The Heart and Dementia

By William K. Summers, MD
© William K. Summers, MD

When I was a resident at Washington University (St. Louis), I remember being told that the memory difficulties of the elderly were vascular. No tests were done. The patient was told there was "hardening of the arteries". Today, that same patient would be told that they have Alzheimer's disease. Again, testing is often not done and little treatment is offered.

Both approaches are wrong. Over 70 illnesses can cause memory loss. It is essential to fully evaluate someone with memory difficulties. Cardiac diseases are a major cause of memory loss. Memory loss can be seen after heart attacks, rheumatic heart disease, coronary artery bypass, heart valve diseases, cardiac arrhythmias and other infections of the heart.

One heart dysrrhythmia stands above the rest - Atrial Fibrillation. Here the topart of the heart beats irregularly and rapidly (over 100 beats per minute). Atrial Fibrillation (AF) is present in as many as 10 per cent of Americans over 75 years old. The association between AF and memory difficulties is so common that the pre-1900 name for AF was "delirium cordis". This is Latin for "confusion from the heart". In addition to "small strokes" causing memory difficulties, AF is associated with full stroke syndromes. About one out of five AF patients will suffer from strokes each year.

AF can first present as a stroke, fainting spell, or memory difficulty. It is easy to diagnose with a cardiogram or 24-hour heart monitor. Regrettably, some patients do not receive aggressive treatment to prevent strokes and small strokes from AF.

A recent article in the Journal of the American Medical Association reviewed some of the stroke prevention treatments for AF. The results were overwhelming; consideration of active treatment with blood thinning medication is a must. Treatment with aspirin results in about a 36% drop in this risk of stroke. Full individualized doses of Coumadin (warfarin) results in a 66% drop in this risk of stroke. Data was presented about combining Coumadin with aspirin, but because of poor study design, the results were inconclusive. As yet, the addition of vitamin E with other blood thinners has not been studied in AF. And there are other blood thinners such as ticlopidine and clopidogrel. The final analysis of combinations of anticoagulants (blood thinners) may yet show a near elimination of memory deterioration by AF.

If one is over 65 and has a sense of palpitations and or sudden deterioration of memory capacity, ask your doctor to at least do a cardiogram. If AF is diagnosed, insist on protecting your brain with blood-thinning medications.

This article written by Dr. Summers appeared in the Summer, 1999, issue of Prime Time - Albuquerque, NM. The NM Senior Citizen News publishes these articles monthly. You can pick up a copy of the paper at your closest New Mexico Senior Citizen Center.