Coronary Revascularization and Cognitive Decline

Gottesman, Rebecca F.; Johansen, Michelle C

doi:10.1001/jama.2021.5816

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…Indeed, other studies have found that depression is associated with both CAD and cognition and increases the risk of developing CAD [ 134 , 135 , 136 ], likely due to its pro-inflammatory state with increased levels of IL-1, IL-6 and TNF-alpha [ 137 , 138 ]. Other proposed mechanisms include decreased medication compliance, poor compliance to recommended healthy lifestyle changes [ 139 ], sympathoadrenal system hyperactivity [ 136 ], platelet hyperresponsiveness [ 140 ] and reduced heart rate variability [ 141 ]. Frailty rates are higher in patients with CI 1 year post-PCI, in comparison to patients without CI [ 128 ].…”

Section: Resultsmentioning

confidence: 99%

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review

Thong,

Quek,

Loo

et al. 2023

Biology

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Cognitive impairment (CI) shares common cardiovascular risk factors with acute myocardial infarction (AMI), and is increasingly prevalent in our ageing population. Whilst AMI is associated with increased rates of CI, CI remains underreported and infrequently identified in patients with AMI. In this review, we discuss the evidence surrounding AMI and its links to dementia and CI, including pathophysiology, risk factors, management and interventions. Vascular dysregulation plays a major role in CI, with atherosclerosis, platelet activation, microinfarcts and perivascular inflammation resulting in neurovascular unit dysfunction, disordered homeostasis and a dysfunctional neurohormonal response. This subsequently affects perfusion pressure, resulting in enlarged periventricular spaces and hippocampal sclerosis. The increased platelet activation seen in coronary artery disease (CAD) can also result in inflammation and amyloid-β protein deposition which is associated with Alzheimer’s Dementia. Post-AMI, reduced blood pressure and reduced left ventricular ejection fraction can cause chronic cerebral hypoperfusion, cerebral infarction and failure of normal circulatory autoregulatory mechanisms. Patients who undergo coronary revascularization (percutaneous coronary intervention or bypass surgery) are at increased risk for post-procedure cognitive impairment, though whether this is related to the intervention itself or underlying cardiovascular risk factors is debated. Mortality rates are higher in dementia patients with AMI, and post-AMI CI is more prevalent in the elderly and in patients with post-AMI heart failure. Medical management (antiplatelet, statin, renin-angiotensin system inhibitors, cardiac rehabilitation) can reduce the risk of post-AMI CI; however, beta-blockers may be associated with functional decline in patients with existing CI. The early identification of those with dementia or CI who present with AMI is important, as subsequent tailoring of management strategies can potentially improve outcomes as well as guide prognosis.

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Section: Resultsmentioning

confidence: 99%

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review

Thong,

Quek,

Loo

et al. 2023

Biology

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“…There is a large and controversial amount of literature evaluating the association with coronary revascularization and risk of incident dementia, [37][38][39][40][41][42][43][44][45] but few studies have evaluated this association with noncardiac surgery. [15][16][17][18][19][20] Silber et al 19 demonstrated similar results to ours with a lower rate of incident dementia in individuals who underwent appendectomy compared with a matched nonsurgical control group (HR 0.89; 95% CI 0.86-0.92; p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Association between surgery and rate of incident dementia in older adults: A population‐based retrospective cohort study

Reich,

Gill,

Eckenhoff

et al. 2024

J American Geriatrics Society

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BackgroundThe risk of incident dementia after surgery in older adults is unclear. The study objective was to examine the rate of incident dementia among older adults after elective surgery compared with a matched nonsurgical control group.MethodsWe conducted a population‐based, propensity‐matched retrospective cohort study using data from linked administrative databases in Ontario, Canada. All community‐dwelling individuals aged 66 years and older who underwent one of five major elective surgeries between April 1, 2007 and March 31, 2011 were included. Each surgical patient was matched 1:1 on surgical specialty of the surgeon at consultation, age, sex, fiscal year of entry, and propensity score with a patient who attended an outpatient visit with a surgeon of the same surgical specialty but did not undergo surgery. Patients were followed for up to 5 years after cohort entry for the occurrence of a new dementia diagnosis, defined from administrative data. Cause‐specific hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between surgery and the hazard of incident dementia. Subgroup and sensitivity analyses were performed.ResultsA total of 27,878 individuals (13,939 matched pairs) were included in the analysis. A total of 640 (4.6%) individuals in the surgical group and 965 (6.9%) individuals in the control group developed dementia over the 5‐year follow‐up period. Individuals who underwent surgery had a reduced rate of incident dementia compared with their matched nonsurgical controls (HR 0.88; 95% CI 0.80–0.97; p = 0.01). This association was persistent in most subgroups and after sensitivity analyses.ConclusionsElective surgery did not increase the rate of incident dementia when compared with matched nonsurgical controls. This could be an important consideration for patients and surgeons when elective surgery is considered.

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“…Its occurrence not only leads to the decline of physical function of patients, but also increases medical expenses 11 . Cognitive impairment post PCI has been a major unfavorable factor in the prognosis of patients 19 . Accumulating evidence has demonstrated that the occurrence of postoperative cognitive dysfunction (POCD) is not simply due to ACS, but may also be caused by factors such as surgical operation and intraoperative anesthesia 20,21 .…”

Section: Discussionmentioning

confidence: 99%

“…11 Cognitive impairment post PCI has been a major unfavorable factor in the prognosis of patients. 19 Accumulating evidence has demonstrated that the occurrence of postoperative cognitive dysfunction (POCD) is not simply due to ACS, but may also be caused by factors such as surgical operation and intraoperative anesthesia. 20,21 The etiological mechanism of brain dysfunction after cardiac surgery is mainly the formation of postoperative primary intracranial thrombus, hypoperfusion and inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Serum levels of 25-OH vitamin D levels predict cognitive impairments among acute coronary syndrome patients

Fu,

Li,

et al. 2023

Journal of Cardiovascular Medicine

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Background The cognitive impairment after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) has become a crucial clinical concern that cannot be ignored. However, studies on the early warning factors of cognitive impairment after PCI are still insufficient. Methods This study reviewed the postoperative cognitive function of 284 patients who underwent PCI in our hospital from June 2019 to June 2022. During the 21-day follow-up, all participants included in the analysis were divided into the cognitive impairment (CI) group (n = 82) and the noncognitive impairment (NCI) group (n = 186) according to their Montreal cognitive assessment (MoCA) scale. Participants’ serum 25(OH)D3 levels on admission and serum neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP) and S100β levels were measured 21 days after surgery. Results Age more than 65 years, hypertension, operation time longer than 60 min, left ventricular ejection fraction less than 50% and serum 25(OH)D3 less than 31.41 ng/ml were the risk factors for cognitive dysfunction in ACS patients 21 days after PCI. Serum levels of 25(OH)D3, NSE, S100β and GFAP were significantly higher in patients with cognitive impairment than in patients without cognitive impairment. Conclusion Postoperative serum NSE, S100β and GFAP levels were significantly negatively correlated with serum 25(OH)D3 levels at admission. The serum 25(OH)D3 level is a risk factor and predictor of cognitive impairment in patients with ACS after PCI.

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Coronary Revascularization and Cognitive Decline

Cited by 6 publications

References 18 publications

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review

Association between surgery and rate of incident dementia in older adults: A population‐based retrospective cohort study

Serum levels of 25-OH vitamin D levels predict cognitive impairments among acute coronary syndrome patients

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