Ann Intern Med：房颤增痴呆风险再添新证

　　伊朗学者的一项荟萃分析表明，在伴或不伴卒中病史的人群中，房颤均与认知缺损和痴呆风险升高相关。论文于2013年3月5日在线发表于《内科学年鉴》（Ann Intern Med）。

　　研究者检索了Medline、PsycINFO、Cochrane和EMBASE等数据库及相关参考文献，并确认了报告房颤与认知缺损相关性校正风险估计的前瞻性和非前瞻性研究。

　　结果显示，共有21项研究符合纳入标准。在首发或复发卒中患者中，以及在包括伴或不伴卒中病史的更广泛人群中，房颤与认知缺损风险升高均显著相关（相对危险度[RR] 2.70和1.40）。在后组人群中相关性不依赖于卒中病史，但更广泛人群研究存在显著异质性。将分析局限于前瞻性研究可得出相似结果。将分析局限于痴呆研究可降低异质性，但未显著改变综合估计值（RR 1.38）。

与房颤相关的拓展阅读：

• Eur Heart J：女性房颤可以提前预警
• Am J Cardiol：肾功能不全与房颤抗凝患者不良转归相关
• 伴房颤的肾病患者肾衰风险增加
• Christoph Diener：阿哌沙班会改变房颤防治的临床实践吗？
• JACC：房颤伴心衰患者的生活质量和运动能力
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Cognitive Impairment Associated With Atrial Fibrillation: A Meta-analysis

Background: Atrial fibrillation (AF) has been linked with an increased risk for cognitive impairment and dementia.

Purpose: To complete a meta-analysis of studies examining the association between AF and cognitive impairment.

Data Sources: Search of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE databases and hand search of article references.

Study Selection: Prospective and nonprospective studies reporting adjusted risk estimates for the association between AF and cognitive impairment.

Data Extraction: Two abstracters independently extracted data on study characteristics, risk estimates, methods of AF and outcome ascertainment, and methodological quality.

Data Synthesis: Twenty-one studies were included in the meta-analysis. Atrial fibrillation was significantly associated with a higher risk for cognitive impairment in patients with first-ever or recurrent stroke (relative risk [RR], 2.70 [95% CI, 1.82 to 4.00]) and in a broader population including patients with or without a history of stroke (RR, 1.40 [CI, 1.19 to 1.64]). The association in the latter group remained significant independent proof of clinical stroke history (RR, 1.34 [CI, 1.13 to 1.58]). However, there was significant heterogeneity among studies of the broader population (I² = 69.4%). Limiting the analysis to prospective studies yielded similar results (RR, 1.36 [CI, 1.12 to 1.65]). Restricting the analysis to studies of dementia eliminated the significant heterogeneity (P = 0.137) but did not alter the pooled estimate substantially (RR, 1.38 [CI, 1.22 to 1.56]).

Limitations: There is an inherent bias because of confounding variables in observational studies. There was significant heterogeneity among included studies.

Conclusion: Evidence suggests that AF is associated with a higher risk for cognitive impairment and dementia, with or without a history of clinical stroke. Further studies are required to elucidate the association between AF and subtypes of dementia as well as the cause of cognitive impairment.

Primary Funding Source: Deane Institute for Integrative Research in Atrial Fibrillation and Stroke at the Massachusetts General Hospital.