Cognitive status of patients with coronary artery disease and concomitant atrial fibrillation

封面

如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

Background. Cognitive impairment (CI) is a public health problem. Multimorbid patients with coronary artery disease (CAD) and atrial fibrillation (AF) are at higher risk of developing CI, which can lead to poorer quality of life, difficulty in adherence to medications, and a higher incidence of adverse drug reactions.

Objective. Assessment of cognitive functions (CF) in CAD patients depending on the presence of concomitant AF and bleeding.

Methods. The study included 150 patients ≥18 years of age with CAD, who were divided into 2 groups depending on the presence of concomitant AF: Group 1 – 77 CAD patients who received clopidogrel and acetylsalicylic acid (ASA) without AF (15 [20, 5%] women, mean age – 63 [57; 71] years), group 2 – 73 CAD patients with AF treated with clopidogrel and rivaroxaban/apixaban (15 [20.6%] women, mean age – 70 [61.5; 74.0] years). All patients underwent a retrospective assessment of hemorrhagic complications using a special questionnaire and assessment of CF using a number of neuropsychological tests: Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Trial Making Test (TMT, part A, B), Word Fluency Test, Word-List Recall Test, Stroop Color-Word Conflict Test.

Results. Among CAD patients with concomitant AF, there were statistically significantly fewer people with MMSE score 28–30 points, in contrast to CAD patients without AF (18 (24.3%) versus 33 (42.9%), respectively, p=0.003). Also, patients with concomitant AF spent statistically significantly more time completing Stroop test part 3 compared to CAD patients without AF (190 [153; 225] and 159 [122; 218.5], respectively, p=0.048). When analyzing the CF of patients depending on the presence of bleeding, the only statistically significant difference was revealed - patients without bleeding spent statistically significantly more time completing TMT part A than patients with a history of bleeding (100.3 [75; 125] versus 87.4 [63.8; 102.8], respectively, p=0.015).

Conclusion. The results of the neuropsychological study indicate an unfavorable effect of concomitant AF on the CF state of patients with CAD.

全文:

受限制的访问

作者简介

Valeria De

Russian Medical Academy of Continuous Professional Education

Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0002-3900-758X
SPIN 代码: 1817-6115
俄罗斯联邦, Moscow

Svetlana Batyukina

Russian Medical Academy of Continuous Professional Education

Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0003-1316-7654
SPIN 代码: 8409-9521
俄罗斯联邦, Moscow

Alexey Kochetkov

Russian Medical Academy of Continuous Professional Education

Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0001-5801-3742
SPIN 代码: 9212-6010
俄罗斯联邦, Moscow

Maria Klepikova

Russian Medical Academy of Continuous Professional Education

Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0003-4258-1889
SPIN 代码: 1718-1030
俄罗斯联邦, Moscow

Valeriy Konik

City Clinical Hospital n.a. F.I. Inozemtsev of the Moscow Healthcare Department

Email: ostroumova.olga@mail.ru
ORCID iD: 0009-0001-2306-1565
俄罗斯联邦, Moscow

Olga Ostroumova

Russian Medical Academy of Continuous Professional Education; I.M. Sechenov First Moscow State Medical University (Sechenov University)

编辑信件的主要联系方式.
Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0002-0795-8225
SPIN 代码: 3910-6585

Professor, Dr. Sci.(Med.), Head of the Department of Therapy and Multimorbid Pathology n.a. Academician M.S. Vovsi, Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases

