Cognitive Decline in Older Patients With Non- ST Elevation Acute Coronary Syndrome

Sophie Z Gu, Benjamin Beska, Danny Chan, Dermot Neely, Jonathan A Batty, Jennifer Adams-Hall, Helen Mossop, Weiliang Qiu, Vijay Kunadian, Sophie Z Gu, Benjamin Beska, Danny Chan, Dermot Neely, Jonathan A Batty, Jennifer Adams-Hall, Helen Mossop, Weiliang Qiu, Vijay Kunadian

Abstract

Background Dementia is a growing health burden of an aging population. This study aims to evaluate the prevalence of cognitive impairment and the predictors of cognitive decline at 1 year in older patients with non-ST-elevation acute coronary syndrome undergoing invasive care. Methods and Results Older patients with non-ST-elevation acute coronary syndrome were recruited into the ICON1 study. Cognition was evaluated using Montreal Cognitive Assessment. The composite major adverse cardiovascular events comprised death, myocardial infarction, unplanned revascularization, stroke, and significant bleeding at 1 year. Of 298 patients, 271 had cognitive assessment at baseline, and 211 (78%) had follow-up Montreal Cognitive Assessment at 1 year. Mean age was 80.5±4.8 years. There was a high prevalence (n=130, 48.0%) of undiagnosed cognitive impairment (Montreal Cognitive Assessment score <26) at baseline. Cognitive impairment patients were more likely to reach major adverse cardiovascular events by Kaplan-Meier analysis ( P=0.047). Seventy-four patients (35.1%) experienced cognitive decline (Montreal Cognitive Assessment score drop by ≥2 points) at 1 year. Recurrent myocardial infarction was independently associated with cognitive decline at 1 year (odds ratio 3.19, 95% confidence interval 1.18-8.63, P=0.02) after adjustment for age and sex. Conclusions In older patients undergoing invasive management of non-ST-elevation acute coronary syndrome, there is a high prevalence of undiagnosed cognitive impairment at baseline. Recurrent myocardial infarction is independently associated with cognitive decline at 1 year. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT01933581.

Keywords: cognition; cognitive impairment; coronary artery disease; non‐ST‐segment–elevation acute coronary syndrome.

Figures

Figure 1
Figure 1
Flow diagram of ICON‐1 screening, recruitment, and cognition subgroup analysis. ACS indicates acute coronary syndrome; GP, general practitioner; ICON‐1, Study to Improve Cardiovascular Outcomes in High Risk Patients With Acute Coronary Syndrome.
Figure 2
Figure 2
Kaplan–Meier plot, demonstrating time to first MACE stratified by baseline cognitive status. Log‐rank test for equality of survival distributions demonstrates a significant difference between the survival curves (χ2=3.96, 1 degree of freedom, P=0.047). MACE indicates major adverse cardiovascular events (death, nonfatal myocardial infarction, urgent revascularization, stroke, and significant bleeding).
Figure 3
Figure 3
A, Histogram of the change in MoCA score from baseline to follow‐up. B, Parallel boxplots of the overall change in mean MoCA score at 1 year from baseline split by baseline cognition. MoCA indicates Montreal Cognitive Assessment.

