Frequent Premature Atrial Contractions Are Associated With Poorer Cognitive Function in the Atherosclerosis Risk in Communities (ARIC) Study

Mary R. Rooney, Faye L. Norby, Ankit Maheshwari, Pamela L. Lutsey, Samuel C. Dudley, Elsayed Z. Soliman, Laura R. Loehr, Thomas H. Mosley, Josef Coresh, Alvaro Alonso, Lin Y. Chen

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


OBJECTIVE: To evaluate the association of premature atrial contraction (PAC) frequency with cognitive test scores and prevalence of dementia or mild cognitive impairment (MCI).

MATERIALS AND METHODS: We conducted a cross-sectional analysis using Atherosclerosis Risk in Communities study visit 6 (January 1, 2016, through December 31, 2017) data. We included 2163 participants without atrial fibrillation (AF) (age mean ± SD, 79±4 years; 1273 (58.9%) female; and 604 (27.97.0% Black) who underwent cognitive testing and wore a leadless, ambulatory electrocardiogram monitor for 14 days. We categorized PAC frequency based on the percent of beats: less than 1%, minimal; 1% to <5%, occasional; greater than or equal to 5%, frequent. We derived cognitive domain-specific factor scores (memory, executive function, language, and global z-score). Dementia and MCI were adjudicated.

RESULTS: During a mean analyzable time of 12.6±2.6 days, 339 (15.7%) had occasional PACs and 107 (4.9%) had frequent PACs. Individuals with frequent PACs (vs minimal) had lower executive function factor scores by 0.30 (95% CI, -0.46 to -0.14) and lower global factor scores by 0.20 (95% CI, -0.33 to -0.07) after multivariable adjustment. Individuals with frequent PACs (vs minimal) had higher odds of prevalent dementia or MCI after multivariable adjustment (odds ratio, 1.74; 95% CI, 1.09 to 2.79). These associations were unchanged with additional adjustment for stroke.

CONCLUSION: In community-dwelling older adults without AF, frequent PACs were cross-sectionally associated with lower executive and global cognitive function and greater prevalence of dementia or MCI, independently of stroke. Our findings lend support to the notion that atrial cardiomyopathy may be a driver of AF-related outcomes. Further research to confirm these associations prospectively and to elucidate underlying mechanisms is warranted.

Original languageEnglish (US)
Pages (from-to)1147-1156
Number of pages10
JournalMayo Clinic Proceedings
Issue number5
StatePublished - May 2021

Bibliographical note

Publisher Copyright:
© 2021 Mayo Foundation for Medical Education and Research


  • Aged
  • Aged, 80 and over
  • Atherosclerosis/diagnosis
  • Atrial Premature Complexes/diagnosis
  • Cognitive Dysfunction/diagnosis
  • Cross-Sectional Studies
  • Dementia/diagnosis
  • Electrocardiography, Ambulatory
  • Female
  • Health Surveys
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Neuropsychological Tests
  • Prevalence
  • Risk Assessment
  • Risk Factors

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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