俄罗斯联邦, Moscow; Moscow

参考

  1. Ушкалова Е.А., Ткачева О.Н., Рунихина Н.К. и соавт. Особенности фармакотерапии у пожилых пациентов. Введение в проблему. Рациональная фармакотерапия в кардиологии. 2016;12(1):94–100. [Ushkalova E.A., Tkacheva O.N., Runihina N.K. et al. Features of pharmacotherapy in elderly patients. An introduction to the problem. Rational pharmacotherapy in cardiology. 2016; 12(1):94–100. (In Russ.)]. doi: 10.20996/1819-6446-2016-12-1-94-100.
  2. GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105–25. doi: 10.1016/S2468-2667(21)00249-8.
  3. Eshkoor S.A., Hamid T.A., Mun C.Y., Ng C.K. Mild cognitive impairment and its management in older people. Clin Interv Aging. 2015;10:687–93. doi: 10.2147/CIA.S73922.
  4. Sierra C. Hypertension and the Risk of Dementia. Front Cardiovasc Med. 2020;7:5. doi: 10.3389/fcvm.2020.00005.
  5. Singh-Manoux A., Fayosse A., Sabia S., et al. Atrial fibrillation as a risk factor for cognitive decline and dementia. Eur Heart J. 2017;38(34):2612–18. doi: 10.1093/eurheartj/ehx208.
  6. Deckers K., Schievink S.H.J., Rodriquez M.M.F., et al. Coronary heart disease and risk for cognitive impairment or dementia: Systematic review and meta-analysis. PLoS One. 2017;12(9):e0184244. doi: 10.1371/journal.pone.0184244.
  7. Ortiz G.G., Huerta M., Gonzбlez-Usigli H.A., et al. Cognitive disorder and dementia in type 2 diabetes mellitus. World J Diabetes. 2022;13(4):319–37. doi: 10.4239/wjd.v13.i4.319.
  8. Kelly D.M., Rothwell P.M. Disentangling the Relationship Between Chronic Kidney Disease and Cognitive Disorders. Front Neurol. 2022;13:830064. doi: 10.3389/fneur.2022.830064.
  9. Трубникова О.А., Тарасова И.В., Мамонтова А.С. и др. Предикторы умеренных когнитивных расстройств у пациентов с ишемической болезнью сердца в сочетании с сахарным диабетом 2-го типа. Клиническая медицина. 2016;94(1):31–5. [Trubnikova O.A., Tarasova I.V., Mamontova A.S., et al. Predictors of moderate cognitive disorders in patients with coronary heart disease and type 2 diabetes mellitus. Klin Med (Mosk). 2016;94(1):31–5. (In Russ.)].
  10. Шаталова Н.А., Дзамихов К.К., Кочетков А.И. и др. Состояние когнитивных функций у полиморбидных пациентов с артериальной гипертензией, фибрилляцией предсердий и хронической болезнью почек. Медицинский алфавит. 2023;(33):50–6. [Shatalova N.A., Dzamikhov K.K., Kochetkov A.I., et al. Cognitive function status in polymorbid patients with arterial hypertension, atrial fibrillation and chronic kidney disease. Medical alphabet. 2023;(33):50–6. (In Russ.)]. doi: 10.33667/2078-5631-2023-33-50-56.
  11. Mozaffarian D., Benjamin E.J., Go A.S., et al. Heart disease and stroke statistics–2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–60. doi: 10.1161/CIR.0000000000000350.
  12. Карпов Ю.А., Сорокин Е.В. Стабильная ишемическая болезнь сердца: стратегия и тактика лечения. 2-е изд., перераб. и доп. М.: Медицинское информационное агентство, 2012. 271 с. [Karpov Yu.A., Sorokin E.V. Stable ischemic heart disease: strategy and tactics of treatment. 2nd ed., Revised and enlarged. Moscow: Medical Information Agency, 2012. 271 p. (In Russ.)].
  13. Карпов Ю.А., Кухарчук В.В., Лякишев А. и др. Диагностика и лечение хронической ишемической болезни сердца. Практические рекомендации. Кардиологический вестник. 2015;3:3–33. [Karpov Yu.A., Kuharchuk V.V., Ljakishev A. et al. Diagnosis and treatment of chronic ischemic heart disease. Clinical guidelines. Kardiologicheskij Vestnik. 2015;3:3–33. (In Russ.)].
  14. Александрова Г.А., Ахметзянова Р.Р., Голубев Н.А. и др. Здравоохранение в России. 2023: Статистический сборник. Росстат. М., 2023. 179 с. [Aleksandrova G.A., Akhmetzyanova R.R., Golubev N.A., et al. Healthcare in Russia. 2023: Statistical collection. Rosstat. M., 2023. 179 p. (In Russ.)].
