Cognitive Decline May Accelerate After MI, Angina

JACC

Adults with incident coronary heart disease (CHD) may be at a higher risk for faster cognitive decline in the long-term, according to a study published June 17 in the Journal of the American College of Cardiology.

The study is one of the largest longitudinal studies investigating the progression of cognitive decline before and after CHD diagnosis. Wuxiang Xie, PhD, et al., included data from a total of 7,888 stroke-free participants from the English Longitudinal Study of Aging, a community-based, biannual, cohort study of adults age 50 and older, from 2002 – 2017. Individuals who had a history of stroke, heart attack and/or angina, had a confirmed diagnosis of dementia and/or Alzheimer's disease, or had an incident of stroke during follow-up were excluded.

Three cognitive tests were used to assess participants' cognitive function in eight waves across a 12-year follow-up period. First, verbal memory was assessed by testing immediate and delayed recall of 10 unrelated words. Second, participants were asked to orally name as many different animals as possible in one minute to test semantic fluency. Third, temporal orientation was assessed through four questions regarding the current date (day, month, year and day of the week). Higher scores indicated better cognitive function.

During the study period, 5.6 percent of participants experienced a myocardial infarction (MI) or angina. Those with CHD showed faster rates of cognitive decline in all three tests. Patients diagnosed with angina showed a robust decline in temporal orientation, whereas MI patients had significant cognitive decline in verbal memory and semantic fluency, and worse overall cognitive decline. The researchers found no association between cognitive decline and pre-CHD-diagnosis, nor a short-term cognitive decline after the CHD event occurred. They report that CHD might directly contribute to cognitive decline due to the lack of oxygen to the brain.

In an accompanying editorial comment, Suvi P. Rovio, PhD, said the links between cardiovascular and brain health suggest that compromised cardiovascular risk factor levels from early age may damage both vascular and neural tissues of the brain.

"This study provides evidence on the role of incident coronary heart disease as a possible factor bending the course of cognitive decline trajectory in older age," she said. "While primordial and primary prevention would be the most optimal outlooks to postpone clinical cognitive impairment, it is crucial to identify specific at-risk populations for targeted secondary and tertiary prevention."

Clinical Topics: Prevention, Sleep Apnea

Keywords: Cognition Disorders, Mild Cognitive Impairment, Longitudinal Studies, Tertiary Prevention, Risk Factors, Oxygen, Cardiovascular Diseases, Dementia, Alzheimer Disease, Stroke, Coronary Disease, Cognition, Myocardial Infarction, Brain, Primary Prevention


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