Research letter examines pacemaker use in patients with cognitive impairment

Dr. Nicole R. Fowler and her fellow reserachers have found that patients with dementia were more likely to receive a pacemaker then patients without cognitive impairment.

Older adults with mild (MCI) and dementia can have co-existing cardiac illnesses and that makes them eligible for therapy with devices to correct rhythm abnormalities. But the risks and benefits need to be weighed carefully with patients, families and clinicians.

The authors examined data from the National Alzheimer Coordinating Center Uniform Data Set gathered from 33 Alzheimer Disease Centers from September 2005 through December 2011. There were 16,245 participants with a baseline visit and at least one follow-up.

At baseline, 7,446 participants (45.8 percent) had no cognitive impairment, 3,460 (21.3 percent) had MCI and 5,339 (32.9 percent) had dementia. Participants who had dementia at the visit before being assessed for a pacemaker were 1.6 times more likely to receive a pacemaker compared with participants without cognitive impairment and participants with MCI were 1.2 times more likely. Over the seven-year study period, rates of pacemakers were 4 per 1,000 person-years for participants without cognitive impairment, 4.7 per 1,000 person-years for participants with MCI and 6.5 per 1,000 person-years for participants with dementia.

Patients with were more likely to receive a than patients without cognitive impairment, even after adjusting for clinical risk factors. This runs counter to the normative expectation that patients with a serious life-limiting and cognitively disabling illness might be treated less aggressively. While it is possible that unmeasured confounding by indication explains this observation, future research should explore the patient, caregiver and clinician influences on decision making regarding cardiac devices in this population.

More information: JAMA Intern Med. Published online July 21, 2014. DOI: 10.1001/jamainternmed.2014.3450.

add to favorites email to friend print save as pdf

Related Stories

Amnestic mild cognitive impairment doubles risk of death

Jul 16, 2012

Researchers at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center have found that people with a form of mild cognitive impairment (MCI), a risk factor for developing Alzheimer's disease, ...

Recommended for you

New ALS associated gene identified using innovative strategy

Oct 22, 2014

Using an innovative exome sequencing strategy, a team of international scientists led by John Landers, PhD, at the University of Massachusetts Medical School has shown that TUBA4A, the gene encoding the Tubulin Alpha 4A protein, ...

Can bariatric surgery lead to severe headache?

Oct 22, 2014

Bariatric surgery may be a risk factor for a condition that causes severe headaches, according to a study published in the October 22, 2014, online issue of Neurology, the medical journal of the American Academy of Neurol ...

Bipolar disorder discovery at the nano level

Oct 22, 2014

A nano-sized discovery by Northwestern Medicine scientists helps explain how bipolar disorder affects the brain and could one day lead to new drug therapies to treat the mental illness.

User comments