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Objectives: To determine whether rate or rhythm control strategy may affect cognition in older adults with atrial fibrillation (AF)., Design: Retrospective analysis of the REgistro POliterapie SIMI database., Setting: Italian internal medicine and geriatric wards., Participants: Individuals aged 65 and older (N=1,082, mean age 80.6 ± 7; 50% male) with AF before hospital admission (for any cause)., Measurements: Evaluation of cognitive performance using the Short Blessed Test (SBT) according to rhythm and rate control strategy, anticoagulant and antiplatelet therapy, age, education, and comorbidities., Results: Two hundred seventy-two participants (25%) received rhythm control therapy, 331 (30.6%) rate control therapy, and 479 (44.3%) no therapy of interest. Four hundred thirty-six (40.3%) in the total sample and in the different rhythm and rate control strategy groups were treated with an oral anticoagulant. Cognitive performance (mean SBT score) was found to be higher in the rhythm control group (7.5 ± 6.6) than in the no therapy (9.9 ± 7.9) and rate control (10.6 ± 8.3) (p<.001) groups. Logistic regression models adjusted for age, sex, education, anticoagulant and antiplatelet therapy, and comorbidities found that the rhythm control strategy (adjusted odds ratio (aOR)=0.56, 95% confidence interval (CI)=0.40-0.79, p=.001) and education (aOR 0.50, 95% CI=0.35-0.62; p<.001) were associated with less likelihood of cognitive impairment CONCLUSION: In the absence of anticoagulation, rhythm control of AF may protect against cognitive decline. J Am Geriatr Soc 66:2178-2182, 2018., (© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.)

Objectives: To evaluate whether the relationship between blood pressure (BP) measures and cognitive function is different according to age and functional status in older outpatients., Design: Cross-sectional., Setting: Outpatient hospital-based Milan Geriatrics 75+ Cohort Study., Participants: Individuals aged 75 and older (N = 1,540)., Measurements: Blood pressure, Mini-Mental State Examination (MMSE), basic activities of daily living (ADLs), and instrumental activities of daily living (IADLs) were assessed. Associations between BP measures and MMSE score were first analyzed in the total population using linear regression models and were then further examined according to strata of age, ADLs, and IADLs. All analyses were adjusted for sociodemographic factors and presence of comorbidities., Results: In the total population, higher systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP) were all associated with higher MMSE score (all P < .05). Each 10-mmHg higher SBP and DBP was associated with a 0.26- and 0.55-point higher MMSE score, respectively. The associations between MMSE score and SBP, DBP, and MAP differed materially according to strata of age and functioning and were most pronounced in those aged 85 and older, with ADL impairments, and with IADL impairments., Conclusion: Higher BP is associated with better cognitive function in the oldest old and in those with impaired functional status., (© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.)