Abstract:Both cognitive impairment and cardiovascular diseases have a high incidence in the elderly population, increasing the burden of care and reducing the quality of life. Studies have suggested that cognitive impairment interacts with cardiovascular diseases such as coronary heart disease, abnormal blood pressure, heart failure, and arrhythmia. On one hand, cognitive impairment in the elderly influences the progression and self-management of cardiovascular diseases and increases the risk of cardiovascular-related … Show more
“… 48 Moreover, the endothelial dysfunction that characterizes CMDs can disrupt the integrity of the blood–brain barrier, leading to impaired amyloid-β clearance. 49 At the intersection of many of these mechanisms is inflammation, which plays a well-established role in the pathogenesis of CMDs 50 and may accelerate the progression of both neurodegenerative and vascular brain pathologies. 51 , 52 Elucidating the mechanisms by which cardiometabolic multimorbidity impacts dementia will require future studies integrating longitudinal measures of cognitive function with neuropathological, genetic, and biomarker data.…”
Aims
Cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke, are established risk factors for dementia, but their combined impact has been investigated only recently. This study aimed to examine the association between mid- and late-life cardiometabolic multimorbidity and dementia and explore the role of genetic background in this association.
Methods and results
Within the Swedish Twin Registry, 17 913 dementia-free individuals aged ≥60 were followed for 18 years. CMDs [including age of onset in mid (60) or late (≥60) life] and dementia were ascertained from medical records. Cardiometabolic multimorbidity was defined as having ≥2 CMDs. Cox regression was used to estimate the CMD–dementia association in (i) a classical cohort study design and (ii) a co-twin study design involving 356 monozygotic and dizygotic pairs. By comparing the strength of the association in the two designs, the contribution of genetic background was estimated. At baseline, 3,312 (18.5%) participants had 1 CMD and 839 (4.7%) had ≥2 CMDs. Over the follow-up period, 3,020 participants developed dementia. In the classic cohort design, the hazard ratio (95% confidence interval) of dementia was 1.42 (1.27–1.58) for 1 CMD and 2.10 (1.73–2.57) for ≥2 CMDs. Dementia risk was stronger with mid-life as opposed to late-life CMDs. In the co-twin design, the CMD–dementia association was attenuated among monozygotic [0.99 (0.50–1.98)] but not dizygotic [1.55 (1.15–2.09)] twins, suggesting that the association was in part due to genetic factors common to both CMDs and dementia.
Conclusion
Cardiometabolic multimorbidity, particularly in mid-life, is associated with an increased risk of dementia. Genetic background may underpin this association.
“… 48 Moreover, the endothelial dysfunction that characterizes CMDs can disrupt the integrity of the blood–brain barrier, leading to impaired amyloid-β clearance. 49 At the intersection of many of these mechanisms is inflammation, which plays a well-established role in the pathogenesis of CMDs 50 and may accelerate the progression of both neurodegenerative and vascular brain pathologies. 51 , 52 Elucidating the mechanisms by which cardiometabolic multimorbidity impacts dementia will require future studies integrating longitudinal measures of cognitive function with neuropathological, genetic, and biomarker data.…”
Aims
Cardiometabolic diseases (CMDs), including diabetes, heart disease, and stroke, are established risk factors for dementia, but their combined impact has been investigated only recently. This study aimed to examine the association between mid- and late-life cardiometabolic multimorbidity and dementia and explore the role of genetic background in this association.
Methods and results
Within the Swedish Twin Registry, 17 913 dementia-free individuals aged ≥60 were followed for 18 years. CMDs [including age of onset in mid (60) or late (≥60) life] and dementia were ascertained from medical records. Cardiometabolic multimorbidity was defined as having ≥2 CMDs. Cox regression was used to estimate the CMD–dementia association in (i) a classical cohort study design and (ii) a co-twin study design involving 356 monozygotic and dizygotic pairs. By comparing the strength of the association in the two designs, the contribution of genetic background was estimated. At baseline, 3,312 (18.5%) participants had 1 CMD and 839 (4.7%) had ≥2 CMDs. Over the follow-up period, 3,020 participants developed dementia. In the classic cohort design, the hazard ratio (95% confidence interval) of dementia was 1.42 (1.27–1.58) for 1 CMD and 2.10 (1.73–2.57) for ≥2 CMDs. Dementia risk was stronger with mid-life as opposed to late-life CMDs. In the co-twin design, the CMD–dementia association was attenuated among monozygotic [0.99 (0.50–1.98)] but not dizygotic [1.55 (1.15–2.09)] twins, suggesting that the association was in part due to genetic factors common to both CMDs and dementia.
