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   Vascular Medicine    
   Cardiology Today    
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   Understanding link between vascular disease, dementia critical for elderly    
      
   Kuller L, et al. J Am Coll Cardiol. 2016;doi:10.1016/j.jacc.2015.12.034.    
   Swardfager W, Black SE. J Am Coll Cardiol. 2016;doi:10.1016/j.ja   
   c.2016.01.007.    
      
   March 4, 2016    
   Adults aged at least 80 years are more likely to experience the effects of   
   dementia than CVD, according to research published in the Journal of the   
   American College of Cardiology.    
      
   Coronary artery calcium (CAC) was identified as a determinant of mortality,   
   CHD and MI in this population.    
      
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   Lewis H. K uller, MD, DrPH , emeritus professor, department of epidemiology,   
   Graduate School of Public Health, University of Pittsburgh, and colleagues   
   investigated the link between CAC, carotid intima-media thickness, stenosis   
   and ankle-brachial index --   
    all measures of subclinical CVD -- with the risk for dementia, CHD and   
   all-cause mortality. The study included 532 older adults who participated in   
   the Cardiovascular Health Study-Cognition Study between 1998 and 2013. The   
   mean age was 93 years.    
      
   All participants underwent a yearly cognitive evaluation at the clinic or   
   during home visits. Electron bean tomography scanning was used to measure CAC.    
      
   The final analysis included 311 of 433 patients who did not have clinical CAD   
   in 1998 or 1999. Of those, the majority were white women (n = 157).    
      
   According to the findings, 36% of patients had a CAC score > 400 Hounsfield   
   units. An elevated CAC score was associated with increased total mortality (HR   
   = 1.73; 95% CI, 1.18-2.54). Although only 16% of the 422 deaths reported were   
   determined to be    
   caused by dementia, 64% of all patients who died had been diagnosed with   
   dementia before their death. Twenty-five percent of the deaths were determined   
   to be due to CHD.    
      
   Women and blacks, the researchers reported, had lower CAC scores and fewer   
   white women had dementia (P = .19).    
      
   In addition, lower ankle-brachial index was associated with increased risk for   
   dementia for white women, whereas maximal percent stenosis was a strong   
   predictor of dementia for white men. By the end of the study, only 9% of the   
   remaining patients did not    
   have dementia.    
      
   "As age at first [MI] continues to rise, dementia will be an important   
   comorbidity and will affect treatment decisions and outcomes," Kuller said in   
   a press release. "If delay or prevention of atherosclerosis resulted in the   
   reduction or slowing of    
   progression of brain disease and subsequent incidence of dementia, then there   
   is the potential for a very substantial impact on reducing the majority of   
   dementia in very old ages."    
      
   Kuller also said there is a need "to test such hypotheses by substantially   
   modifying risk factors, slowing the progression of atherosclerosis and   
   determining whether such an effect will substantially reduce the incidence of   
   dementia and specific    
   neuropathology among older patients."    
      
   In a related editorial, Walter Swardfager, PhD, and Sandra E. Black, MD, both   
   of the LC Campbell Cognitive Neurology Unit, Hurvitz Brain Sciences Research   
   Program, Sunnybrook Research Institute, Toronto, noted that these findings   
   emphasize "the    
   importance of determining whether preventing atherosclerosis will also prevent   
   Alzheimer's disease. The question is germane because [Alzheimer's disease] is   
   the most common dementia diagnosis, and the clinical risk factors for [it] are   
   also risk factors    
   for atherosclerosis."    
      
   What is still unknown, according to Swardfager and Black, is "how exactly   
   [Alzheimer's disease] and vascular disease may be co-contributors or causally   
   related.    
      
   "As more individuals live to older ages, we can expect a dramatic increase in   
   the incidence and prevalence of dementia. Atherosclerosis, even if clinically   
   undeclared, will likely contribute to these cases, suggesting the importance   
   of pharmacological    
   and nonpharmacological management of vascular risk factors beginning in   
   midlife." - by Tracey Romero    
      
   D isclosure: The study was supported by NHLBI, the National Institute of   
   Neurological Disorders and Stroke, and the National Institute on Aging. The   
   researchers report no relevant financial disclosures. Swardfager reports   
   receiving funding from the    
   department of psychiatry at the Sunnybrook Research Institute and from the   
   Canadian Partnership for Stroke Recovery. Black reports receiving funding from   
   the Brill Chair in Neurology in the department of medicine at the University   
   of Toronto and the    
   Toronto Dementia Research Alliance as well as institutional grants from Biogen   
   Idec, Cognoptix, Eli Lilly, GE Healthcare, Novartis, Pfizer, Roche, Transition   
   Therapeutics and personal honoraria from Boehringer Ingelheim, Merck and   
   Novartis.    
      
        
        
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