Kasra Moazzami1, Samaah Sullivan2, Bruno B Lima1, Jeong Hwan Kim1, Muhammad Hammadah1, Zakaria Almuwaqqat1, Amit J Shah1, Ihab Hajjar3, Felicia C Goldstein4, Allan I Levey4, J Douglas Bremner5, Arshed A Quyyumi6, Viola Vaccarino7. 1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America. 2. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America. 3. Department of Neurology, Emory University School of Medicine, Emory University, Atlanta, GA, United States of America; Goizuetta Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, United States of America; Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, GA, United States of America. 4. Department of Neurology, Emory University School of Medicine, Emory University, