Impact of cardiovascular disease and diabetes on cerebral cognition in older adults: the role of routine echocardiography in a primary care setting of Northern Sweden

Abstract

Background: Older adulthood is often associated with type 2 diabetes (DM), and cardiovascular comorbidities (CVD), such as hypertension, atrial fibrillation (AF) with or without heart failure (HF). A combination of the illnesses may contribute to the decline in cerebral cognition. It is, however, not known whether there exists an association between cognitive function and cardiovascular diseases and co-existing DM in a community setting equipped with outpatient echocardiography services. Subjects and methods: One hundred and thirty peri-octogenarians (79±11 years,), divided into four groups (Controls, CVD-DM, CVD+DM, and DM-CVD), matched for age, and gender, participated in the study to undergo a routine standard Doppler echocardiography, measures of which included left ventricular (LV) ejection fraction, left atrial (LA) size, pulmonary artery systolic pressure (PASP), and LV diastolic indices such as E/A-wave velocity ratio. Routine biochemistry included glomerular filtration rate and NT-proBNP, in addition to plasma glucose and HbA1c. Cognition was measured using a Mini-Mental State Examination (MMSE) score. In the CVDDM group 14 out of 47 had AF+HF, In the CVD+DM 7 out of 24 had AF+HF (Chi sq p for trend = 0.9): i.e., a total of 30% had a combined co morbidity of DM+AF+HF. All of them had SGLT2 inhibitors alone or in combination of GLP1-RA. In the CVD group 27 out of 47 had AFIB, while in the DM+CVD group 11 of 24 had AFIB (Ci Sq p for trend=0.8) Results: Mean ± SD of MMSE scores, LVEF%, PASP (mmHg), E/A ratio, and LA size (mm) in the Controls were respectively 27±3, 58±10, 22±5, and 34±9. MMSE scores did not differ. LVEF was significantly lower, and PASP higher in CVD with or without DM (all p<0.05). LA was not only larger in these groups, LA size and PASP could predict MMSE at an adjusted R2 value of 0.6 (p<0.05). E/A ratio and NT-proBNP contributed, albeit non significantly (p=0.06, Figure 1). When controlled for background AF and HF, DM and CVD equipoised MMSE score (p=NS). Conclusion: In this community-based cross-sectional study, cerebral cognition, as assessed by MMSE scoring, was found to be preserved in DM with or without co-existing CVD, compared with age-matched Controls. DM and CVD equally contributed to the level of cognition. Whether the newest anti hyperglycemic agents preserve cognition beyond impacting a favorable cardiac outcome is a matter to be resolved by larger, multinational trails. Routine echocardiography in primary care plays a vital role to monitor cardiac function in an increasingly older adults faced with a significant disease burden (DM+AF+HF+CAD) with risk for impaired cognition.