P3–161: Antithrombotic medication use and dementia incidence among people with mild cognitive impairment and atrial fibrillationстатья из журнала
Аннотация: Atrial fibrillation (AF) is an established risk factor for stroke and transient ischemic attacks (TIA), which in turn elevate dementia risk. However, AF also may be an independent risk factor for dementia. In the absence of an established cause for higher dementia incidence among patients diagnosed with AF, the role of antithrombotic medications, including both anticoagulants and antiplatelets, is investigated. Study participants included patients with mild cognitive impairment enrolled at a National Institutes on Aging Alzheimer's Disease Center (ADC) who were aged 50+ years and reported AF at any ADC visit prior to dementia diagnosis. Patients with documented stroke or TIA were excluded. Our exposure was time-varying self-reported antithrombotic medication use, assessed at every ADC visit. We modeled dementia incidence using logistic regression with generalized estimating equations, accounting for participant clustering within ADCs and adjusting for race, sex, education, marital status, and vascular disease score (simple count of hypertension, hypercholesterolemia, and diabetes). Our cohort included 412 participants, with an average baseline age of 78 years (SD: 8). Participants were followed for an average of 3.4 years (SD: 1.9) from baseline visit. Antithrombotics were used by 330 (80%) participants; 156 participants used anticoagulants only and 142 participants used antiplatelets only, while 32 participants reported using both medication types during follow-up. One-hundred four (25%) participants developed clinical dementia during follow-up. Participants taking antithrombotic medication, compared to participants not taking antithrombotic medication, had an estimated 60% higher dementia incidence risk (95% CI: 1.17–2.20; p=0.0035). Among participants taking anticoagulants only, compared to no antithrombotic medication use, the observed risk of dementia incidence was 71% higher (95% CI: 1.22–2.42, p=0.0021). In our cohort, antithrombotic medication use by participants with an MCI diagnosis and AF, in the absence of stroke or TIA, was associated with a higher risk of dementia incidence over an average of 3.4 years of follow-up. Further, the use of anticoagulants, the most commonly prescribed therapeutic regimen to treat AF, was observed to alter risk of dementia incidence significantly. Antithrombotic medications used to treat AF, anticoagulants particularly, may be responsible for triggering yet unidentified mechanisms that lead to higher dementia incidence.
Год издания: 2013
Авторы: Dana H. Meranus, Walter A. Kukull
Издательство: Wiley
Источник: Alzheimer s & Dementia
Ключевые слова: Cerebrovascular and Carotid Artery Diseases, Atrial Fibrillation Management and Outcomes, Neurological Disorders and Treatments
Открытый доступ: bronze
Том: 9
Выпуск: 4S_Part_15