Left Ventricular Hypertrophy and Cognitive Decline in Old Age

Article type: Research Article

Authors: Mahinrad, Simin^{a; 1} | Vriend, Annelotte E.^{a; 1} | Jukema, J. Wouter^b | van Heemst, Diana^a | Sattar, Naveed^c | Blauw, Gerard Jan^a | Macfarlane, Peter W.^d | Clark, Elaine N.^d | de Craen, Anton J.M.^{a; †} | Sabayan, Behnam^{a; e; f; *}

Affiliations: [a] Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands | [b] Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands | [c] BHF Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, UK | [d] Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK | [e] Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands | [f] Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

Correspondence: [*] Correspondence to: Behnam Sabayan, MD, PhD, Feinberg School of Medicine, Northwestern University, 251 East Huron Street, Galter Suite 3-150, Chicago, IL 60611, USA. Tel.: +1 3128689432; E-mail: behnam.sabayan@northwestern.edu.

Note: [1] These authors contributed equally to this work.

Note: [†] Deceased 17 January 2016.

Abstract: Background: Patients with advanced heart failure run a greater risk of dementia. Whether early cardiac structural changes also associate with cognitive decline is yet to be determined. Objective: We tested whether left ventricular hypertrophy (LVH) derived from electrocardiogram associates with cognitive decline in older subjects at risk of cardiovascular disease. Methods: We included 4,233 participants (mean age 75.2 years, 47.8% male) from PROSPER (PROspective Study of Pravastatin in the Elderly at Risk). LVH was assessed from baseline electrocardiograms by measuring the Sokolow-Lyon index. Higher levels of Sokolow-Lyon index indicate higher degrees of LVH. Cognitive domains involving selective attention, processing speed, and immediate and delayed memory were measured at baseline and repeated during a mean follow-up of 3.2 years. Results: At baseline, LVH was not associated with worse cognitive function. During follow-up, participants with higher levels of LVH had a steeper decline in cognitive function including in selective attention (p = 0.009), processing speed (p = 0.010), immediate memory (p < 0.001), and delayed memory (p = 0.002). These associations were independent of cardiovascular risk factors, co-morbidities, and medications. Conclusion: LVH assessed by electrocardiogram associates with steeper decline in cognitive function of older subjects independent of cardiovascular risk factors and co-morbidities. This study provides further evidence on the link between subclinical cardiac structural changes and cognitive decline in older subjects.

Keywords: Cardiovascular disease, cognitive function, elderly, left ventricular hypertrophy

DOI: 10.3233/JAD-161150

Journal: Journal of Alzheimer's Disease, vol. 58, no. 1, pp. 275-283, 2017