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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.3 no.4 São Paulo Oct./Dec. 2009

http://dx.doi.org/10.1590/S1980-57642009DN30400008 

Original Articles

Association between cardiovascular disease and dementia

Claudia Kimie Suemoto1 

Renata Eloah Ferretti2 

Lea Tenenholz Grinberg2 

Kátia Cristina de Oliveira2 

José Marcelo Farfel1 

Renata Elaine Paraizo Leite2 

Ricardo Nitrini3 

Wilson Jacob Filho1 

Carlos Augusto Pasqualucci2 

Brazilian Aging Brain Study Group

11Department of Geriatrics, University of São Paulo, School of Medicine, São Paulo SP, Brazil.

2Department of Pathology, University of São Paulo, School of Medicine, São Paulo SP, Brazil.

3Department of Neurology, University of São Paulo, School of Medicine, São Paulo SP, Brazil.


Abstract

Longitudinal studies have shown association between cardiovascular risk factors and dementia. However, these studies are not capable of detecting asymptomatic cardiovascular alterations and thus may provide erroneous estimates of association. Autopsy studies could be more useful in elucidating these questions. The present clinicopathological study sought to examine the relationship between dementia, cardiovascular risk factors and disease.

Methods:

603 subjects, who underwent autopsy, were classified regarding the presence of dementia, according to post mortem cognitive classification. Demographics, cardiovascular risk factors, and anatomically-proven cardiovascular disease (myocardial hypertrophy, cerebral and carotid atherosclerosis) were compared among cognitively normal persons and individuals with dementia.

Results:

Cognitive deficit was associated with advanced age, stroke, physical inactivity and low body mass index (p<0.05). Circle of Willis atherosclerosis was greater in patients with dementia than in controls on univariate analysis (p=0.01). However, this association lost significance when adjusted by age and gender (p=0.61). Heart failure and anatomopathological cardiac parameters were more severe in the control group than in demented individuals (p<0.05). Carotid artery atherosclerosis and intima-media thickness were similar in both groups.

Conclusion:

Advanced age, stroke, physical inactivity and low body mass index were linked to dementia. Circle of Willis atherosclerosis was associated with dementia only when age was not considered. Our results suggest that cerebral artery atherosclerosis was not directly associated with clinical expression of dementia.

Key words: atherosclerosis; circle of Willis; carotid artery disease; cardiomyopathy; dementia.

Resumo

Estudos longitudinais tem mostrado associação entre fatores de risco cardiovascular e demência. Entretanto, estes estudos não são capazes de detectar alterações cardiovasculares assintomáticas e podem, assim, fornecer estimativas de associação errôneas. Estudos de autópsia podem ser mais úteis em elucidar estas questões. O presente estudo clinicopatológico busca examinar a relação entre demência, fatores e doença cardiovascular.

Métodos:

603 sujeitos submetidos à autópsia foram classificados quanto à presença de demência, usando uma classificação cognitiva post-mortem. Dados demográficos, fatores de risco cardiovascular e doença cardiovascular comprovada anatomicamente (hipertrofia miocárdica, aterosclerose cerebral e carotídea) foram comparados entre indivíduos cognitivamente normais e com demência.

Resultados:

Déficit cognitivo esteve associado à idade avançada, acidente vascular cerebral, sedentarismo e baixo índice de massa corpórea (p<0,05). Aterosclerose do polígono de Willis foi maior em pacientes com demência do que em controles na análise univariada (p=0,01). Insuficiência cardíaca e parâmetros anatomopatológicos cardíacos foram mais graves entre o grupo controle que entre os indivíduos dementados (p<0,05). Aterosclerose de artérias carótidas e espessura íntima-média foram similares entre os grupos.

Conclusão:

Idade avançada, acidente vascular cerebral, sedentarismo e baixo índice de massa corpórea estiveram relacionados à demência. Aterosclerose de polígono de Willis esteve associada à demência, somente quando a idade não foi considerada. Nossos resultados sugerem que a aterosclerose de artérias cerebrais não está diretamente relacionada com a expressão clínica de demência.

Palavras-chave: aterosclerose; polígono de Willis; doença arterial carotídea; cardiomiopatia; demência.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

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Received: September 13, 2009; Accepted: November 03, 2009

Claudia Kimie Suemoto - Av. Dr. Arnaldo 455 / Sl 1351 - 01246-903 São Paulo SP - Brazil. E-mail: cksuemoto@usp.br

Disclosure: The authors report no conflicts of interest.

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