Dementia and Heart Health: Are They Related?

Heart Disease Linked to Dementia in Women

Dementia and Heart Health: Are They Related? | Johns Hopkins Medicine

Older women with a history of heart disease and heart-related issues were more ly to develop dementia as well as thinking and memory problems than those without heart disease, according to the study “Cardiovascular Disease and Cognitive Decline in Postmenopausal Women” released in the Journal of the American Heart Association on Dec. 18, 2013.

“Our study provides new evidence on a broad scale, including many different types of heart disease with a specific focus on postmenopausal women,” said lead author Dr. Bernhard Haring, who is based at the Comprehensive Heart Failure Center at the University of Würzburg in Germany.

Female heart attack survivors twice as ly to see declines in memory, cognitive ability

Women who’d had a heart attack, in particular, were twice as ly to see declines in their thinking and memory skills, researchers found.

Haring and his colleagues used data from a long-term study of more than 6,000 women ages 65 to 79.

Researchers asked the women if they had ever been diagnosed with any heart problems. They also gave them a test of brain function at the beginning of the study and then once every year.

None of the women had thinking and memory problems at the outset. Close to 900 reported having heart disease.

About eight years later, more than 400 women showed signs of cognitive decline or dementia. Women who said they’d had heart disease were 29 percent more ly to have cognitive problems than those without heart disease.

Women who’d had a heart attack had the highest risk of developing thinking and memory trouble, the researchers reported in the Journal of the American Heart Association.

Those with a history of bypass surgery or peripheral vascular disease—hardening of the arteries that bring blood to the legs and feet—were also at greater risk, Haring said.

But neither an abnormal heart rhythm nor heart failure was linked to a decline in brain function.

High blood pressure, diabetes also linked to greater cognitive decline

Regardless of whether women had heart disease, those with high blood pressure and diabetes had a higher risk of cognitive decline. But no link was seen with obesity.

The new study is important because of the sheer number of women involved, Dr. Richard O’Brien said. He is chairman of Neurology at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, and wasn’t involved in the research.

Understanding the connection between heart disease and dementia is important because heart disease is reversible but Alzheimer’s disease is not, O’Brien said.

“Given that the number of individuals suffering from dementia is increasing in all developed countries, it is important and necessary to first investigate the reasons of why this is happening and to identify those particularly at risk and second to find measures on how to prevent and treat affected individuals,” Haring said.

An aging circulatory system could lead to worsening brain function in many ways, he said. Gradual buildup of plaque in the veins and arteries or inflammation may play a role, as could small bits of tissue death in the brain over time due to poor blood supply.

“Heart disease is more than just blocked arteries, it’s an inflammatory process as well and also affects the turnover of brain endothelial cells, cerebrospinal fluid production (which washes away bad things in the brain)—lots of things,” O’Brien told Reuters Health in an email. “Which exactly is the most important, nobody knows.”

About 35 percent of people over age 80 have dementia, he noted.

Women with any kind of heart disease should see their doctor on a regular basis, Haring said.

“Cardiovascular risk factors such as hypertension and in particular diabetes should be managed adequately as these may provide a link between (heart disease) and worsening cognitive functioning over time,” Haring said.


Tending to heart health may keep dementia at bay

Dementia and Heart Health: Are They Related? | Johns Hopkins Medicine

There's no definitive evidence about what can prevent Alzheimer's disease. But experts believe healthy behaviors that are good for your overall health can slow or delay some forms of dementia.

Heart and blood vessel health earlier in life is associated with Alzheimer’s and other dementia in later years. So, minimizing cardiovascular disease risk factors could help prevent damage to the brain that can lead to dementia, said Dr. Rebecca Gottesman, a professor of neurology and epidemiology at Johns Hopkins University.

“It’s probably important to control these risk factors, and it’s probably important to control them at a younger age,” she said.

Those with heart disease risks during middle age are more ly to have dementia when they are older, according to a study led by Gottesman in 2017. The research followed the progress of more than 15,000 people in four U.S. communities beginning in 1987 when the participants were 45 to 64 years old.

Middle-aged study participants who had heart disease risks such as high blood pressure, smoking or diabetes when the study began were more at risk for developing dementia later. The research found an especially high dementia risk in people who had diabetes in middle age.

In a separate study published last year, Gottesman looked at the presence of amyloid, or protein pieces that form plaque in the brain and are believed to be a main cause of Alzheimer’s.

That study showed people with such heart risks as high cholesterol, high blood pressure, diabetes, obesity and smoking in middle age were more ly to accumulate amyloid in the brain as they aged. The more of the risk factors present, the more ly amyloid was later detected.

The exact link between cardiovascular disease risk factors and dementia and Alzheimer’s isn’t clear, Gottesman said. But research suggests middle-age heart and vascular health may affect brain changes that cause deterioration.

