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 Older people who scored badly on a test of decision making and
problem-solving - so-called executive function skills - had nearly
double the risk of heart attack and 50 percent higher risk of stroke
compared to people who did better on the tests.
Since lower scores on cognitive function tests might indicate
previous vascular damage in the brain, the researchers expected a
connection to stroke risk, but were surprised to see an increased
risk for heart attack as well, said Dr. Behnam Sabayan of Leiden
University Medical Center in the Netherlands.
“This might reflect that damage to the vessels is a global
phenomenon in our body and when we see abnormalities in one organ we
should think about the other organs as well,” Sabayan, a coauthor of
the study, told Reuters Health by email. “This is another line of
evidence showing that pathologies at the levels of heart or the
brain are not independent.”
Neurologists and cardiologists should collaborate for early
detection of older people at risk for either cardiac or brain
vascular disorders, he said.
Researchers studied 3,926 older people in the Netherlands, Ireland
and Scotland. The average age was 75 years old, and participants had
either a history of heart disease or an increased risk for it due to
high blood pressure, diabetes or smoking, but no history of an
actual heart attack or stroke.
The researchers used four tests to assess the participants’
selective attention, decision processing speed, immediate memory and
delayed memory.
Over three years of follow-up there were 375 coronary events,
including heart attacks or deaths due to heart disease, and 155
strokes in the group.
The researchers divided the participants equally into three groups
based on their executive function skills scores at the beginning of
the study. Those in the lowest-scoring third were 85 percent more
likely to develop coronary heart disease and 51 percent more likely
to have a stroke than those in the highest-scoring third.
Those with lower scores were at higher risk even when the
researchers accounted for age, gender, education, body mass index,
blood pressure, total cholesterol, current smoking and history of
diabetes.
There were 69 strokes in the low-scoring group, compared with 48
strokes among those with high scores.
Scores on the memory tests did not appear to be related to heart
attack or stroke risk, the study team reports in Neurology.
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“This is just adding to the evidence to support what we already
know, there is a relationship between cardiovascular risk factors
and cognition,” said Dr. Olaoluwa Okusaga of the University of
Texas-Harris County Psychiatric Center in Houston, who was not part
of the new study.
“This study is novel in that they identified a specific domain,
executive function, as being predictive of cardiovascular risk,”
Okusaga told Reuters Health.
Executive function includes making decisions and weighing options,
so it could be that people with lower decision-making scores make
poorer decisions in their daily lives that make them more prone to
heart attack or stroke, he said.
Before doctors change what they do, this study should be replicated,
he noted, but in the meantime, keeping mentally active by doing
things like puzzles may help prevent cognitive decline.
Unlike innate intelligence, or IQ, cognitive abilities can change
over time and are more vulnerable to exposure to factors like
uncontrolled blood pressure in midlife, Sabayan said.
Older people with slower thought processing are less likely to
follow physicians' lifestyle and medical recommendations, he said.
“Therefore, our findings highlight that older subjects with impaired
cognition need closer attention in terms of cardiovascular risk
management,” he said.
“This does not mean that everyone should undergo cognitive
assessment to determine their heart attack or stroke risk, instead
it means when older patients present with cognitive problems their
physician should take into account risk of future cardiovascular
events and provide preventive care,” he said.
SOURCE: http://bit.ly/1M9QMev Neurology, online August 5, 2015.
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