  15. Otterstad J.E., Kirwan B.A., Lubsen J., et al. Action Investigators. Incidence and outcome of atrial fibrillation in stable symptomatic coronary disease. Scandinavian cardiovascular journal. 2006;40:152–59. doi: 10.1080/14017430600746268.
  16. Kralev S., Schneider K., Lang S., et al. Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography. PLoS One. 2011;6(9):e24964. doi: 10.1371/journal.pone.0024964.
  17. Michniewicz E., Mlodawska E., Lopatowska P., et al. Patients with atrial fibrillation and coronary artery disease - Double trouble. Adv Med Sci. 2018;63(1):30–5. doi: 10.1016/j.advms.2017.06.005.
  18. Kannel W.B., Abbott R.D., Savage D.D., McNamara P.M. Coronary heart disease and atrial fibrillation: The Framingham study. Am Heart J. 1983;106(2):389–96. doi: 10.1016/0002-8703(83)90208-9.
  19. Lip G., Freedman B., De Caterina R., Potpara T.S. Stroke prevention in atrial fibrillation: Past, present and future. Comparing the guidelines and practical decision-making. Thromb Haemost. 2017;117:1230–39. doi: 10.1160/TH16-11-0876.
  20. Valgimigli M., Bueno H., Byrne R.A., et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. 2018;39:213–60. doi: 10.1093/eurheartj/ehx419.
  21. Клинические рекомендации «Фибрилляция и трепетание предсердий у взрослых» 2020 г. Минздрав России. [Clinical Guidelines «Atrial fibrillation and flutter in adults» 2020. Ministry of Health of Russia. (In Russ.)].
  22. Hindricks G., Potpara T., Nikolaos D., et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42:373–498. doi: 10.1093/eurheartj/ ehaa612.
  23. Lam D.H., Bell S.M., Hira R.S. Concomitant Use of Antiplatelets and Anticoagulants in Patients with Coronary Heart Disease and Atrial Fibrillation: What Do Recent Clinical Trials Teach Us? Curr Atheroscler Rep. 2018;20:4. doi: 10.1007/s11883-018-0703-4.
  24. Alexander J.H., Wojdyla D., Vora A.N., et al. Risk/Benefit Tradeoff of Antithrombotic Therapy in Patients with Atrial Fibrillation Early and Late after an Acute Coronary Syndrome or Percutaneous Coronary Intervention. Circulation. 2020;141:1618–27. doi: 10.1161/CIRCULATIONAHA.120.046534.
  25. Andт G., Costa F. Double or triple antithrombotic therapy after coronary stenting and atrial fibrillation: A systematic review and meta-analysis of randomized clinical trials. Int J Cardiol. 2020;302:95–102. doi: 10.1016/j.ijcard.2019.12.054.
  26. Chudiak A., Uchmanowicz I., Mazur G. Relation between cognitive impairment and treatment adherence in elderly hypertensive patients. Clin Interv Aging. 2018;13:1409–18. doi: 10.2147/CIA.S162701.
  27. Bowman M., Mundell G., Grabell J, et al. Generation and validation of the Condensed MCMDM-1VWD Bleeding Questionnaire for von Willebrand disease. J Thromb Haemost. 2008;6:2062–66. doi: 10.1111/j.1538-7836.2008.03182.x.
  28. Nasreddine Z.S., Phillips N.A., Bйdirian V., et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–99. doi: 10.1111/j.1532-5415.2005.53221.x.
  29. Folstein M.F., Folstein S.E., McHugh P.R. «Mini-mental state». A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98. doi: 10.1016/0022-3956(75)90026-6.
  30. Reitan R. Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills.1958. 8. 271–76. doi: 10.2466/pms.1958.8.3.271.
  31. Strauss E. A compendium of neuropsychological tests: Administration, Norms, and Commentary. E. Strauss. Oxford: Oxford University Press. 2006. P. 1240.
  32. Morris J.C., Heyman A., Mohs R.C., et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology. 1989;39(9):1159–65. doi: 10.1212/wnl.39.9.1159.
  33. MacLeod C.M. Half a century of research on the Stroop effect: an integrative review. Psychol Bull. 1991.109(2):163–203. doi: 10.1037/0033-2909.109.2.163.
  34. Shavelle R.M., Paculdo D.R., Strauss D.J., et al. Cognitive impairment and mortality in the Cardiovascular Health Study. J Insur Med 2009;41:110–16.
