| Objective: To study the incidence of cognitive dysfunction and risk factors for cognitive dysfunction in patients with AF.Methods: The clinical data collection and the evaluation of the cognitive function during the hospitalization should be completed. General population characteristics, personal history, characteristics of AF(type of AF such as primary AF,paroxysmal AF, permanent AF,andpersistent AF and duration from AF were diagnosed), complications, surgery, medication, laboratory results, echocardiogram were recorded. Calculation BMI according to height and weight.CHA2DS2- VASc score was used to assess the risk of thromboembolism. Using MMSE scale to evaluate total cognitive function and different fields including directional force, immediate memory, attention and calculation force,delayed memory ability, language ability. The total score was 30 points. Patients were divided into 3 groups depending on the scores of MMSE scale and education background: MMSE score≥27 points were normal; The diagnostic criteria of dementia:illiterate < 20 points, elementary <17 points, junior high school and above < 24 points. The others were mild cognitive dysfunction. Compare the clinical data between the three groups. Single factor analysis of variance and chi-square test were used to observate the various factors between the 3 groups. Compared measurement data between the two groups using the t test. Pearson correlation analysis were used to analysis two continuous variables correlation. Orderly classification Logistic regression analysis was used to finding out the risk factors for cognitive dysfunction.Rusult: 1. Characteristics of the sample:474 patients were included in this study and their average age was 72.66 ± 10.42. Each account for men and women were 228(48.1%) and 246(51.9%).There were30(6.3%)patients with primary AF,144(30.4%)patients with paroxysmal AF, 102(21.5%) patients with persistent AF and 198(41.8%) patients with permanent AF. Average MMSE score was 23.27±5.36 points. There were 324 patients have cognitive dysfunction, accounting for 68.35%.Mild cognitive dysfunction were 183 cases(38.60%) and dementia were 141(29.75%). The MMSE score and all fields had significant difference(P < 0.05) between 3 groups, and the comparison between each two groups in various aspects also had significant difference(P < 0.05). Mild cognitive dysfunction and dementia had lower score in various aspects comparing with normal group.2. Comparison between clinical data:The result show that age, BMI, daily drinking, education background, the type of AF, CHA2DS2- VASc score, history of radiofrequency ablation surgery, coronary heart disease, history of myocardial infarction, tardy arrhythmia and permanent pacemaker, malignant ventricular arrhythmia, left ventricular hypertrophy, severe cardiac insufficiency, left ventricular ejection fraction and left atrial diameter, stroke, type 2 diabetes, COPD, FPG, NT-pro BNP, D-dimer, Fbg, PLT and beta adrenergic receptor blockers, digoxin, statins applications had significant difference(P < 0.05). Pearson analysis showed that BMI, ejection fraction,age, duration from AF were diagnosed, left atrial diameter CHA2DS2-VASc score, FPG, NT-pro BNP, Fbg,D-dimer were correlated with MMSE score.Polytomous Ordinal Logistic Regression analysis showed that age(OR=1.034,95%CI:1.000-1.057), BMI(OR=0.926,95%CI:0.875-0.978), education background( illiteracy OR=7.800 95%CI:3.367-18.047, primary school OR=6.284 95%CI:2.995-13.197, junior high school OR=3.438,95%CI:1.706-6.931, high school and technical secondary school OR=2.147 95%CI:1.054-4.367)and type of AF(primary AF OR=0.188 95%CI:0.077-0.458,paroxysmal AF OR=0.196 95%CI:0.108-0.354, permanent AF OR=0.384,95%CI:0.205-0.720), no radiofrequency ablation surgery( OR=2.598 95%CI:1.823-6.190), no history of myocardial infarction( OR=0.305 95%CI:0.161-0.579),no tardy arrhythmia( OR=4.019 95%CI:1.675-9.641),no malignant ventricular arrhythmia(OR=0.120 95%CI:0.046-0.309), no left ventricular hypertrophy(OR=0.120 95%CI:0.038-0.377), NYHA Ⅰ-Ⅱ(OR = 0.436, 95% CI: 0.265-0.717), FPG(OR = 1.215, 95% CI: 1.049-1.408), Fbg(OR = 2.083, 95% CI: 1.523-2.847), no taking digoxin(OR = 0.234, 95% CI: 0.106-0.513).(note: The last item is the reference group in the Orderly classification Logistic regression analysis)Conclusion: 1.Patients with AF have a high incidence of cognitive dysfunction.2. BMI and ejection fraction have positively correlation with MMSE score.Age, duration from AF were diagnosed, left atrial diameter, CHA2DS2-VASc score, FPG, NT- pro BNP, Fbg, D-dimer have negatively correlation with MMSE score.3. Higher BMI, better education background, history radiofrequency ablation surgery, tardy arrhythmia are the protection factors for cognitive function in patients with atrial fibrillation;Age, type of AF, history of myocardial infarction, malignant ventricular arrhythmia, left ventricular hypertrophy, NYHA Ⅲ- Ⅳ, FPG, Fbg, taking digoxin are independent risk factors for cognitive dysfunction in patients with atrial fibrillation.The risk of cognitive dysfunction in patients with primary AF,paroxysmal AF, permanent AF,andpersistent AF are increasing. |
