition: a longitudinal population-based study of people aged 85 and older. Stroke 2007;38:1454-1460.