Association Between Acute Myocardial Infarction and Cognition

Abstract

ImportanceThe magnitude of cognitive change after incident myocardial infarction (MI) is unclear.ObjectiveTo assess whether incident MI is associated with changes in cognitive function after adjusting for pre-MI cognitive trajectories.Design, Setting, and ParticipantsThis cohort study included adults without MI, dementia, or stroke and with complete covariates from the following US population-based cohort studies conducted from 1971 to 2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Data were analyzed from July 2021 to January 2022.ExposuresIncident MI.Main Outcomes and MeasuresThe main outcome was change in global cognition. Secondary outcomes were changes in memory and executive function. Outcomes were standardized as mean (SD) T scores of 50 (10); a 1-point difference represented a 0.1-SD difference in cognition. Linear mixed-effects models estimated changes in cognition at the time of MI (change in the intercept) and the rate of cognitive change over the years after MI (change in the slope), controlling for pre-MI cognitive trajectories and participant factors, with interaction terms for race and sex.ResultsThe study included 30 465 adults (mean [SD] age, 64 [10] years; 56% female), of whom 1033 had 1 or more MI event, and 29 432 did not have an MI event. Median follow-up was 6.4 years (IQR, 4.9-19.7 years). Overall, incident MI was not associated with an acute decrease in global cognition (−0.18 points; 95% CI, −0.52 to 0.17 points), executive function (−0.17 points; 95% CI, −0.53 to 0.18 points), or memory (0.62 points; 95% CI, −0.07 to 1.31 points). However, individuals with incident MI vs those without MI demonstrated faster declines in global cognition (−0.15 points per year; 95% CI, −0.21 to −0.10 points per year), memory (−0.13 points per year; 95% CI, −0.22 to −0.04 points per year), and executive function (−0.14 points per year; 95% CI, −0.20 to −0.08 points per year) over the years after MI compared with pre-MI slopes. The interaction analysis suggested that race and sex modified the degree of change in the decline in global cognition after MI (race × post-MI slope interaction term, P = .02; sex × post-MI slope interaction term, P = .04), with a smaller change in the decline over the years after MI in Black individuals than in White individuals (difference in slope change, 0.22 points per year; 95% CI, 0.04-0.40 points per year) and in females than in males (difference in slope change, 0.12 points per year; 95% CI, 0.01-0.23 points per year).ConclusionsThis cohort study using pooled data from 6 cohort studies found that incident MI was not associated with a decrease in global cognition, memory, or executive function at the time of the event compared with no MI but was associated with faster declines in global cognition, memory, and executive function over time. These findings suggest that prevention of MI may be important for long-term brain health.

Myocardial Infarction Bends the Curve of Age-Related Cognitive Decline, but How?

“…An acceleration in the annual rate of cognitive decline after MI was also seen in 7888 participants in the English Longitudinal Study on Aging, 2 of whom 254 had an MI and 286 had angina during up to 12 years of follow-up. Like the results reported by Johansen et al, 1 persons with incident MI or angina had annual rates of cognitive decline before MI similar to those of persons who never had an MI but then experienced accelerated cognitive decline after MI without an acute post-MI decrease in cognition.…”

“…The increase in the annual rate of decline was small in the study by Johansen et al 1 For example, for global cognition, it was 0.15 SDs of overall performance. However, it is possible that accruing subclinical decline over years or decades could eventually impair function or decrease cognitive reserve, making the person more vulnerable to the effects of age-related neurodegenerative pathologies.…”

“…It seems unlikely that immediate consequences of myocardial tissue injury are the explanation for the post-MI decline found in the study by Johansen et al 1 Although MI can cause left ventricular thrombus and embolism, stroke was excluded as the cause of the decline. Acute infarction with left ventricular dysfunction could cause cerebral hypoperfusion, but if that were the main driver, one might expect an acute decrease in cognitive test scores at the next visit, not a slow progressive decline over years.…”

“…3 In that systematic review, coronary heart disease was not associated with increased risk of dementia due to Alzheimer disease (hazard ratio, 1.07; 95% CI, 0.90-1.28), 3 raising the possibility that it was due to vascular cognitive impairment. However, in the study by Johansen et al, 1 the association between MI and dementia was not tested directly. What these epidemiological studies do not tell us is the reason for the post-MI acceleration in cognitive decline.…”

“…In this issue of JAMA Neurology, Johansen et al 1 reported that there was an acceleration of age-related cognitive decline following acute myocardial infarction (MI). In an analysis of more than 30 000 persons pooled from 6 major US epidemiological cohort studies, the 1033 individuals who had an MI during study follow-up had a steeper annual decline in cognition after the MI compared with before the MI.…”