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Greater odds for lower cognitive function in older patients with persistent AF
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In community-dwelling older adults, persistent atrial fibrillation is associated with lower cognitive function, according to new data from the ARIC study.
There was no relationship between paroxysmal AF and cognitive function in the cohort, investigators wrote in a research letter to the Journal of the American College of Cardiology.
According to the study background, AF is associated with cognitive impairment and dementia independent of stroke, but it was not known whether AF burden had an effect on cognitive function.
Lin Yee Chen, MD, MS, associate professor and medical director of the cardiac electrophysiology laboratory, cardiovascular division, department of medicine, University of Minnesota Medical School, Minneapolis, and colleagues analyzed 325 participants from the ARIC cohort study (mean age, 76.9 years; 52.9% women) who completed their fifth visit as part of the study from 2011 to 2013, underwent a brain MRI scan and wore a leadless ECG monitor (Zio Patch, iRhythm Technologies) to detect AF. Median wear time of the monitor was 13.9 days (interquartile range [IQR], 13.3-14) and median analyzable time was 13.6 days (IQR, 12.8-13.8).
Lin Yee Chen
All participants underwent numerous neuropsychological tests addressing various cognitive domains.
Chen and colleagues reported that 8% of participants had AF as determined by the monitor and 4.6% had prior ischemic stroke. Of the 26 individuals with AF, 14 had paroxysmal AF (AF burden, 1%-6%) and 12 had persistent AF (AF burden, 100%).
Presence of any AF was not associated with lower cognitive scores after adjustment for clinical stroke, Chen and colleagues wrote.
However, they wrote, compared with individuals without AF, those with persistent AF had lower scores on the Digit Span Backward test (P = .04), the Trail Making Test, part B (P = .05) and the Animal Naming Test (P < .001), even after adjustment for ischemic stroke and subclinical cerebral infarct.
The results refute the hypothesis that a link between higher AF burden and lower cognitive function could be explained by subclinical cerebral infarcts, according to the researchers.
Limitations include a mostly white population, evaluation of cognitive scores at a single point in time, possible play of chance and a bimodal AF burden description, they wrote.
“These associations are significant as they suggest that higher [AF] burden may be related to lower cognitive function,” Chen said in a press release. “To determine [AF] burden, and not just the presence of [AF], continuous monitoring and analysis of all the data are required. Further research is needed to confirm these findings and the underlying mechanisms.”
According to the release, Chen was awarded a grant from the NHLBI to further study this issue. – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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