Cardiovascular disease in dementia

Abstract

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.