Incident myocardial infarction (MI) is associated with more rapid declines in global cognition, memory and executive function over time, but not at the time of the event, a new pooled cohort study shows. These findings were reported by Michelle C. Johansen, MD, PhD, of the Johns Hopkins University School of Medicine, Baltimore, and colleagues in an article published Tuesday online in JAMA Neurology. Dementia is common around the world and, despite the high volume of research dedicated to the field, remains costly, morbid and lacks treatment options. Understanding cardiovascular impacts on the development of dementia could help identify potential treatment targets to slow or prevent cognitive decline. More than 7 million people worldwide experience acute MI, but previous studies report contradictory results in whether MI is associated with incident or long-term cognitive decline. The present study investigated how MI might be associated with changes in cognitive function post-adjustment for pre-MI cognitive trajectories. This cohort study combined six other cohort studies that occurred between 1971 and 2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. The data from the present study were analyzed between July 2021 and January 2022. The primary outcome was change in global cognition, and the secondary outcomes were changes in memory and cognition. Mean standard deviation (SD) T scores of 50 ±10 , and a one-point difference represented cognitive differences by 0.1-SD. Changes in cognition at incident MI (change in the intercept) and the rate of cognitive change over the years after MI (change in the slope) were predicted by linear mixed-effects models. Race and sex had interaction terms. Of the 30,465 patients in the study, 1,033 had one or more MI events (mean age at baseline=59 years; 46% female; 13% Black, 83.7% white), and 29,432 (mean age at baseline=54 year; 56% female; 23% Black, 68.6% White) did not have an MI event. The median follow-up was 6.4 years (interquartile range [IQR]=4.9-19.7 years), and there was no association between incident MI and acute decrease in global cognition (-0.18 points; 95% confidence interval [CI]: -0.52 to 0.17), executive function (-0.17 points; 95% CI: -0.53 to 0.18) or memory (0.62 points; 95% CI: -0.07 to 1.31). However, compared with patients who had no MI, patients with incident MI demonstrated more rapid decline in global cognition (-0.15 points per year; 95% CI: -0.21 to -0.10), executive function (-0.14 points per year; 95% CI: -0.20 to -0.08) and memory (-0.13 points per year; 95% CI: -0.22 to -0.04) over the years compared with pre-MI slopes. The degree of change in the decline in global cognition post-MI was modified by race and sex, as suggested by the interaction analysis (race × post-MI slope interaction term, p=0.02; sex × post-MI slope interaction term, p=0.04). There was a smaller change in the decline in Black individuals than in white individuals (difference in slope change=0.22 points per year; 95%CI: 0.04 to 0.40). The same differences were observed in females compared with males (difference in slope change=0.12 points per year; 95%CI: 0.01 to 0.23). Overall, incident MI was not associated with acute decreased rates of global cognition, memory or executive function at the time of MI, but MI was associated with cognitive decline in these domains in the years following the MI. “Our results may have important public health implications,” the authors concluded. “Discussion of the potential cognitive ramifications of MI should be considered as a potential motivator when counseling patients at risk for MI. Additionally, individuals who have experienced an MI should be followed up for accelerated cognitive decline in the years after MI. The findings also suggest that prevention of MI may be a strategy to preserve brain health in older adults.” Source: Johansen MC, Ye W, Gross A, et al. Association Between Acute Myocardial Infarction and Cognition. JAMA Neurol. 2023 May 30 (Article in Press). Image Credit: chika_milan – stock.adobe.com