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. 2015 Apr 14;131(15):1333-9.
doi: 10.1161/CIRCULATIONAHA.114.012438. Epub 2015 Feb 19.

Low cardiac index is associated with incident dementia and Alzheimer disease: the Framingham Heart Study

Angela L Jefferson  1 , Alexa S Beiser  2 , Jayandra J Himali  2 , Sudha Seshadri  2 , Christopher J O'Donnell  2 , Warren J Manning  2 , Philip A Wolf  2 , Rhoda Au  2 , Emelia J Benjamin  2
Affiliations

Low cardiac index is associated with incident dementia and Alzheimer disease: the Framingham Heart Study

Angela L Jefferson et al. Circulation. .

Abstract

Background: Cross-sectional epidemiological and clinical research suggests that lower cardiac index is associated with abnormal brain aging, including smaller brain volumes, increased white matter hyperintensities, and worse cognitive performances. Lower systemic blood flow may have implications for dementia among older adults.

Methods and results: A total of 1039 Framingham Offspring Cohort participants free of clinical stroke, transient ischemic attack, and dementia formed our sample (age, 69±6 years; 53% women). Multivariable-adjusted proportional hazard models adjusting for Framingham Stroke Risk Profile score (age, sex, systolic blood pressure, antihypertensive medication, diabetes mellitus, cigarette smoking, cardiovascular disease history, atrial fibrillation), education, and apolipoprotein E4 status related cardiac magnetic resonance imaging-assessed cardiac index (cardiac output divided by body surface area) to incident all-cause dementia and Alzheimer disease (AD). Over the median 7.7-year follow-up period, 32 participants developed dementia, including 26 cases of AD. Each 1-SD unit decrease in cardiac index increased the relative risk of both dementia (hazard ratio [HR]=1.66; 95% confidence interval [CI], 1.11-2.47; P=0.013) and AD (HR=1.65; 95% CI, 1.07-2.54; P=0.022). Compared with individuals with normal cardiac index, individuals with clinically low cardiac index had a higher relative risk of dementia (HR=2.07; 95% CI, 1.02-4.19; P=0.044). If participants with clinically prevalent cardiovascular disease and atrial fibrillation were excluded (n=184), individuals with clinically low cardiac index had a higher relative risk of both dementia (HR=2.92; 95% CI, 1.34-6.36; P=0.007) and AD (HR=2.87; 95% CI, 1.21-6.80; P=0.016) compared with individuals with normal cardiac index.

Conclusion: Lower cardiac index is associated with an increased risk for the development of dementia and AD.

Keywords: Alzheimer disease; blood circulation; brain; cardiac output; dementia; hemodynamics.

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Figures

Figure 1
Figure 1
Participant Selection Details.
Figure 2
Figure 2
Cumulative Incidence of Dementia Between Normal and Impaired Cardiac Index. Cumulative incidence of dementia between impaired cardiac index and normal cardiac index adjusted for age, sex, and education.
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References

    1. Jefferson AL, Poppas A, Paul RH, Cohen RA. Systemic hypoperfusion is associated with executive dysfunction in geriatric cardiac patients. Neurobiol Aging. 2007;28:477–483. - PMC - PubMed
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