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 The study can’t explain why people with dementia are more likely to
get the devices, which help control irregular heart rhythms,
according to the lead author.
“It may be completely appropriate,” Nicole Fowler said. “There may
be something that we haven’t been able to measure that makes people
with dementia need them more.”
Alternatively, she told Reuters Health that the difference could
represent family members or doctors choosing more aggressive
treatment for people with dementia.
Fowler worked on the new study while at the University of Pittsburgh
School of Medicine. She’s now affiliated with the Indiana University
Center for Aging Research in Indianapolis.
She and her colleagues write in a research letter in JAMA Internal
Medicine that people with dementia and a lesser form of thinking and
memory trouble known as mild cognitive impairment can also have
heart problems.
People with dementia, their family members and their doctors should
weigh the risks and benefits of using pacemakers, they add.
For the new study, the researchers analyzed data on 16,245 people
seen at 33 Alzheimer’s Disease Centers from September 2005 through
December 2011.
At their first visit to the centers, about 46 percent of people had
no evidence of dementia. Another 21 percent had mild cognitive
impairment and 33 percent had dementia.
Over the course of the study, four people out of every 1,000 who
didn’t have signs of dementia at their first visit received a
pacemaker each year. The rate increased to 4.7 per 1,000 people
among those with mild cognitive impairment and 6.5 per 1,000 people
among those with dementia.
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The researchers found that people with dementia were 60 percent more
likely to receive a pacemaker than those without dementia after
taking into account their age, sex, race, location, heart health,
blood pressure, stroke risk and cognitive decline during the study.
They write that the findings are counter to expectations that people
with serious and often fatal conditions might be treated less
aggressively.
Additional studies will be required to find out exactly why people
with dementia are more likely to receive pacemakers, Fowler said.
“Medical decisions for patients with dementia are really hard,” she
said. “We know from the data that families really struggle to make
medical decisions . . . It’s important to find out what are some of
the things patients and families need to support their decision
making.”
SOURCE: http://bit.ly/1qHE3Wz
JAMA Internal Medicine, online July 28, 2014.
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