Abstract
Background: We tested the hypothesis that surrogate markers of brain degeneration such as atrophy are more prevalent in persons with atrial fibrillation who are at risk for cognitive deficits. Methods: We analyzed the data from the 2,962 women and 2,239 men and added minority cohort of 256 men and 431 women (all aged ≥65 years) enrolled in the Cardiovascular Health Study. Examination components have included medical history questionnaires, measurement of ankle-brachial index, abdominal and carotid ultrasound studies, ambulatory electrocardiograms, and cerebral magnetic resonance imaging (MRI) over the past decade. Atrophy was graded using a nine point scale (1 through 9) based on severity of atrophy. Logistic regression analysis was performed to determine the relationship between atrial fibrillation and prominent atrophy after adjusting for potential confounders. Results: Atrial fibrillation was present in 125 (3.4%) of the 2775 participants who received an MRI at baseline evaluation. The mean mini mental status score (±SD) was similar among participants with atrial fibrillation compared to those without atrial fibrillation (27.8 ±2.3 versus 27.6 ±2.7, p=0.4). The proportion of participants with prominent sulcal atrophy (score of 4 or greater) was non significantly higher among patients with atrial fibrillation (61 of 125 and 1097 of 2650, p=0.1). The proportion of participants with prominent ventricular atrophy (score of 4 or greater) was non significantly higher among patients with atrial fibrillation (69 of 126 and 1287 of 2651, p=0.2). The proportion of participants with previous cortical infarction (46 of 125 and 765 of 2650, p=0.06) and marked perivascular space expansion (5 of 125 and 27 of 2650, p=0.006) on MRI was significantly higher among patients with atrial fibrillation and sulcal atrophy. After adjusting for age, gender, and previous infarction, participants with atrial fibrillation did not have a higher risk of prominent atrophy (odds ratio 0.7, 95% confidence interval 0.5 -0.9, p=0.005). Conclusions: We observed that brain atrophy was more prevalent among persons with atrial fibrillation but due to the age differences and the higher occurrence of previous infarctions.
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