| 1. |
- Ding, Mozhu, et al.
(författare)
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Atrial fibrillation and use of antithrombotic medications in older people : A population-based study
- 2017
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 249, s. 173-178
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Tidskriftsartikel (refereegranskat)abstract
- Background: Trends in the use of antithrombotic drugs in elderly patients with atrial fibrillation (AF) are largely unknown. We estimated the prevalence of AF in an older population, and examined whether use of anticoagulant and antiplatelet drugs in older AF patients has changed over time. Methods: Data from the population-based Swedish National study on Aging and Care in Kungsholmen (n = 3363, age = 60 years, 64.9% women) were used (2001-2004 and 2007-2010). AF cases were identified through 12-lead electrocardiogram, physician examinations, and patient register records (ICD-10 code I48). We used the CHADS(2) and CHA(2)DS(2)-VASc scores to estimate stroke risk, and an incomplete HAS-BLED score to estimate bleeding risk. Results: At baseline (2001-2004), 328 persons (9.8%) were ascertained to have AF. The prevalence of AF increased significantly with age from 2.8% in people aged 60-66 years to 21.2% in those = 90 years, and was more common in men than in women (11.2% vs. 9.0%). Among AF patients with CHADS2 score = 2 at baseline, 25% were taking anticoagulant drugs and 54% were taking antiplatelet drugs. High bleeding risk was significantly associated with not using anticoagulant drugs in AF patients (multi-adjusted OR = 2.50, p = 0.015). Between 2001-2004 and 2007-2010, use of anticoagulant drugs increased significantly, especially in AF patients with CHA2DS2-VASc score >= 2 (23% vs. 33%, p = 0.008) and in those with HAS-BLED score <3 (32% vs. 53%, p = 0.004). Conclusion: AF is common among old people. The use of anticoagulant drugs increased over time in AF patients, yet still two-thirds of those with high stroke risk remained untreated.
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| 2. |
- Ding, Mozhu, et al.
(författare)
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Atrial fibrillation, antithrombotic treatment, and cognitive aging : A population-based study
- 2018
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Ingår i: Neurology. - 0028-3878 .- 1526-632X. ; 91:19, s. e1732-e1740
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo examine the association of atrial fibrillation (AF) with cognitive decline and dementia in old age, and to explore the cognitive benefit of antithrombotic treatment in patients with AF.MethodsThis population-based cohort study included 2,685 dementia-free participants from the Swedish National Study on Aging and Care in Kungsholmen, who were regularly examined from 2001-2004 to 2010-2013. AF was ascertained from clinical examination, ECG, and patient registry. Global cognitive function was assessed using the Mini-Mental State Examination. We followed the DSM-IV criteria for the diagnosis of dementia, the NINDS-AIREN (National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherche et l'Enseignement en Neurosciences) criteria for vascular dementia, and the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) criteria for Alzheimer disease. Data were analyzed using multiple linear mixed-effects and Cox regression models.ResultsWe identified 243 participants (9.1%) with AF at baseline. During the 9-year follow-up period, 279 participants (11.4%) developed AF and 399 (14.9%) developed dementia. As a time-varying variable, AF was significantly associated with a faster annual Mini-Mental State Examination decline (beta coefficient = -0.24, 95% confidence interval [ CI]: -0.31 to -0.16) and an increased hazard ratio (HR) of all-cause dementia (HR = 1.40, 95% CI: 1.11-1.77) and vascular and mixed dementia (HR = 1.88, 95% CI: 1.09-3.23), but not Alzheimer disease (HR = 1.33, 95% CI: 0.92-1.94). Among people with either prevalent or incident AF, use of anticoagulant drugs, but not antiplatelet treatment, was associated with a 60% decreased risk of dementia (HR = 0.40, 95% CI: 0.18-0.92).Conclusion AF is associated with a faster global cognitive decline and an increased risk of dementia in older people. Use of anticoagulant drugs may reduce dementia risk in patients with AF.
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| 3. |
- Ding, Mozhu, et al.
(författare)
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Cerebral Small Vessel Disease Associated With Atrial Fibrillation Among Older Adults : A Population-Based Study.