References

    1. Fowkes R, Byrne M, Sinclair H, Tang E, Kunadian V. Coronary artery disease in patients with dementia. Coron Artery Dis. 2016;27:511–520.
    1. Newman AB, Fitzpatrick AL, Lopez O, Jackson S, Lyketsos C, Jagust W, Ives D, DeKosky ST, Kuller LH. Dementia and Alzheimer's disease incidence in relationship to cardiovascular disease in the Cardiovascular Health Study cohort. J Am Geriatr Soc. 2005;53:1101–1107.
    1. Breteler MM, Claus JJ, Grobbee DE, Hofman A. Cardiovascular disease and distribution of cognitive function in elderly people: the Rotterdam Study. BMJ. 1994;308:1604–1608.
    1. Aronson MK, Ooi WL, Morgenstern H, Hafner A, Masur D, Crystal H, Frishman WH, Fisher D, Katzman R. Women, myocardial infarction, and dementia in the very old. Neurology. 1990;40:1102–1106.
    1. Justin Zaman M, Stirling S, Shepstone L, Ryding A, Flather M, Bachmann M, Myint PK. The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP). Eur Heart J. 2014;35:1551–1558.
    1. Chan D, Lawson L, Kunadian V. Management of older patients presenting with non‐ST‐elevation acute coronary syndrome. EuroIntervention. 2018;14:e258–e260.
    1. Kunadian V, Neely RDG, Sinclair H, Batty JA, Veerasamy M, Ford GA, Qiu W. Study to Improve Cardiovascular Outcomes in high‐risk older patieNts (ICON1) with acute coronary syndrome: study design and protocol of a prospective observational study. BMJ Open. 2016;6:e012091.
    1. Batty J, Qiu W, Gu S, Sinclair H, Veerasamy M. One‐year clinical outcomes in older patients with non‐ST elevation acute coronary syndrome undergoing coronary angiography: an analysis of the ICON1 study. Int J Cardiol. 2019;274:45–51.
    1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–699.
    1. Krishnan K, Rossetti H, Hynan LS, Carter K, Falkowski J, Lacritz L, Cullum CM, Weiner M. Changes in Montreal Cognitive Assessment scores over time. Assessment. 2017;24:772–777.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA; Cardiovascular Health Study Collaborative Research Group . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–M156.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.
    1. Malek M, Kathy A, Sharon OC, David S, Edward WC. Trajectory and variability characterization of the Montreal Cognitive Assessment in older adults. Aging Clin Exp Res. 2018;30:993–998.
    1. Gharacholou SM, Reid KJ, Arnold SV, Spertus J, Rich MW, Pellikka PA, Singh M, Holsinger T, Krumholz HM, Peterson ED, Alexander KP. Cognitive impairment and outcomes in older adult survivors of acute myocardial infarction: findings from the translational research investigating underlying disparities in acute myocardial infarction patients’ health status registry. Am Heart J. 2011;162:860–869.e1.
    1. Volonghi I, Pendlebury ST, Welch SJV, Mehta Z, Rothwell PM. Cognitive outcomes after acute coronary syndrome: a population based comparison with transient ischaemic attack and minor stroke. Heart. 2013;99:1509–1514.
    1. Salzwedel A, Heidler M‐D, Haubold K, Schikora M, Reibis R, Wegscheider K, Jöbges M, Völler H. Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation. Vasc Health Risk Manag. 2017;13:55–60.
    1. Sundbøll J, Hováth‐Puhó E, Adelborg K, Schmidt M, Pedersen L, Bøtker HE, Henderson VW, Sørensen HT. Higher risk of vascular dementia in myocardial infarction survivors. Circulation. 2018;137:567–577.
    1. Duijndam S, Denollet J, Nyklíček I, Kupper N. Perceived cognition after percutaneous coronary intervention: association with quality of life, mood and fatigue in the THORESCI Study. Int J Behav Med. 2017;24:552–562.
    1. Deckers K, Schievink SHJ, Rodriquez MMF, Van RJ, van Oostenbrugge RJ, van Boxtel MPJ, Verhey FRJ, Köhler S. Coronary heart disease and risk for cognitive impairment or dementia: systematic review and meta‐analysis. PLoS One. 2017;12:e0184244.
    1. Stellos K, Panagiota V, Kögel A, Leyhe T, Gawaz M, Laske C. Predictive value of platelet activation for the rate of cognitive decline in Alzheimer's disease patients. J Cereb Blood Flow Metab. 2010;30:1817–1820.
    1. Abete P, Della‐Morte D, Gargiulo G, Basile C, Langellott A, Galizia G, Testa G, Vincenzo C, Bonaduce D, Cacciatore F. Cognitive impairment and cardiovascular diseases in the elderly. A heart‐brain continuum hypothesis. Ageing Res Rev. 2014;18:41–52.
    1. Thackeray JT, Hupe HC, Wang Y, Bankstahl JP, Berding G, Ross TL, Bauersachs J, Wollert KC, Bengel FM. Myocardial inflammation predicts remodeling and neuroinflammation after myocardial infarction. J Am Coll Cardiol. 2018;71:263–275.
    1. Leclercq F, Kassnasrallah S, Cesari JB, Blard JM, Macia JC, Messner‐Pellenc P, Mariottini CJ, Grolleau‐Raoux R. Transcranial Doppler detection of cerebral microemboli during left heart catheterization. Cerebrovasc Dis. 2001;12:59–65.
    1. Devapalasundarum AN, Silbert BS, Evered LA, Scott DA, MacIsaac AI, Maruff PT. Cognitive function in patients undergoing coronary angiography. Heart Asia. 2010;2:75–79.
    1. Fougère B, Delrieu J, Del Campo N, Soriano G, Sourdet S, Vellas B. Cognitive frailty: mechanisms, tools to measure, prevention and controversy. Clin Geriatr Med. 2017;33:339–355.
    1. Malek‐Ahmadi M, Powell JJ, Belden CM, O'Connor K, Evans L, Coon DW, Nieri W. Age‐ and education‐adjusted normative data for the Montreal Cognitive Assessment (MoCA) in older adults age 70–99. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2015;22:755–761.

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