Individuals who experience a myocardial infarction (heart attack) appear to have a faster cognitive decline over time than those who do not experience a myocardial infarction, according to a report published yesterday in JAMA Neurology.
The findings point to the importance of tracking the cognitive function of patients who have experienced a myocardial infarction and suggest that high-risk patients should be counseled on the potential cognitive ramifications of such an event, wrote lead author Michelle C. Johansen, M.D., Ph.D., of Johns Hopkins University and colleagues. “The findings also suggest that prevention of [myocardial infarction] may be a strategy to preserve brain health in older adults,” they added.
Johansen and colleagues analyzed data from six U.S. prospective cohort studies conducted from 1971 to 2019. The studies, which included repeated measures of cognition and blood pressure over time, included the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and the Northern Manhattan Study.
The sample included 30,465 individuals, average age 64, who had no history of myocardial infarction, dementia, or stroke at the time of their first cognitive assessment; 29% of the individuals were Black, 8% were Hispanic, 69% were White, and 56% were female. The individuals were followed for a median of 6.4 years, during which time 1,033 (3.4%) experienced one or more myocardial infarction events. The primary outcome measure was change in global cognition; secondary outcomes were changes in memory and executive function.
Overall, a myocardial infarction was not associated with immediate changes in global cognition, memory, or executive function. However, individuals with one or more myocardial infarction event demonstrated faster declines over the years after the myocardial infarction than those who did not have a myocardial infarction in all three measures of cognition: global cognition (−0.15 points per year), memory (−0.13 points per year), and executive function (−0.14 points per year). “[T]he decline in global cognition after … [myocardial infarction] was equivalent to 6 to 13 years of cognitive aging, representing an important public health problem,” Johansen and colleagues wrote.
They continued, “The lack of a significant cognitive change in the short term in the overall study population suggests that cognitive change is not secondary to acute illness or delirium but rather a sustained impairment in cognition.
In an accompanying editorial, Eric E. Smith, M.D., M.P.H., of the University of Calgary and Lisa C. Silbert, M.D., M.C.R., of Oregon Health and Science University, wrote, “Patients with history of [myocardial infarction] should be asked about cognitive symptoms periodically, with follow-up cognitive screening for patients in whom symptoms are endorsed by themselves or an informant. Referral to a cognitive specialist or neuropsychologist may be warranted in select cases.”
For related information see the Psychiatric News article, “Dementia Risk Higher in Patients With Atrial Fibrilation.”
(Image: Mohammed Haneefa Nizamudeen)