Why is middle age so crucial?

It may be that middle age is a “critical window” for risk factors affecting dementia onset, Gottesman said. Or, it’s possible high blood pressure, diabetes, being overweight and smoking play a big role even in earlier in life, but the cumulative effects aren’t seen until middle age.

“Some of this damage can take decades to occur,” she said.

For instance, the sooner a smoker quits, the better. Smokers are at higher risk for chronic conditions such atherosclerosis, which is the buildup of fatty substances in the arteries. That buildup can lead to heart disease and stroke.

An estimated 5.7 million Americans have Alzheimer’s today and that number is increasing, according to the Alzheimer’s Association. Worldwide, it’s expected that 75 million people will have dementia by 2030 and that 131 million will by 2050.

“Often these diseases place burdens on families, financial and otherwise,” Gottesman said, adding that “no one is fully prepared.”

In 2018, the total direct cost for caring for people with Alzheimer’s will reach $277 billion in the United States. That number could rise to $1.1 trillion by 2050.

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Heart disease risk in middle age tied to dementia later

Dementia and Heart Health: Are They Related? | Johns Hopkins Medicine

Reuters Health – Middle-aged people with risk factors for heart attacks and stroke may be more ly to develop dementia in old age than people with healthy cardiovascular systems, a U.S. study suggests.

previous research, the current study linked so-called vascular risk factors such as diabetes, smoking, and high blood pressure to higher odds of dementia. However, the study also found an increased risk of dementia for older adults who had only slightly elevated blood pressure in middle age, a condition known as prehypertension.

“This study showed associations, but doesn’t prove that treating risk factors actually decreases risk,” said lead study author Dr. Rebecca Gottesman of the Johns Hopkins University School of Medicine in Baltimore.

“That being said, we know that it is important otherwise for your heart and brain health to control obesity, diabetes, and high blood pressure, and to quit smoking,” Gottesman said by email. “It is ly that controlling these over time is helpful for reducing dementia risk.”

The researchers examined data on 15,744 adults living in Maryland, North Carolina, Mississippi and Minnesota.

At the start, participants ranged in age from 44 to 66, with an average age of 57.

Roughly 25 years later, 1,516 people had been diagnosed with dementia, researchers report in JAMA Neurology.

The oldest participants were about eight times more ly to develop dementia than the youngest people in the study.

People with a gene, APOE, that’s associated with Alzheimer’s disease, were twice as ly to develop dementia as individuals without this gene.

Smoking in middle age was associated with 41 percent higher odds of dementia later on, while diabetes was linked to a 77 percent greater risk.

So-called prehypertension, when blood pressure is elevated but not high enough to be formally diagnosed as high blood pressure, was tied to a 31 percent higher lihood of dementia. Full-blown hypertension was associated with 39 percent greater odds of dementia.

The study wasn’t a controlled experiment designed to prove if or how poor cardiovascular health in middle age might contribute to dementia later in life.

It’s possible that vascular risk factors lead to strokes, which damage the brain and cause cognitive impairment, said Dr. Andrew Budson, chief of cognitive and behavioral neurology at the VA Boston Healthcare System and a researcher at Boston University.

Vascular disease might also hasten changes in the brain that contribute to Alzheimer’s, the most common type of dementia, Budson, who wasn’t involved in the study, said by email.

“Most of these modifiable risk factors, such as smoking, hypertension and diabetes, damage the endothelium – the inside of blood vessel walls – that in time, leads to strokes,” Budson added.

Healthy blood vessels in middle age may help protect against cognitive decline, said Dr. Jeffrey Burns, co-director of the University of Kansas Alzheimer’s Disease Center in Kansas City.

“These findings underscore the importance of taking action in mid-life to reduce the long-term risk of dementia,” Burns, who wasn’t involved in the study, said by email.

This may include quitting smoking or changing diet and exercise habits to reduce the risk of diabetes and high blood pressure, said Hannah Gardener, a neurology researcher at the University of Miami Medical School in Florida who wasn’t involved in the study.

The American Heart Association recommends the Dietary Approaches To Stop Hypertension (DASH) diet or a Mediterranean-style diet to help prevent cardiovascular disease. Both diets emphasize cooking with vegetable oils with unsaturated fats, eating nuts, fruits, vegetables, low-fat dairy products, whole grains, fish and poultry, and limiting red meat and added sugars and salt.

“Physical activity and adherence to a healthy diet, a Mediterranean-style diet, are powerful tools that can help at-risk individuals lose weight, reduce blood pressure and maintain healthy (blood sugar) levels,” Gardener said by email.

“Focusing on these risk factors even before midlife provides patients an opportunity to treat and reverse these risk factors with the goal of reducing their dementia risk before it is too late,” Gardener said.

SOURCE: JAMA Neurology, online August 7, 2017.

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