• Posted March 25, 2022

Mental Decline Can Follow a Heart Attack

As if recovering from a heart attack wasn't hard enough, new research shows many patients may suffer severe thinking declines.

Researchers in Poland found that in the six months after a heart attack, 50% of patients experienced some decline in thinking, memory and ability to perform basic tasks.

"Assessment of cognitive status isn't a routine clinical practice among cardiology patients, so our knowledge of it is largely unknown," explained lead researcher Dr. Dominika Kasprzak, a cardiologist at the J. Strus Hospital in Poznan. "We have a lot of unanswered questions, so further study is necessary to investigate these problems."

Still, there is a high prevalence of thinking dysfunction in patients following a heart attack, she said.

"These disturbances can be both temporary and permanent. There is a group of patients who will develop deficits only after longer observation. We should be aware of these cognitive deficits and monitor patients after heart attack regularly, but also in terms of their cognitive status," Kasprzak said.

"If we detect changes in cognitive functioning early, we are able to implement appropriate management, and we have time to refer them to other specialists, such as psychologists or neurologists," she added.

For the study, Kasprzak and her colleagues tested the thinking abilities of 220 heart attack patients a few days after their heart attack and again six months later. Their average age was 60.

About 50% of patients had normal cognitive functioning when tested both times, but the other 50% had some thinking impairments. About 35% to 40% of patients showed impairment in the days after their heart attack, and 27% to 33% showed impairment six months later, the researchers found.

For about 50% of the patients who suffered thinking impairment, their problems were temporary, but for the other half, they were permanent. About 1 in 9 patients who had normal cognitive functioning after their heart attack showed cognitive decline six months later, the researchers noted.

Cognitive deficits can affect quality of life and make it more difficult to keep up with treatments and lifestyle changes to prevent a second heart attack, Kasprzak said.

None of the patients had a history of dementia or thinking disorders before their heart attack.

How a heart attack results in cognitive impairment isn't known, but Kasprzak said psychological stress and sleep problems around the time of a heart attack may lead to temporary deficits. Permanent cognitive impairment, however, could indicate damage to the brain, but sleep disturbances, depression and anxiety could also play a role.

It's not likely that age-related declines can explain the patients' high rate of cognitive impairment, Kasprzak said. But age may amplify the effects. In fact, older patients and those with severe cardiovascular disease were more likely to show permanent cognitive impairment, she said.

"These are only our preliminary results," Kasprzak said. "We are conducting a continuation of this study, and we have a bigger group of participants -- about 400 patients -- and we will try to analyze specific cognitive domains."

Dr. Gregg Fonarow, director of the Ahmanson-University of California, Los Angeles, Cardiomyopathy Center, said that earlier studies have suggested there may be an acceleration in thinking declines in people with heart disease.

"The mechanisms contributing to the cognitive decline identified require further study," Fonarow said. He noted that past studies have suggested that exercise can reduce global cognitive decline.

The findings will be presented April 3 at the American College of Cardiology annual meeting, in Washington, D.C. Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

More information

For more on heart and brain health, see the U.S. Centers for Disease Control and Prevention.

SOURCES: Dominika Kasprzak, MD, cardiologist, J. Strus Hospital, Poznan, Poland; Gregg Fonarow, MD, director, Ahmanson-University of California, Los Angeles, Cardiomyopathy Center; presentation, April 3, 2022, American College of Cardiology annual meeting, Washington, D.C.