- 2021
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Ingår i: Stroke. - : American Heart Association. - 0039-2499 .- 1524-4628. ; 52:8, s. 2685-2689
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Cerebral small vessel disease, as a potential mechanism underlying the association between atrial fibrillation (AF) and dementia, remains poorly investigated. In this cohort study, we sought to examine the association between AF and cerebral small vessel disease markers among older adults.METHODS: Data on 336 participants (age ≥60 years, mean 70.2 years; 60.2% women) free of dementia, disability, and cerebral infarcts were derived from the population-based Swedish National Study on Aging and Care in Kungsholmen. Structural brain magnetic resonance imaging examinations were performed at baseline (2001-2004) and follow-ups (2004-2007 and 2007-2010). Magnetic resonance imaging markers of cerebral small vessel disease included perivascular spaces, lacunes, and volumes of white matter hyperintensities, lateral ventricles, and total brain tissue. AF was assessed at baseline and follow-ups through clinical examinations, electrocardiogram, and medical records. Data were analyzed using linear mixed-effects models.RESULTS: At baseline, 18 persons (5.4%) were identified to have prevalent AF and 17 (5.6%) developed incident AF over the 6-year follow-up. After multivariable adjustment, AF was significantly associated with a faster annual increase in white matter hyperintensities volume (β coefficient=0.45 [95% CI, 0.04-0.86]) and lateral ventricular volume (0.58 [0.13-1.02]). There was no significant association of AF with annual changes in perivascular spaces number (β coefficient=0.53 [95% CI, -0.27 to 1.34]) or lacune number (-0.01 [-0.07 to 0.05]).CONCLUSIONS: Independent of cerebral infarcts, AF is associated with accelerated progression of white matter lesions and ventricular enlargement among older adults.
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| 4. |
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| 5. |
- Ding, Mozhu
(författare)
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The role of atrial fibrillation in cognitive aging : a population-based study
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The role of atrial fibrillation (AF) in brain and cognitive aging (e.g., cognitive decline and dementia) is still unclear. In this doctoral thesis, we aimed to investigate the temporal trends and potential determinants of dementia incidence, the occurrence of AF and the pattern of use of antithrombotic drugs, the association of AF with cognitive decline and dementia, and the association of AF with various structural brain abnormalities among older adults. Data were derived from the population-based Kungsholmen Project (KP), the Swedish National study on Aging and Care in Kungsholmen (SNAC-K), and the SNAC-K MRI sub-study. Study I. In the KP (1987-1989 to 1997-1998) and the SNAC-K (2001-2004 to 2010-2013) cohorts, 440 out of 1473 persons and 388 out of 1746 persons developed incident dementia, respectively. The incidence rate of dementia declined by 30% during the second decade (hazard ratio [HR] = 0.70; 95% confidence interval [CI]: 0.61-0.80). The decline was evident mainly among women and in people with low education. Vascular disorders and cognitive reserve factors explained only a small proportion of the decline (HR = 0.77, 95% CI: 0.65-0.90). Study II. In SNAC-K, 328 (9.8%) of 3363 persons were ascertained to have AF at baseline. The prevalence of AF increased with advancing age and was slightly higher than previously reported. From 2001-2004 to 2007-2010, the use of anticoagulant drugs substantially increased among people with AF, especially in people with high risk of stroke or low risk of bleeding. However, still two-thirds of those at high stroke risk remained untreated with anticoagulants. Study III. At baseline of SNAC-K, 243 (9.1%) of the 2685 dementia-free participants were identified to have AF. During the 9-year follow-up period, 279 (11.4%) people were ascertained to have incident AF and 399 (14.9%) developed incident dementia. As a time-varying variable, AF was associated with a faster annual decline in global cognition (β coefficient = -0.24, 95% CI: -0.31, -0.16) and a higher risk of all-cause dementia (HR = 1.40, 95% CI: 1.11-1.77) and vascular and mixed dementia (HR = 1.88, 95% CI: 1.09-3.23), but not Alzheimer’s disease. Among participants with AF, use of anticoagulant drugs, but not antiplatelets, was associated with a reduced risk of dementia (HR = 0.40, 95% CI: 0.18-0.92). Study IV. In the SNAC-K MRI sample, 39 (7.2%) of 540 people were identified to have AF at baseline. AF was associated with a higher odds ratio (OR) of the presence of cerebral infarcts (OR=3.98, 95% CI: 1.31-12.09). During the 6-year follow-up period, among 248 people who were free of cerebral infarcts, AF was associated with a faster increase in white matter hyperintensity volume (β coefficient = 0.45, 95% CI: 0.04-0.85) and lateral ventricular volume (β coefficient = 0.57, 95% CI: 0.13-1.02). Conclusion. Dementia incidence had declined among older adults from the late 1980s to the early 2010s, and improved cardiovascular health and cognitive reserve could only partially explain the decline. In addition, AF is common in old age, and despite an increase in the use of anticoagulant drugs among older people with AF over time, still two-thirds of those with high risk of stroke remained untreated. Furthermore, AF is associated with an accelerated cognitive decline and a greater risk of dementia, and the use of anticoagulant drugs may prevent older patients with AF from developing dementia. Finally, AF is associated with a faster increase in white matter lesions and brain atrophy in the absence of cerebral infarcts.