Conclusion
Cardiometabolic multimorbidity, particularly in mid-life, is associated with an increased risk of dementia. Genetic background may underpin this association.
“…After coronary artery bypass graft (CABG) surgery, arrhythmia is another common symptom, occurring in approximately 20 to 40% of patients [ 27 ]. Atrial fibrillation has been identified as a significant risk factor of cognitive impairment [ 28 , 29 ]. Moreover, CABG surgery is also related to cognitive impairments, with around 50% of patients with cognitive impairment after 1 to 5 years post-surgery [ 30 ].…”
Coronary heart disease (CHD) is one of the main cardiovascular diseases that can cause disability and death across the globe. Although previous research explored the links between CHD and cognitive deficits, only a subset of cognitive abilities was analyzed and a small clinical sample size was used. Thus, the aim of the current study is to assess how CHD can affect the cognitive domains of episodic memory, semantic verbal fluency, fluid reasoning, and numerical ability in a large cohort of participants from the United Kingdom. Results revealed that episodic memory, semantic verbal fluency, fluid reasoning, and numerical ability are negatively affected by CHD. Prevention and intervention should be developed to preserve cognitive abilities in people with CHD, but more studies should explore specific ways of doing so.
“…Multimorbidity is prevalent in the elderly population, particularly cardiovascular diseases co-occurring with cognitive deficits [ 30 , 31 ]. However, the pathogenesis of these comorbidities remains unclear, although it is possible that cardiovascular disease and cognition may share several biological pathways [ 31 ].…”
Section: Discussionmentioning
confidence: 99%
“…Multimorbidity is prevalent in the elderly population, particularly cardiovascular diseases co-occurring with cognitive deficits [ 30 , 31 ]. However, the pathogenesis of these comorbidities remains unclear, although it is possible that cardiovascular disease and cognition may share several biological pathways [ 31 ]. Cardiovascular diseases may induce vascular pathogenesis, structural changes in the brain, inflammation, immunomodulation, and endocrine and metabolic disorders.…”
The aim of this study was to identify dementia trajectories and their associated predictors among elderly Taiwanese people over a 14-year period using a nationwide representative longitudinal study. This retrospective cohort study was performed using the National Health Insurance Research Database. Group-based trajectory modeling (GBTM) was used to distinguish the specific trajectory groups of incident dementia during 2000–2013. All 42,407 patients were classified by GBTM to identify the trajectory of incident dementia, which included high- (n = 11,637, 29.0%), moderate- (n = 19,036, 44.9%), and low-incidence (n = 11,734, 26.1%) groups. Those diagnosed with hypertension (adjusted odds ratio [aOR] = 1.43; 95% confidence interval [CI] = 1.35–1.52), stroke (aOR = 1.45, 95% CI = 1.31–1.60), coronary heart disease (aOR = 1.29, 95% CI = 1.19–1.39), heart failure (aOR = 1.62, 95% CI = 1.36–1.93), and chronic obstructive pulmonary disease (aOR = 1.10, 95% CI = 1.02–1.18) at baseline revealed tendencies to be classified into high-incidence groups in dementia risk. The results from a 14-year longitudinal study identified three distinct trajectories of incident dementia among elderly Taiwanese people: patients with cardiovascular disease risk factors and cardiovascular disease events tended to be classified into high-incidence dementia groups. Early detection and management of these associated risk factors in the elderly may prevent or delay the deterioration of cognitive decline.
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