As we age, so do our brains. However, not everyone’s brain ages at the same rate. Certain events and health conditions can also impact the way our brain ages.
According to a study published in the journal JAMA Neurology, a heart attack or stroke may put you at risk of accelerated cognitive decline in later years. This cognitive decline exceeds what is considered appropriate for the aging mind, the study notes.
The study analyzed research between 1971 and 2019 of more than 30,000 people and found that more than 1,000 patients who had a heart attack during the research experienced cognitive decline (not Alzheimer’s or dementia) at a small, but more accelerated, rate, than those who did not have a heart attack.
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The highest annual rate of decline after a heart attack was seen in whites in comparison to Black individuals and in men compared with women. It could not be explained by stroke or new atrial fibrillation — an irregular, often rapid heart rhythm that can lead to blood clots in the heart, according to the study.
What’s causing this type of cognitive decline? Researchers point to four potential culprits:
- Depression after having a heart attack, which has been linked to dementia
- Chronic inflammation, blood pressure abnormalities and small blood vessel disease, which are also linked to dementia
- Congestive heart failure, which can cause severe hypotension or lower blood pressure and affect the brain.
- Medication, which may cross the blood-brain barrier and therefore affect cognitive function
While it is important to pay attention to any declines in your brain, many people often confuse age-related cognitive decline with Alzheimer’s disease and other dementias. But the two should not be confused, according to experts.
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BlackDoctor.org spoke with Carl Horton, a cardiologist with Texas Health Cleburne and Texas Health Physicians Group to discuss how to spot the difference between age-related cognitive decline and dementia, the link between heart disease and brain health, and how to protect yourself.
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What is the link between heart disease and brain health?
This has been noted in several studies in the past. I don’t think they know the exact mechanism of why there is accelerated decline after myocardial infarction, but they do have a couple of possible ideologies.
Patients sometimes have major intracardiac production. They also deal with congestive heart failure and reduced cerebral perfusion.
Another mechanism is thought to be that some patients who have underlying heart disease can develop Alzheimer’s.
Also, coronary artery disease or sclerosis can affect the arteries in the brain and if it affects those arteries, you also have localized inflammation that may lead to a pause in the blood flow or actually cause micro strokes.
Those are some of the postulated mechanisms of why it’s thought that you may have accelerated cognitive decline after having a chronic event.
The study shows that depression also plays a role in cognitive decline as well. How does depression affect the brain?
Depression is thought to be a risk factor for dementia, and that is something that we see also in cardiac patients (particularly if they have a large myocardial infarction) or patients if they’re found to have severe coronary artery disease.
Sometimes those patients, in particular, end up needing open heart surgery, bypass or graft surgery and so depression is very common with those patients after they have one of those major life events.
It’s known that patients are at risk for dementia in the future and dementia is more the end stage of decline of a lot of cognitive abilities. Moderate cognitive decline is much more slower.
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As we talk about dementia and cognitive decline, I was wondering if there is a difference between age-related cognitive decline and dementia.
Usually, age-related decline is something that happens more gradually and slowly and it can affect patients at various stages. This is usually not as severe, whereas dementia is more severe.
There are several different types of dementia, which includes Alzheimer’s, vascular-related dementia and Lewy body dementia. And with alcohol-related dementia, there are certain cognitive abilities that are more severely affected. Cognitive decline is more about a milder gradual loss of those functions but dementia is usually a more severe stage.
Can you talk about some steps that people can take to keep their hearts and their brains healthy?
I think one thing that kind of came out of this study was that in order to try to prevent cognitive decline, one of the things that we all need to be doing is trying to prevent heart disease to begin with.
Of course, you want to focus on eating a much healthier diet – one that’s higher in fruits and vegetables and has less red meat. You want to eat a heart-healthy, Mediterranean diet overall to try to prevent heart disease.
From a clinical standpoint, if we have a patient that has a myocardial infarction, we need to be looking for signs of cognitive decline much earlier.
You mentioned that depression can lead to dementia. What steps can people take to combat depression?
Individuals should address the issue with their primary care physician. As a cardiologist, I usually don’t treat depression, but I do urge and encourage patients to seek treatment if they need it. Sometimes they may not really be aware of it. Instead, their family members may notice it, and they should be encouraged to visit their physician to receive the appropriate treatment.
