Risk of Dementia in Adults With Congenital Heart Disease

Abstract

Editorial, see p XXXBACKGROUND: More children with congenital heart disease (CHD) are surviving to adulthood, and CHD is associated with risk factors for dementia. We compared the risk of dementia in CHD adults to that of the general population. METHODS:In this cohort study, we used medical registries and a medical record review covering all Danish hospitals to identify adults with CHD diagnosed between 1963 and 2012. These individuals with CHD were followed from January 1, 1981, 30 years of age, or date of first CHD registration (index date for matched members of the general population cohort) until hospital diagnosis of dementia, death, emigration, or end of study (December 31, 2012). For each individual with CHD, we identified 10 members of the general population utilizing the Danish Civil Registration System matched on sex and birth year. We computed cumulative incidences and hazard ratios (HRs) of dementia, adjusting for sex and birth year. RESULTS:The cumulative incidence of dementia was 4% by 80 years of age in 10 632 adults with CHD (46% male). The overall HR comparing adults with CHD with the general population cohort was 1.6 (95% confidence interval [CI], 1.3−2.0). The HR among individuals with CHD without extracardiac defects was 1.4 (95% CI, 1.1−1.8). Adults with mild-to-moderate CHD had an HR of 1.5 (95% CI, 1.1−2.0), whereas the HR was 2.0 (95% CI, 1.2−3.3) for severe CHD, including univentricular hearts. The HR for early onset dementia (<65 years of age) was 2.6 (95% CI, 1.8−3.8), whereas the late-onset HR was 1.3 (95% CI, 1.0−1.8).CONCLUSIONS: CHD was associated with an increased risk of dementia compared with the general population, in particular for early onset dementia. Further understanding of dementia risk in the population with CHD is a potential target for future investigation.

‘Big issues’ in neurodevelopment for children and adults with congenital heart disease

“…As the growing ACHD population ages, new concerns are emerging regarding an increased risk of neurocognitive decline and dementia, particularly early-onset dementia, compared with population norms 38 47. This may be evident earlier in life than typically expected and associated with tachycardia, atrial fibrillation, hypertension, stroke, disordered glucose metabolism, coronary artery disease and heart failure 47 48. Other risk factors for dementia are also more common in the CHD population, including genetic disorders and the impact of reduced exercise capacity.…”

“…Other risk factors for dementia are also more common in the CHD population, including genetic disorders and the impact of reduced exercise capacity. Adults with severe CHD are considered to have a greater risk of dementia, particularly those with single ventricle morphology 47…”

The new era of whole-exome sequencing in congenital heart disease: brand-new insights into rare pathogenic variants

“…Progress in CHD management is associated with improved survival and elevated risk for delayed cardiac complications, often in a multisystem-disease context encompassing neurodevelopmental and other congenital abnormalities (4). Genetic risk denotes the odds of becoming affected by a disorder; it may be elevated because of inherited genes causing or raising susceptibility to it.…”

Exaggerated systemic oxidative‐inflammatory‐nitrosative stress in chronic mountain sickness is associated with cognitive decline and depression

“…However, few studies have considered how lifelong exposure to hypoxia affects cognitive function and whether compensatory adaptations to sustain adequate tissue O 2 delivery prevent acute impairments from potentially progressing to irreversible dementia. The lack of information is surprising given an estimated 140 million high-altitude (HA) dwellers permanently live above 2500 m through economic and social necessity (Bailey et al 2018b) and an evolving body of literature indicating that hypoxaemia is responsible for the higher prevalence of cognitive impairment and dementia observed in patients living at sea level with cardiopulmonary disease (Peers et al 2009;Bagge et al 2018).…”