Association of Abnormal P-Wave Indices With Dementia and Cognitive Decline Over 25 Years: ARIC-NCS (The Atherosclerosis Risk in Communities Neurocognitive Study)

Alejandra Gutierrez, Faye L. Norby, Ankit Maheshwari, Mary R. Rooney, Rebecca F. Gottesman, Thomas H. Mosley, Pamela L. Lutsey, Niki Oldenburg, Elsayed Z. Soliman, Alvaro Alonso, Lin Y. Chen

Research output: Contribution to journalArticle

Abstract

Background Abnormal P-wave indices (PWIs)-reflecting underlying left atrial abnormality-are associated with increased risk of stroke independent of atrial fibrillation. We assessed whether abnormal PWIs are associated with incident dementia and greater cognitive decline, independent of atrial fibrillation and ischemic stroke. Methods and Results We included 13 714 participants (mean age, 57±6 years; 56% women; 23% black) who were followed for dementia through the end of 2015. (Abnormal P-wave terminal force in lead V1, ≥4000 μV×ms), abnormal P-wave axis (>75° or <0°), prolonged P-wave duration (>120 ms), and advanced interatrial block were determined from ECGs at visits 2 to 4. Dementia was adjudicated by an expert panel using data from cognitive tests and hospitalization International Classification of Diseases codes. Cognitive function was measured longitudinally using 3 neuropsychological tests. Cox proportional hazards models were used to assess the association between time-dependent abnormal PWIs with incident dementia. Linear regression models were used to evaluate PWIs with cognitive function over time. At the conclusion of the study, 19%, 16%, 28%, and 1.9% of participants had abnormal P-wave terminal force in lead V1, abnormal P-wave axis, prolonged P-wave duration, and advanced interatrial block, respectively. During mean follow-up of 18 years, there were 1390 (10%) dementia cases. All abnormal PWIs except advanced interatrial block were associated with an increased risk of dementia even after adjustment for incident atrial fibrillation and stroke: multivariable hazard ratio of abnormal P wave terminal force in lead V1=1.60, 95% CI, 1.41 to 2.83; abnormal P-wave axis, hazard ratio =1.36, 95% CI, 1.17 to 2.57; prolonged P-wave duration, hazard ratio=1.60, 95% CI, 1.42 to 1.80. Only abnormal P-wave terminal force in lead V1 was associated with greater decline in global cognition. Conclusions Abnormal PWIs are independently associated with an increased risk of dementia. This novel finding should be replicated in other cohorts and the underlying mechanisms should be evaluated.

Original languageEnglish (US)
Pages (from-to)e014553
JournalJournal of the American Heart Association
Volume8
Issue number24
DOIs
StatePublished - Dec 17 2019

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Dementia
Atherosclerosis
Atrial Fibrillation
Cognition
Stroke
Linear Models
Neuropsychological Tests
International Classification of Diseases
Cognitive Dysfunction
Proportional Hazards Models
Electrocardiography
Hospitalization
Lead

Keywords

  • atrium
  • cognitive impairment
  • dementia
  • electrocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of Abnormal P-Wave Indices With Dementia and Cognitive Decline Over 25 Years : ARIC-NCS (The Atherosclerosis Risk in Communities Neurocognitive Study). / Gutierrez, Alejandra; Norby, Faye L.; Maheshwari, Ankit; Rooney, Mary R.; Gottesman, Rebecca F.; Mosley, Thomas H.; Lutsey, Pamela L.; Oldenburg, Niki; Soliman, Elsayed Z.; Alonso, Alvaro; Chen, Lin Y.

In: Journal of the American Heart Association, Vol. 8, No. 24, 17.12.2019, p. e014553.

