Younger age at heart failure diagnosis tied to dementia risk
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Key takeaways:
- Younger age at HF diagnosis was associated with greater risk for any type of dementia.
- Clinicians should monitor neurocognitive status of people diagnosed with HF before age 65 years.
Adults diagnosed with HF before age 65 years were 67% more likely to be diagnosed with dementia during 12 years of follow-up compared with adults diagnosed at age 75 years or older, suggesting careful neurocognitive monitoring is needed.
“As a highly vascularized organ, the brain is particularly vulnerable to disruption in cerebral blood flow and even subclinical dysfunction in cardiac output could contribute to cognitive decline and subsequent dementia,” Fanfan Zheng, PhD, of the School of Nursing at Peking Union Medical College in Beijing, and colleagues wrote in the study background. “Therefore, it is rational to assume that the low cardiac output of HF, which is inadequate to meet metabolic demands and causes chronic cerebral hypoxia, may link HF to dementia.”
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The researchers noted that a younger-onset age of HF, which represents a longer period of exposure to cerebral hypoxia or other risk factors before the clinical manifestation of dementia in late life, may cumulatively cause more cerebrovascular damage and contribute to a higher risk for subsequent dementia.
Zheng and colleagues analyzed data from 14,413 adults with HF and 442,791 adults without HF, all without dementia at baseline, who participated in the UK Biobank cohort study (mean age, 57 years). Researchers also used propensity score matching for 14,412 patients with HF to analyze the associations of HF and its onset age with subsequent all-cause dementia, Alzheimer’s disease and vascular dementia.
The findings were published in JACC: Heart Failure.
During median follow-up of 12.8 years, 6.95% of patients died, 1.38% developed all-cause dementia, 0.59% developed Alzheimer’s disease and 0.28% developed vascular dementia in the overall cohort. Researchers found that adults with HF had a higher overall risk for all-cause dementia compared with those without HF (HR = 1.14; 95% CI, 1.04-1.25), as well as higher risk for vascular dementia (HR = 1.48; 95% CI, 1.23-1.77).
Within the HF cohort, 30.66% of patients died, 3.73% developed all-cause dementia, 1.12% developed Alzheimer’s disease and 1.21% developed vascular dementia during follow-up.
In Cox regression analysis, those with HF had higher risk for all-cause dementia (adjusted HR = 1.18; 95% CI, 1.03-1.36), Alzheimer’s disease (aHR = 1.64; 95% CI, 1.37-1.96) and vascular dementia (aHR = 1.27; 95% CI, 1.03-1.57) per 10-year decrease in age at HF onset.
In adjusted propensity score matching analyses, researchers found that the strength of association between HF and all-cause dementia increased with decreasing onset age of HF. The HR was 1.05 for adults aged 75 years and older (95% CI, 0.85-1.29); 1.1 for those aged 65 to 74 years (95% CI, 0.9-1.34); and 1.67 for those younger than 65 years (95% CI, 1.2-2.31).
“These results may suggest that, although HF was not associated with Alzheimer’s disease in the whole population, individuals with an HF onset age before 65 years of age did have a higher risk of developing Alzheimer’s disease, in addition to all-cause dementia and vascular dementia,” the researchers wrote. “Careful monitoring of cognitive function is warranted in this particularly vulnerable population to detect cognitive deterioration as early as possible, so that timely intervention such as cognitive training could be implemented to prevent or at least delay the onset of subsequent dementia.”
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