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Multicenter Study
. 2017 Feb;67(655):e111-e117.
doi: 10.3399/bjgp16X688813. Epub 2016 Dec 19.

Impact of coronary heart disease on cognitive decline in Alzheimer's disease: a prospective longitudinal cohort study in primary care

Markus Bleckwenn  1 , Luca Kleineidam  2 , Michael Wagner  2 , Frank Jessen  3 , Siegfried Weyerer  4 , Jochen Werle  4 , Birgitt Wiese  5 , Dagmar Lühmann  6 , Tina Posselt  6 , Hans-Helmut König  7 , Christian Brettschneider  8 , Edelgard Mösch  9 , Dagmar Weeg  10 , Angela Fuchs  11 , Michael Pentzek  11 , Tobias Luck  12 , Steffi G Riedel-Heller  13 , Wolfgang Maier  14 , Martin Scherer  15
Affiliations
Multicenter Study

Impact of coronary heart disease on cognitive decline in Alzheimer's disease: a prospective longitudinal cohort study in primary care

Markus Bleckwenn et al. Br J Gen Pract. 2017 Feb.

Abstract

Background: Arteriosclerotic disorders increase the risk of dementia. As they have common causes and risk factors, coronary heart disease (CHD) could influence the course of dementia.

Aim: To determine whether CHD increases the speed of cognitive decline in Alzheimer's disease, and to discuss the potential for secondary cardiovascular prevention to modify this decline.

Design and setting: Prospective multicentre cohort study in general practices in six cities in Germany.

Method: Participants were patients with probable mild-to-moderate Alzheimer's dementia or mixed dementia (n = 118; mean age 85.6 [±3.4] years, range 80-96 years). The authors assessed the presence of CHD according to the family physicians' diagnosis. Cognitive performance was measured during home visits for up to 3 years in intervals of 6 months, using Mini Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SoB). The authors also recorded whether patients died in the observation period.

Results: At baseline, 65 patients (55%) had CHD and/or a heart condition following a myocardial infarction. The presence of CHD accelerated cognitive decline (MMSE, P<0.05) by about 66%, and reduced cognitive-functional ability (CDR-SoB, P<0.05) by about 83%, but had no impact on survival.

Conclusion: The study shows that CHD has a significant influence on cognitive decline in older patients with late-onset dementia. The dementia process might therefore be positively influenced by cardiovascular prevention, and this possible effect should be further investigated.

Keywords: Alzheimer’s disease; cardiovascular diseases; cardiovascular risk; cognitive decline; dementia; family practice; primary health care.

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Figures

Figure 1.
Figure 1.
Cognitive decline measured by MMSE. Range = 0–30. Lower scores indicate worse cognitive performance. CHD = coronary heart disease. MMSE = Mini Mental State Examination.
Figure 2.
Figure 2.
The course of cognitive and functional performance measured by CDR-SoB. Range = 0–18. Higher scores indicate worse cognitive and functional performance. CDR-SoB = Clinical Dementia Rating Sum-of-Boxes. CHD = coronary heart disease.
See this image and copyright information in PMC

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