Research output: Contribution to journalArticle

Gutierrez, Alejandra ; Norby, Faye L. ; Maheshwari, Ankit ; Rooney, Mary R. ; Gottesman, Rebecca F. ; Mosley, Thomas H. ; Lutsey, Pamela L. ; Oldenburg, Niki ; Soliman, Elsayed Z. ; Alonso, Alvaro ; Chen, Lin Y. / Association of Abnormal P-Wave Indices With Dementia and Cognitive Decline Over 25 Years : ARIC-NCS (The Atherosclerosis Risk in Communities Neurocognitive Study). In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 24. pp. e014553.
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title = "Association of Abnormal P-Wave Indices With Dementia and Cognitive Decline Over 25 Years: ARIC-NCS (The Atherosclerosis Risk in Communities Neurocognitive Study)",
abstract = "Background Abnormal P-wave indices (PWIs)-reflecting underlying left atrial abnormality-are associated with increased risk of stroke independent of atrial fibrillation. We assessed whether abnormal PWIs are associated with incident dementia and greater cognitive decline, independent of atrial fibrillation and ischemic stroke. Methods and Results We included 13 714 participants (mean age, 57±6 years; 56{\%} women; 23{\%} black) who were followed for dementia through the end of 2015. (Abnormal P-wave terminal force in lead V1, ≥4000 μV×ms), abnormal P-wave axis (>75° or <0°), prolonged P-wave duration (>120 ms), and advanced interatrial block were determined from ECGs at visits 2 to 4. Dementia was adjudicated by an expert panel using data from cognitive tests and hospitalization International Classification of Diseases codes. Cognitive function was measured longitudinally using 3 neuropsychological tests. Cox proportional hazards models were used to assess the association between time-dependent abnormal PWIs with incident dementia. Linear regression models were used to evaluate PWIs with cognitive function over time. At the conclusion of the study, 19{\%}, 16{\%}, 28{\%}, and 1.9{\%} of participants had abnormal P-wave terminal force in lead V1, abnormal P-wave axis, prolonged P-wave duration, and advanced interatrial block, respectively. During mean follow-up of 18 years, there were 1390 (10{\%}) dementia cases. All abnormal PWIs except advanced interatrial block were associated with an increased risk of dementia even after adjustment for incident atrial fibrillation and stroke: multivariable hazard ratio of abnormal P wave terminal force in lead V1=1.60, 95{\%} CI, 1.41 to 2.83; abnormal P-wave axis, hazard ratio =1.36, 95{\%} CI, 1.17 to 2.57; prolonged P-wave duration, hazard ratio=1.60, 95{\%} CI, 1.42 to 1.80. Only abnormal P-wave terminal force in lead V1 was associated with greater decline in global cognition. Conclusions Abnormal PWIs are independently associated with an increased risk of dementia. This novel finding should be replicated in other cohorts and the underlying mechanisms should be evaluated.",
keywords = "atrium, cognitive impairment, dementia, electrocardiography",
author = "Alejandra Gutierrez and Norby, {Faye L.} and Ankit Maheshwari and Rooney, {Mary R.} and Gottesman, {Rebecca F.} and Mosley, {Thomas H.} and Lutsey, {Pamela L.} and Niki Oldenburg and Soliman, {Elsayed Z.} and Alvaro Alonso and Chen, {Lin Y.}",
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T1 - Association of Abnormal P-Wave Indices With Dementia and Cognitive Decline Over 25 Years

T2 - ARIC-NCS (The Atherosclerosis Risk in Communities Neurocognitive Study)

AU - Gutierrez, Alejandra

AU - Norby, Faye L.

AU - Maheshwari, Ankit

AU - Rooney, Mary R.

AU - Gottesman, Rebecca F.

AU - Mosley, Thomas H.

AU - Lutsey, Pamela L.

AU - Oldenburg, Niki

AU - Soliman, Elsayed Z.

AU - Alonso, Alvaro

AU - Chen, Lin Y.

