A new study analyzed research between 1971 and 2019 of more than 30,000 people.
The data found more than 1,000 patients who had a heart attack during the research experienced cognitive decline (not Alzheimer's or dementia) at a small, but more accelerated, rate, than those who did not have a heart attack.
Researchers can’t explain the link, but Dr. Carl Horton, a cardiologist with Texas Health Cleburne and Texas Health Physicians Group, spoke with KERA’s Sam Baker about some possibilities.
Inflammation
When you have inflammation in the arteries or vessels, that puts you at risk for developing plaque or stenosis within the arteries. And from those you would be at risk for having immune mediators’ antibodies that can affect the vessels. And some of this is thought to contribute to cerebral hyperperfusion of the brain over an extended period of time.
Congestive heart failure
Also, when patients have a myocardial infarction, they sometimes develop congestive heart failure afterward. They can also be at risk for arrhythmias. And also sometimes, if they have severe congestive heart failure, they can develop severe hypotension, or lower blood pressure, which can also affect the brain.
Medication
Some medications may cross the blood-brain barrier and therefore affect cognitive function. Some patients, you know, could be having micro strokes and not know it, and that could be affecting their cognitive function.
And so with those conditions in addition to coronary artery disease, you really have to kind of raise the radar and know that our patients could be affected by this in the future.
One possible explanation that was also given may be depression after having a heart attack.
I think patients before they have their first event feel invincible. They feel like, you know, that nothing is ever going to hurt them or happen to them. And after they have a major event, it really weighs on their psyche and they base their mortality for the first time.
So is this something that you or other cardiologists talk about with your patients after having heart attacks?
Well, I definitely talk about depression potentially, you know, post a major post-bypass surgery, because we do see clinical depression that I encourage patients to seek treatment or therapy if they need it.
What is the takeaway from all of this? What steps should people take to avoid the possible risk of cognitive decline stemming from a heart attack?
You want to focus on the prevention of atherosclerosis or coronary artery disease, which could hopefully improve your cognitive function as you get older. Certainly, you can't prevent all age-related cognitive decline, but it happens in most patients as they get older. But you don't want it to accelerate or happen quicker than it otherwise would.
I think the second takeaway for practicing physicians and clinicians is to be mindful that this can occur and to try to watch out for it and try to diagnose it early if you can.
Some of the milder forms that we see are harder to diagnose. You need more specific neurologic testing. But certainly, if you hear from family members, their patients are having more difficulty than before, then they should be referred.
This is by no means a new topic. Researchers have been studying this possible time for a long time.
Correct. And, of course, there's going to be more of a focus on it because our population is aging. And so there's more research being done as to patients with cognitive decline or dementia, then I think that this is going to be a more studied topic in the future.
RESOURCES:
Cognitive decline accelerates after heart attack, study finds
Heart attack may speed up cognitive decline, study finds
Cognitive skills declined faster in the years after a heart attack
DSHS: Heart Disease and Stroke
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