Myocardial infarction is associated with accelerated cognitive decline

The development of myocardial infarction (MI) was associated with accelerated long-term cognitive decline, but not with acute cognitive decline.

At a median follow-up of 6.4 years, those who had a heart attack experienced a faster and more sustained decline in global cognition (-0.15 points per year, 95% CI -0.21 to -0.10), Michel reported. Johansen, M.D., Ph.D., Johns Hopkins University School of Medicine, Baltimore, and co-author.

Scores for memory (-0.13 points per year, 95% CI -0.22 to -0.04) and executive functioning (-0.14 points per year, 95% CI -0.20 to -0.08) also declined more rapidly over time in patients with myocardial infarction. bottom.

“We also quantified the magnitude of cognitive changes after myocardial infarction. Global cognitive decline after myocardial infarction corresponds to 6 to 13 years of cognitive aging and is an important public health problem.” ,” write Johansen et al. JAMA Neurology.

Race (P.=0.02) and gender (P.= 0.04) appeared to correct for global cognitive decline after MI, with steeper year-to-year declines in whites compared to blacks and men compared to women.

In an observational cohort study of over 30,000 adults, post-MI global cognition (-0.18 points, 95% CI -0.52 to 0.17) and executive functioning (-0.17 points, 95% CI -0.53 to 0.18) ) did not show a sharp drop. or memory (0.62 points, 95% CI -0.07 to 1.31).

Eric Smith, M.D., MPH, University of Calgary, Canada and Lisa Silbert, M.D., Ph.D., Oregon Health and Science University, MCR, notes that the slope of post-MI cognitive decline cannot be explained by stroke or new atrial fibrillation bottom. in Portland, Accompanying editorial.

“The lack of immediate cognitive decline followed by a sharp decline over the next few years suggests that MI is not an acute process, but a slow progressive process that accelerates cognitive decline. ,” write Smith and Silbert.

“One possibility is that there is progressive cardiac dysfunction due to ischemic cardiomyopathy, and changes in blood pressure and cardiac output can lead to cerebral ischemia,” the researchers observed. bottom. MI patients may be vulnerable to post-MI arrhythmias, or subclinical disease and ongoing inflammation, the researchers suggested. In addition, myocardial infarction may increase the risk of dementia-related depression.

“Although the mechanism of cognitive decline after myocardial infarction is unknown, the risk appears to be real,” Smith and Silbert said.

“Patients with a history of myocardial infarction should be queried about their cognitive symptoms on a regular basis, and those whose symptoms are corroborated by themselves or informants should undergo follow-up cognitive screening,” the researchers proposed. “In some cases, referral to a cognitive specialist or neuropsychologist may be warranted.”

Johansen et al., from six U.S. cohort studies from 1971 to 2019, included 30,465 adults without myocardial infarction, dementia, or stroke at the time of their first cognitive assessment. Curing risk” was studied.ARIC) Study, study on the development of coronary artery risk in young adults (Cardia), Cardiovascular Health Study (CHS), a study of Framingham descendants (FHS), Multiethnic Studies on Atherosclerosis (Mesa), and the North Manhattan Study (lease).

Incident MI was measured during cohort follow-up. The primary outcome measure was global cognitive change. Secondary outcomes were changes in memory and executive function. Results were normalized as a mean T-score of 50. A difference of 1 point represents a difference of 0.1 standard deviations in cognition. The mean number of global cognitive ratings after an MI event was 2.63.

The mean age at the first cognitive assessment was 60 years. Most participants (56%) were female. 23% were black, 8% Hispanic, and 69% white. Overall, 1,033 participants experienced one or more of her MIs, and 237 participants experienced two or more of her MIs. Those who had a second myocardial infarction did not show a sharp decline in global cognition after the second myocardial infarction, but a sharp decline in executive function.

Johansen and co-authors acknowledged that post-MI cognition measurements may have been taken months after the event, which may have led to an underestimation of acute cognitive changes.

In addition, some demographic data such as occupation and clinical factors such as symptoms of depression were also unknown. The number of post-MI cognitive assessments was also a study limitation.