PY - 2019/12/17

Y1 - 2019/12/17

N2 - Background Abnormal P-wave indices (PWIs)-reflecting underlying left atrial abnormality-are associated with increased risk of stroke independent of atrial fibrillation. We assessed whether abnormal PWIs are associated with incident dementia and greater cognitive decline, independent of atrial fibrillation and ischemic stroke. Methods and Results We included 13 714 participants (mean age, 57±6 years; 56% women; 23% black) who were followed for dementia through the end of 2015. (Abnormal P-wave terminal force in lead V1, ≥4000 μV×ms), abnormal P-wave axis (>75° or <0°), prolonged P-wave duration (>120 ms), and advanced interatrial block were determined from ECGs at visits 2 to 4. Dementia was adjudicated by an expert panel using data from cognitive tests and hospitalization International Classification of Diseases codes. Cognitive function was measured longitudinally using 3 neuropsychological tests. Cox proportional hazards models were used to assess the association between time-dependent abnormal PWIs with incident dementia. Linear regression models were used to evaluate PWIs with cognitive function over time. At the conclusion of the study, 19%, 16%, 28%, and 1.9% of participants had abnormal P-wave terminal force in lead V1, abnormal P-wave axis, prolonged P-wave duration, and advanced interatrial block, respectively. During mean follow-up of 18 years, there were 1390 (10%) dementia cases. All abnormal PWIs except advanced interatrial block were associated with an increased risk of dementia even after adjustment for incident atrial fibrillation and stroke: multivariable hazard ratio of abnormal P wave terminal force in lead V1=1.60, 95% CI, 1.41 to 2.83; abnormal P-wave axis, hazard ratio =1.36, 95% CI, 1.17 to 2.57; prolonged P-wave duration, hazard ratio=1.60, 95% CI, 1.42 to 1.80. Only abnormal P-wave terminal force in lead V1 was associated with greater decline in global cognition. Conclusions Abnormal PWIs are independently associated with an increased risk of dementia. This novel finding should be replicated in other cohorts and the underlying mechanisms should be evaluated.

AB - Background Abnormal P-wave indices (PWIs)-reflecting underlying left atrial abnormality-are associated with increased risk of stroke independent of atrial fibrillation. We assessed whether abnormal PWIs are associated with incident dementia and greater cognitive decline, independent of atrial fibrillation and ischemic stroke. Methods and Results We included 13 714 participants (mean age, 57±6 years; 56% women; 23% black) who were followed for dementia through the end of 2015. (Abnormal P-wave terminal force in lead V1, ≥4000 μV×ms), abnormal P-wave axis (>75° or <0°), prolonged P-wave duration (>120 ms), and advanced interatrial block were determined from ECGs at visits 2 to 4. Dementia was adjudicated by an expert panel using data from cognitive tests and hospitalization International Classification of Diseases codes. Cognitive function was measured longitudinally using 3 neuropsychological tests. Cox proportional hazards models were used to assess the association between time-dependent abnormal PWIs with incident dementia. Linear regression models were used to evaluate PWIs with cognitive function over time. At the conclusion of the study, 19%, 16%, 28%, and 1.9% of participants had abnormal P-wave terminal force in lead V1, abnormal P-wave axis, prolonged P-wave duration, and advanced interatrial block, respectively. During mean follow-up of 18 years, there were 1390 (10%) dementia cases. All abnormal PWIs except advanced interatrial block were associated with an increased risk of dementia even after adjustment for incident atrial fibrillation and stroke: multivariable hazard ratio of abnormal P wave terminal force in lead V1=1.60, 95% CI, 1.41 to 2.83; abnormal P-wave axis, hazard ratio =1.36, 95% CI, 1.17 to 2.57; prolonged P-wave duration, hazard ratio=1.60, 95% CI, 1.42 to 1.80. Only abnormal P-wave terminal force in lead V1 was associated with greater decline in global cognition. Conclusions Abnormal PWIs are independently associated with an increased risk of dementia. This novel finding should be replicated in other cohorts and the underlying mechanisms should be evaluated.

KW - atrium

KW - cognitive impairment

KW - dementia

KW - electrocardiography

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