title: Cognitive impairment and outcomes in older adult survivors of acute myocardial infarction: findings from the translational research investigating underlying disparities in acute myocardial infarction patients' health status registry.
abstract: BACKGROUND
  Cognitive impairment without dementia (CIND) and acute myocardial infarction (AMI) are prevalent in older adults; however, the association of CIND with outcomes after AMI is unknown.
  
  
  METHODS
  We used a multicenter registry to study 772 patients ≥65 years with AMI, enrolled between April 2005 and December 2008, who underwent cognitive function assessment with the Telephone Interview for Cognitive Status-modified (TICS-m) 1 month after AMI. Patients were categorized by cognitive status to describe characteristics and in-hospital treatment, including quality of life and survival 1 year after AMI.
  
  
  RESULTS
  Mean age was 73.2 ± 6.3 years; 58.5% were men, and 78.2% were white. Normal cognitive function (TICS-m >22) was present in 44.4%; mild CIND (TICS-m 19-22) in 29.8%; and moderate/severe CIND (TICS-m <19) in 25.8% of patients. Rates of hypertension (72.6%, 77.4%, and 81.9%), cerebrovascular accidents (3.5%, 7.0%, and 9.0%), and myocardial infarction (20.1%, 22.2%, and 29.6%) were higher in those with lower TICS-m scores (P < .05 for comparisons). AMI medications were similar by cognitive status; however, CIND was associated with lower cardiac catheterization rates (P = .002) and cardiac rehabilitation referrals (P < .001). Patients with moderate/severe CIND had higher risk-adjusted 1-year mortality that was nonstatistically significant (adjusted hazard ratio 1.97, 95% CI 0.99-3.94, P = .054; referent normal, TICS-m >22). Quality of life across cognitive status was similar at 1 year.
  
  
  CONCLUSIONS
  Most older patients surviving AMI have measurable CIND. Cognitive impairment without dementia was associated with less invasive care, less referral and participation in cardiac rehabilitation, and worse risk-adjusted 1-year survival in those with moderate/severe CIND, making it an important condition to consider in optimizing AMI care.
authors.affiliation: Mayo Clinic, Rochester, MN, USA. sgharacholou@uwhealth.org
authors.forename: S Michael
authors.initials: SM
authors.lastname: Gharacholou
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Reid
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.forename: John
authors.initials: J
authors.lastname: Spertus
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Tracey
authors.initials: T
authors.lastname: Holsinger
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications* / Q000473:pathology; D005260:Female; D006299:Health Services for the Aged; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013689:Telephone; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
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