Is the Incidence of Dementia Greater than CHD in the Elderly?

Patients aged 80 and older without cardiovascular disease may be more likely to suffer from dementia than coronary heart disease (CHD), according to a study published Feb. 29 in the Journal of the American College of Cardiology.

Researchers led by Lewis H. Kuller, MD, DrPH, FACC, examined individuals over age 80 to determine if coronary artery calcium (CAC) levels predict risk of death and risk of dementia and CHD. A total of 532 participants from the Cardiovascular Health Study-Cognition Study were evaluated annually from 1998 to 2013. Results showed that patients with CAC levels of zero showed signs of dementia on average just over seven years from the initial measurement versus an average of just over five years for those with CAC scores over 400.

According to researchers, these results suggest several scenarios. The first is that the prevalence of dementia in older populations will likely increase as prevention and treatment of CHD improve and increase the longevity of the general population. A second scenario is that a zero or very low CAC score is associated with a low risk of dementia. However, due to the small sample size these results need to be replicated in other studies of the elderly. The final scenario is that cardiovascular risk factors such as high blood pressure, diabetes, smoking and not exercising that lead to the development of atherosclerosis and eventually CHD could also affect progression of brain pathology, such as the risk of dementia.

In an accompanying editorial, Sandra E. Black, MD, said the study highlights the importance of determining whether preventing atherosclerosis will also prevent dementia, including the most common form – Alzheimer’s disease. “The findings of Kuller and colleagues reinforce the notion that as more individuals live to older ages, we can expect a dramatic increase in the incidence and prevalence of dementia,” Black explains. “Atherosclerosis, even if clinically undeclared, will likely contribute to these cases, suggesting the importance of pharmacological and non-pharmacological management of vascular risk factors beginning in mid-life.”

Clinical Topics: Geriatric Cardiology, Prevention, Atherosclerotic Disease (CAD/PAD), Hypertension, Smoking, Sleep Apnea

Keywords: Aged, Alzheimer Disease, Atherosclerosis, Brain, Calcium, Cardiovascular Diseases, Cognition, Coronary Artery Disease, Diabetes Mellitus, Hypertension, Risk Factors, Smoking

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