title: Impact of coronary heart disease on cognitive decline in Alzheimer's disease: a prospective longitudinal cohort study in primary care.
abstract: BACKGROUND
  Arteriosclerotic disorders increase the risk of dementia. As they have common causes and risk factors, coronary heart disease (CHD) could influence the course of dementia.
  
  
  OBJECTIVE
  To determine whether CHD increases the speed of cognitive decline in Alzheimer's disease, and to discuss the potential for secondary cardiovascular prevention to modify this decline.
  
  
  METHODS
  Prospective multicentre cohort study in general practices in six cities in Germany.
  
  
  METHODS
  Participants were patients with probable mild-to-moderate Alzheimer's dementia or mixed dementia (n = 118; mean age 85.6 [±3.4] years, range 80-96 years). The authors assessed the presence of CHD according to the family physicians' diagnosis. Cognitive performance was measured during home visits for up to 3 years in intervals of 6 months, using Mini Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SoB). The authors also recorded whether patients died in the observation period.
  
  
  RESULTS
  At baseline, 65 patients (55%) had CHD and/or a heart condition following a myocardial infarction. The presence of CHD accelerated cognitive decline (MMSE, P<0.05) by about 66%, and reduced cognitive-functional ability (CDR-SoB, P<0.05) by about 83%, but had no impact on survival.
  
  
  CONCLUSIONS
  The study shows that CHD has a significant influence on cognitive decline in older patients with late-onset dementia. The dementia process might therefore be positively influenced by cardiovascular prevention, and this possible effect should be further investigated.
authors.affiliation: Department of Family Medicine, Institute of General Practice and Family Medicine, Faculty of Medicine, University of Bonn, Bonn, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Bleckwenn
authors.affiliation: Neuropsychology Unit.
authors.forename: Luca
authors.initials: L
authors.lastname: Kleineidam
authors.affiliation: Neuropsychology Unit.
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.affiliation: DZNE, German Center for Neurodegenerative Diseases, Bonn, and director, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Jessen
authors.affiliation: Research Group Psychiatric Epidemiology and Demographic Change, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.affiliation: Research Group Psychiatric Epidemiology and Demographic Change, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Werle
authors.affiliation: Research Group on Medical Statistics and IT Infrastructure, Institute for General Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.affiliation: Department of Primary Medical Care, Center for Psychosocial Medicine.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Lühmann
authors.affiliation: Department of Primary Medical Care, Center for Psychosocial Medicine.
authors.forename: Tina
authors.initials: T
authors.lastname: Posselt
authors.affiliation: Institute of Health Economics and Health Services Research, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.affiliation: Junior Scientists Group, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Brettschneider
authors.affiliation: Clinical Psychology and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Edelgard
authors.initials: E
authors.lastname: Mösch
authors.affiliation: Department for Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Weeg
authors.affiliation: Institute of General Medicine, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.affiliation: Institute of General Medicine, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Pentzek
authors.affiliation: Research Group Public Health II: Epidemiology and Care Research, University of Leipzig, Leipzig, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Luck
authors.affiliation: Institute of Social Medicine, Occupational Health, and Public Health, University of Leipzig, Leipzig, Germany.
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
authors.affiliation: Clinic and Polyclinic for Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, University of Bonn, and DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
mesh_terms: D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors
keywords: Alzheimer’s disease; cardiovascular diseases; cardiovascular risk; cognitive decline; dementia; family practice; primary health care