Heart Attack Survivors may be at Greater Risk of Mental Decline

The impact of a heart attack on the brain may be more severe than previously understood. According to a study presented at the 71st Annual Science Session of the American College of Cardiology, one in three survivors of a heart attack show significant mental decline in the days and months following a heart attack. The findings suggest that more attention needs to be paid to monitor cognitive function after a heart attack, the researchers said.“We found a very high prevalence of previously undiagnosed cognitive impairment among patients hospitalized due to myocardial infarction,” said Dominika Kasprzak, MD, a cardiologist at J. Strus Hospital in Poznan, Poland, and the study’s lead author. “This impairment can be both temporary and permanent, and some patients develop impairment after a delay of several months.”

The study assessed the mental functioning for any mental decline of 220 patients admitted to hospital with a heart attack in Poznan, Poland. Patients underwent two cognitive assessments a few days after the heart attack and then repeated the tests six months later. Two tests are the Mini-Mental State Examination and the Clock Drawing Test, which assess a person's thinking, memory, and ability to perform basic tasks and are commonly used to diagnose symptoms of dementia.

Tests showed that approximately 50% of patients overall had normal cognitive function at both time points, while the other half had some cognitive impairment.

Approximately 35% to 40% of patients show cognitive impairment in the first days after a heart attack, while 27% to 33% show impairment after six months. In some patients with cognitive impairment after a heart attack, the risk was temporary in half of the cases and permanent in the other half. One in nine patients had normal cognitive function shortly after the heart attack, but showed a cognitive decline six months later.

Cognitive disorders can affect a person's quality of life and it can be very challenging to pursue treatments and lifestyle changes to help prevent a second heart attack. Therefore, it is important for cardiologists to be alert to the symptoms of mental decline, as Kasprzak said.

“Cognitive deficits, such as memory loss or not being able to recognize a loved one, can be even more important for our patients than their cardiovascular disease,” Kasprzak said. “We need to monitor our patients regularly to detect changes in their functioning, not only in the heart but also in the brain.”

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None of the study participants had a history of having dementia or cognitive disorders before their heart attack. Although researchers have not attempted to identify

the causes of the depression they have observed, Kasprzak suggested that different drivers may be at work for permanent effects against temporary ones. For example, psychological stress and sleep disturbances during a heart attack may contribute to temporary impairments, while permanent effects may indicate neurosurgery or brain damage. Factors such as sleep disturbance, depression, and anxiety may play a role in patients experiencing a late decline in the months following a heart attack.

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Because participants in the study were relatively young — on average 60 years old — only normal age-related declines could not explain the greater cognitive impairment of patients, Kasprag said. However, age can exacerbate the effects. Elderly patients and patients with blood markers indicating more severe heart disease are more likely to show permanent cognitive impairment.

Researchers are currently analyzing data from a major follow-up study to further explore cognitive trends following heart attacks and the drivers that contribute to these effects. The team also plans to develop a highly effective assessment tool that cardiologists can use to diagnose cognitive impairments during routine follow-up visits.

Source-Medindia