21.10. The interplay of cardiovascular burden with cognition and mortality

Public examination of a doctoral dissertation in the field of Internal Medicine

Doctoral candidate: Lic Med Tuomas Kerola

Time and venue: 21.11.2011 at 12 noon, Päijät-Häme Central Hospital, Lahti, Lecture Hall 1

Language of the public examination: Finnish

Language of the doctoral dissertation: English

Traditional cardiovascular risk markers in mid-life are harbingers of cognitive decline, Alzheimer’s disease and vascular dementia later in life. Normal aging, co-morbidities and other changes connected to cognitive decline make the interpretation of the risk markers assessed in the elderly clearly more challenging. This is the incentive for finding new cardiovascular markers with a more consistent risk stratification capacity for cognitive decline.

The aim of the present study was to evaluate B-type natriuretic peptide (BNP), the Mini Mental State Examination (MMSE) score and echocardiographical measures together with established cardiovascular risk factors for their impact on cognitive decline and mortality in the elderly general population.

The thesis is based on the Kuopio 75+ health study, a prospective population-based stratified cohort study with 601 individuals, aged more than 75 years, from Kuopio, Eastern Finland. The participants were examined at baseline and a follow-up visit at 5 years. Cognitive function, cardiovascular history and cardiovascular risk markers, including BNP, were recorded for all participants, and echocardiography was carried out in a sub-population of 355 individuals. The mortality data is based on a follow-up of a median of 7.9 years. Of the echocardiographical measures, left ventricular (LV) mass, ejection fraction (EF) and mitral inflow pattern (E/A) were all connected to mortality. LV mass and EF moderately predicted cardiovascular mortality. Interestingly, an E/A < 0.75 was more connected to non-cardiovascular than cardiovascular mortality. The presence of dementive illness was more common among individuals with an E/A < 0.75. High-density lipoprotein was associated with EF, while BNP showed no connection to EF.

Among individuals with no dementive illness at baseline, cardiovascular markers were evaluated for their predictive power over mortality, cognitive decline and dementia during the follow-up. While traditional cardiovascular risk-markers and illnesses failed to predict cognitive dysfunction, BNP was a strong predictor of all cognitive end-points. In this sub-group an MMSE score of 18–23 together with BNP were both independent predictors of mortality; the latter also predicted cardiovascular mortality.

The present study supports the notion that cognitive function and cardiovascular risk are closely connected also among the elderly. BNP, a direct marker of left ventricular stress, is a superior predictor of cognitive decline and mortality when compared to traditional risk-factors. The connection of BNP with future dementia and cognitive decline serves as a basis for testing the impact of antihypertensive treatment in the prevention of cognitive impairment in those with elevated BNP.

The doctoral dissertation of Lic Med Tuomas Kerola, entitled The interplay of cardiovascular burden with cognition and mortality will be examined at the Faculty of Health Sciences. The opponent in the public examination will be Professor Timo Strandberg ot the University of Oulu, and the custos will be Docent Raimo Kettunen of the University of Eastern Finland.

Photo available for download at http://uef.fi/vaitoskuvat

For further information, please contact: Tuomas Kerola, p. 050 538 5954, tuomas.kerola@phsotey.fi

Publishing year: 2011

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