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| 6. |
- Ding, Mozhu, et al.
(författare)
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Tracing temporal trends in dementia incidence over 25 years in central Stockholm, Sweden
- 2020
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Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 16:5, s. 770-778
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Recent reports from high-income countries have suggested a declining incidence of dementia.Methods: Trends in dementia incidence over 25 years among people >= 75 years of age were examined using two population-based cohort studies: the Kungsholmen Project (KP, n = 1473, 1987-1998) and the Swedish National study on Aging and Care in Kungsholmen (SNAC-K, n = 1746, 2001-2013).Results: We identified 440 (29.9%) and 388 (22.2%) incident dementia cases in the KP and SNAC-K cohorts, respectively. The incidence of dementia declined by 30% (hazard ratio [HR] = 0.70; 95% confidence interval [CI] 0.61-0.80) during the second decade. Adjustment of education, psychosocial working conditions, lifestyle, and vascular diseases did not substantially change the results (HR = 0.77, 95% CI 0.65-0.90). This decline was observed particularly in women and people with elementary education.Discussion: Our study provides direct evidence of a declining trend in dementia incidence. Improved cognitive reserve and cardiovascular health could partially explain the decline.
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| 7. |
- Xia, Xin, et al.
(författare)
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From Normal Cognition to Cognitive Impairment and Dementia : Impact of Orthostatic Hypotension.
- 2021
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Ingår i: Hypertension. - : Wolters Kluwer. - 0194-911X .- 1524-4563. ; 78:3, s. 769-778
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Tidskriftsartikel (refereegranskat)abstract
- The role of orthostatic hypotension (OH) in the continuum of cognitive aging remains to be clarified. We sought to investigate the associations of OH with dementia, cognitive impairment, no dementia (CIND), and CIND progression to dementia in older adults while considering orthostatic symptoms. This population-based cohort study included 2532 baseline (2001–2004) dementia-free participants (age ≥60 years; 62.6% women) in the SNAC-K (Swedish National Study on Aging and Care in Kungsholmen) who were regularly examined over 12 years. We further divided the participants into a baseline CIND-free cohort and a CIND cohort. OH was defined as a decrease by ≥20/10 mmHg in systolic/diastolic blood pressure upon standing and further divided into asymptomatic and symptomatic OH. Dementia was diagnosed following the international criteria. CIND was defined as scoring ≥1.5 SDs below age group-specific means in ≥1 cognitive domain. Data were analyzed with flexible parametric survival models, controlling for confounding factors. Of the 2532 participants, 615 were defined with OH at baseline, and 322 were diagnosed with dementia during the entire follow-up period. OH was associated with an adjusted hazard ratio of 1.40 for dementia (95% CI, 1.10–1.76), 1.15 (0.94–1.40) for CIND, and 1.54 (1.05–2.25) for CIND progression to dementia. The associations of dementia and CIND progression to dementia with asymptomatic OH were similar to overall OH, whereas symptomatic OH was only associated with CIND progression to dementia. Our study suggests that OH, even asymptomatic OH, is associated with increased risk of dementia and accelerated progression from CIND to dementia in older adults.
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