Prior Myocardial Infarction and Cognitive Decline: The REGARDS Cohort

BACKGROUND: Acute myocardial infarction (MI) is associated with subsequent cognitive decline. Whether the detection of prior MI using routine ECG and self-reported history can identify different trajectories of cognitive decline is uncertain. We sought to determine the association between prior MI and longitudinal cognitive assessments within a national, biracial cohort study. METHODS: We included participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort, enrolled from 2003 to 2007, who had an interpretable ECG and no baseline cognitive impairment. Prior MI at baseline was determined by self-reported history and ECG evidence of MI. Individuals were subdivided into self-reported (no Q-wave with MI history), clinical (Q-wave with MI history), and silent MI (Q-wave without MI history). We examined the interaction between prior MI and longitudinal change in global cognitive function, assessed by annual telephone-based 6-item screener scores, using linear mixed-effects models adjusted for demographics, cardiovascular risk factors, and incident cardiovascular events with censoring for death. CONCLUSIONS: Evidence of prior MI, whether clinically recognized or silent, was associated with an accelerated decline in global cognition. Prior MI may identify individuals at risk for future cognitive impairment.