Abstract 4139587: Age at First Diagnosis of Atrial Fibrillation and Longitudinal Cognitive Decline

Introduction: Evidence is limited to suggest possible associations between the age at first diagnosis of AF and cognitive decline. The two main goals of this study were: 1) to examine if a younger age at which AF onset occurs is linked to a higher rate of longitudinal cognitive decline; and 2) to ascertain whether AF duration may have a cumulative effect on cognitive decline over time. Methods: We retrospectively analyzed the Atherosclerosis Risk in Communities Study (ARIC) data from 1990 to 2013. Three cognitive tests were utilized to evaluate cognitive function: the Delayed Word Recall Test (DWRT), the Digit Symbol Substitution Test (DSST), and the Word Fluency Test (WFT). We divided participants into AF onset age groups (≤55, 56-65, and >65 years old) and used follow-up data to investigate the impact of AF onset age on 14-year cognitive deterioration. We also used data from all previous visits to visit 4 to classify AF duration. The association was estimated using the Generalized Estimating Equations (GEE) model. Results: Table 1 demonstrates the effect of varying the AF onset age and duration on the estimated cognitive change over 14 years of follow-up using our linear models. Participants who experienced their first episode of AF before age 65 showed a significantly higher loss in global cognitive Z score, the DWRT, but not in the DSST (after adjustments) or the WFT. Notably, participants with AF durations longer than 6 years exhibited a larger reduction in overall cognitive Z score, the DWRT, and the DSST. However, only AF durations over 9 years were significantly linked with the WFT. We also found no evidence that physical activities, smoking status, or alcohol consumption were additional risk factors for long-term cognitive impairment. Conclusion: Our investigation of cognitive decline across 14 years in patients in the ARIC cohort found that earlier onset of AF was linked with faster longitudinal cognitive deterioration. Furthermore, a longer AF illness history was linked to a higher rate of cognitive decline. However, when examining various cognitive scores, the age of onset and disease duration had slightly varied effects.