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.
Bibliographical noteFunding Information:
Grant Support: The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute , National Institutes of Health , Department of Health and Human Services , under Contract nos. ( HHSN268201700001I , HHSN268201700002I , HHSN268201700003I , HHSN268201700005I , HHSN268201700004I ). Neurocognitive data is collected by U01 2U01HL096812 , 2U01HL096814 , 2U01HL096899 , 2U01HL096902 , 2U01HL096917 from the NIH ( NHLBI , NINDS , NIA and NIDCD ), and with previous brain MRI examinations funded by R01HL70825 from the NHLBI . Funding for biospecimen collection and laboratory testing at ARIC Visit 6 was supported by grant R01DK089174 from the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH . This work was also supported by grants from the NHLBI [ R01HL126637-01A1 (LYC), R01HL141288 (LYC), T32HL007779 (MRR), K24HL148521 (AA)], and the American Heart Association [ 16EIA26410001 (AA)]. Reagents for the NT-proBNP assay were donated by the Roche Diagnostics Corporation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AHA.
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