  35. Gondim A.S., Coelho Filho J.M., Cavalcanti A.A., et al. Prevalence of functional cognitive impairment and associated factors in Brazilian community-dwelling older adults. Dement Neuropsychol. 2017;11:32–9. doi: 10.1590/1980-57642016dn11-010006.
  36. Mahon S., Parmar P., Barker-Collo S., et al. Determinants, prevalence, and trajectory of long-term post-stroke cognitive impairment: Results from a 4-year follow-up of the ARCOS-IV Study. Neuroepidemiology. 2017;49:129–34. doi: 10.1159/000484606
  37. Liang X., Huang Y., Han X. Associations between coronary heart disease and risk of cognitive impairment: A meta-analysis. Brain Behav. 2021;11:e02108. doi: 10.1002/brb3.2108.
  38. Selnes O.A., McKhann G.M. Neurocognitive complications after coronary artery bypass surgery. Ann Neurol. 2005;57(5):615–21. doi: 10.1002/ana.20481.
  39. Остроумова О.Д., Кочетков А.И., Остроумова Т.М. Фибрилляция предсердий и когнитивные нарушения: распространенность и патогенетические механизмы взаимосвязи (часть 1). Неврология, нейропсихиатрия, психосоматика. 2020;12(3):105–10. [Ostroumova O.D., Kochetkov A.I., Ostroumo-va T.M. Atrial fibrillation and cognitive impairment: prevalence and pathophysio- logical mechanisms for the relationship (Part 1). Neurology, Neuropsychiatry, Psychosomatics. 2020;12(3):105–10. (In Russ.)].
  40. Chen L.Y., Norby F.L., Gottesman R.F., et al. Association of Atrial Fibrillation With Cognitive Decline and Dementia Over 20 Years: The ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study). J Am Heart Assoc. 2018;7(6):e007301. doi: 10.1161/JAHA.117.007301.
  41. Marzona I., O’Donnell M., Teo K., et al. Increased risk of cognitive and functional decline in patients with atrial fibrillation: results of the ONTARGET and TRANSCEND studies. CMAJ. 2012;184(6):329–36. doi: 10.1503/cmaj.111173
  42. de Bruijn R.F., Heeringa J., Wolters F.J., et al. Association Between Atrial Fibrillation and Dementia in the General Population. JAMA Neurol. 2015;72(11):1288–94. doi: 10.1001/jamaneurol.2015.2161
  43. Graff-Radford J., Madhavan M., Vemuri P., et al. Atrial fibrillation, cognitive impairment, and neuroimaging. Alzheimers Dement. 2016;12(4):391–98. doi: 10.1016/j.jalz.2015.08.164.
  44. Gardarsdottir M., Sigurdsson S., Aspelund T., et al. Atrial fibrillation is associated with decreased total cerebral blood flow and brain perfusion. Europace. 2018;20(8):1252–58. doi: 10.1093/europace/eux220.
  45. Akoudad S., Wolters F.J., Viswanathan A., et al. Association of Cerebral Microbleeds With Cognitive Decline and Dementia. JAMA Neurol. 2016;73(8):934–43. doi: 10.1001/jamaneurol.2016.1017.
  46. Wilson D., Jдger H.R., Werring D.J. Anticoagulation for Atrial Fibrillation in Patients with Cerebral Microbleeds. Curr Atheroscler Rep. 2015;17(8):47. doi: 10.1007/s11883-015-0524-7.
  47. Granger C., Alexander J., McMurray J., et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–92. doi: 10.1056/NEJMoa1107039.
  48. Каратеев А.Е., Насонов Е.Л., Яхно Н.Н. и соавт. Клинические рекомендации «Рациональное применение нестероидных противовоспалительных препаратов (НПВП) в клинической практике». Современная ревматология. 2015;9(1):4–23. [Karateev A.E., Nasonov E.L., Yakhno N.N., et al. Clinical guidelines «Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice». Modern Rheumatology Journal. 2015;9(1):4–23. (In Russ.)]. doi: 10.14412/1996-70122015-1-4-23.
  49. Patel M., Mahaffey K., Garg J., et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883–91. doi: 10.1056/NEJMoa1009638.
  50. Schaefer J.K., Errickson J., Li Y., et al. Adverse Events Associated With the Addition of Aspirin to Direct Oral Anticoagulant Therapy Without a Clear Indication. JAMA Intern Med. 2021;181(6):817–24. doi: 10.1001/jamainternmed.2021.1197.
  51. Ciolek C.H., Lee S.Yi. Cognitive Issues in the Older Adult, in Guccione’s Geriatric Physical Therapy, 2020;p. 425–52). doi: 10.1016/C2017-0-00988-6.

补充文件

附件文件
动作
1. JATS XML

版权所有 © Bionika Media, 2024