Cardiovascular disease in dementia

The objective of this thesis was to characterize the burden of cardiovascular diseases in patients with dementia, their treatment and association with survival. Further, we aimed to explore whether cardiac structure in young adults can affect the aging brain. We performed 5 observational cohort studies, based on patients registered in the Swedish Dementia Registry (Papers I-IV) and participants in a population-based study Coronary Artery Risk Development in Young Adults (Paper V).

The results can be summarized as follows: (I) Seventy per cent of patients with dementia are prescribed cardiovascular drugs. Their use is highest in patients with vascular dementia and lowest in patients with Parkinson´s disease dementia. (II) Patients with heart failure and dementia constitute an old and under-diagnosed population. Heart failure with preserved ejection fraction is the most common type of heart failure and vascular dementia the most frequent dementia disorder. (III) The most common chronic cardiovascular disease in patients with dementia is ischemic heart disease (23% of patients are affected), followed by cerebrovascular diseases (20% of patients) and atrial fibrillation (19% of patients). The occurrence and prognostic significant of chronic cardiovascular diseases differs in specific dementia disorders. (IV) Twenty one per cent of patients with dementia are managed invasively for acute myocardial infarction. The use of invasive procedures is associated with lower age and higher cognitive status. This study suggests that the invasive management of myocardial infarction has a benefit for survival of patients with dementia. (V) Higher left atrial volume in young adulthood is associated with lower white matter integrity in mid-life. This study suggests that improvement of cardiac function in young adults may benefit the aging brain.

List of scientific papers

I. Cermakova P, Fereshtehnejad SM, Johnell K, Winblad B, Eriksdotter M, Religa D. Cardiovascular medication burden in dementia disorders: a nationwide study of 19,743 dementia patients in the Swedish Dementia Registry. Alzheimer's Research & Therapy. 2014, 16;6(3):34.
https://doi.org/10.1186/alzrt264

II. Cermakova P, Lund LH, Fereshtehnejad SM, Johnell K, Winblad B, Dahlström U, Eriksdotter M, Religa D. Heart failure and dementia: survival in relation to types of heart failure and different dementia disorders. European Journal of Heart Failure. 2015, 17(6):612-9.
https://doi.org/10.1002/ejhf.222

III. Cermakova P, Johnell K, Fastbom J, Garcia-Ptacek S, Lund LH, Winblad B, Eriksdotter M, Religa D. Cardiovascular diseases in ~30,000 patients in the Swedish Dementia Registry. Journal of Alzheimer´s Disease. 2015, 48(4):949-58.
https://doi.org/10.3233/JAD-150499

IV. Cermakova P, Szummer K, Johnell K, Fastbom J, Winblad B, Eriksdotter M, Religa D. Management of acute myocardial infarction in patients with dementia: data from SveDem, the Swedish Dementia Registry. Journal of the American Medical Directors Association. 2016 Sep 14. pii:S1525-8610(16)30304-8.
https://doi.org/10.1016/j.jamda.2016.07.026

V. Cermakova P, Muller M, Armstrong AC, Religa D, Bryan NR, Lima JA, Launer LJ. Cardiac parameters in young adults and their brain health in midlife: CARDIA Brain MRI Sub-study. [Manuscript]