Cardiac ventricular dimensions predict cognitive decline and cerebral blood flow abnormalities in aging men

Q: What are the key findings of this study?

Enlarged LVIDd at age 68 predicted worse verbal (17.1 vs 21.2, p=0.005) and visuospatial (3.7 vs 4.7, p=0.034) scores 14 years later, while low FS predicted reduced cerebral blood flow.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cognitive decline and cerebral blood flow abnormalities in aging men (n=211). Intervention: Enlarged left ventricular internal dimension in diastole (LVIDd ≥ 32 mm/m2) and low fractional shortening (FS < 25%) vs. Normal LVIDd (22-31 mm/m2) and normal fractional shortening (25-43%). Primary outcome: Synonyms test score (verbal ability) at 14-year follow-up (age 81) (p=0.005).

Q: What does this research mean for the field?

Enlarged left ventricular internal dimension in diastole and reduced fractional shortening in older men predict cognitive decline and cerebral blood flow reductions up to 14 years later. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Linda Furuäng; Per Wollmer; Arkadiusz Siennicki‐Lantz; Sölve Elmståhl

doi:10.1186/1471-2318-13-45

May 14, 2013BMC GeriatricsOpen Access

Cardiac ventricular dimensions predict cognitive decline and cerebral blood flow abnormalities in aging men

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Key result

Enlarged LVIDd at age 68 is linked to worse 14-year cognitive performance, including lower verbal scores.

P=0.005
n=211

Why the study?

The cross-sectional and longitudinal associations between left cardiac ventricular measures in the sixth decade and cognitive performance, as well as whether these measures predict future changes in cerebral blood flow, required investigation.

Key Points

To examine cross-sectional and longitudinal associations between left ventricular measures in the seventh decade of life and cognitive performance, and to determine whether these cardiac measures predict future changes in cerebral blood flow.
A cohort of 211 elderly men aged 68 from the population study 'Men born in 1914' completed M-mode echocardiography and a cognitive test battery at baseline.
Cognitive testing was repeated 14 years later at age 81, and regional cerebral blood flow was measured using 99mTc-HMPAO SPECT in 72 surviving men at age 83.
Associations of left ventricular internal dimension in diastole (LVIDd mm/m2) and fractional shortening (FS) with cognitive scores and regional cerebral blood flow were assessed using general linear models adjusted for education, antihypertensive therapy, and systolic blood pressure.
Men with enlarged baseline LVIDd (n=57) scored lower on the Synonyms test (18.8±6.8 vs. 21.7±5.7, p=0.002) and Digit Symbol Substitution test (32.1±11.2 vs. 35.7±11.8, p=0.048) at age 68, as well as on the Synonyms test (17.1±6.8 vs. 21.2±5.5, p=0.005) and Benton Visual Retention Test (3.7±1.6 vs. 4.7±1.8, p=0.034) at age 81.
In adjusted linear models, baseline LVIDd was negatively associated with Synonyms (B=-0.372, p=0.010) and Benton Visual Retention scores (B=-0.107, p=0.035) at age 81 among 92 survivors.
In normotensive men, lower fractional shortening at age 68 was associated with decreased regional cerebral blood flow 14 years later across the left frontal, bilateral temporal, right parietal, occipital areas, and right basal nuclei after adjusting for systolic blood pressure, smoking, alcohol, and stroke.

Study Design

Type

Cohort (n=211)

Multicenter

No

PICO

P

Population

211 68-year-old men from the 'Men born in 1914' Malmö cohort who completed M-mode echocardiography and cognitive testing, followed for 14-15 years until ages 81-83.

E

Exposure / Comparator

Enlarged left ventricular internal dimension in diastole (LVIDd ≥ 32 mm/m2) and low fractional shortening (FS < 25%) vs Normal LVIDd (22-31 mm/m2) and normal fractional shortening (25-43%)

O

Primary Outcome

Synonyms test score (verbal ability) at 14-year follow-up (age 81), p=0.005

Main Result

Absolute Event Rate: 17.1% vs 21.2%

p-value: p=0.005

Limitations

Study population was limited solely to men, limiting generalizability to women.
Survival and selection bias at age 83, as men with severe vascular risk profiles were more likely to have died before follow-up.
Older definition of hypertension (>160/90 mmHg) resulted in individuals with mild hypertension being classified as normotensive.
Use of M-mode echocardiography, which has variability and is only valid when left ventricular geometry is normal.
High exclusion rate due to incomplete echocardiographic examinations at baseline.

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Implication

Enlarged LVIDd and low FS may flag later cognitive and perfusion risks in older men; leaves open clinical utility pending prospective trials.

Abstract

BACKGROUND: The aims of this study are to examine possible associations between left cardiac ventricular measures in sixth decade and cognitive performance, both cross sectionally and longitudinally, and to examine if left cardiac ventricular measures could predict future changes in cerebral blood flow (CBF). METHODS: 211 elderly men from a cohort of the population study "Men born in 1914" completed M-mode echocardiography and a cognitive test battery at age 68. The cognitive test battery was repeated at age 81. CBF was estimated with 99mTc-HMPAO SPECT in 72 survivors at age 83. Cognitive performance at baseline and at 1st follow up and CBF at 1st follow up were analysed in relation to left ventricular internal dimension in diastole (LVIDd mm/m2) and fractional shortening (FS). RESULTS: Subjects with enlarged LVIDd at age 68 had poorer results on verbal and speed-performance tests at baseline and on verbal and visuo-spatial tests 14 years later on. Low FS was associated with decreased results on visuo-spatial tests at baseline. There was an inverse relationship between LVIDd and both verbal and spatial ability at the baseline and after 14 years of follow-up. Normotensive men with lower FS had also decreased CBF in a majority of brain areas 14 years later. CONCLUSIONS: Mild echocardiographic abnormalities in 68 ys.-old men, as increased LVIDd and lower FS, are associated with lower cognitive test results and may predict cognitive decline and silent cerebral perfusion abnormalities 14 years later.

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Cite This Study

Furuäng et al. (2013) conducted a cohort in Cognitive decline and cerebral blood flow abnormalities in aging men (n=211). Enlarged left ventricular internal dimension in diastole (LVIDd ≥ 32 mm/m2) and low fractional shortening (FS < 25%) vs. Normal LVIDd (22-31 mm/m2) and normal fractional shortening (25-43%) was evaluated on Synonyms test score (verbal ability) at 14-year follow-up (age 81) (p=0.005). Enlarged LVIDd at age 68 predicted worse verbal (17.1 vs 21.2, p=0.005) and visuospatial (3.7 vs 4.7, p=0.034) scores 14 years later, while low FS predicted reduced cerebral blood flow.

synapsesocial.com/papers/6ae8ac05eea962a84129e574 https://doi.org/10.1186/1471-2318-13-45

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Cardiac ventricular dimensions predict cognitive decline and cerebral blood flow abnormalities in aging men

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardiac ventricular dimensions predict cognitive decline and cerebral blood flow abnormalities in aging men

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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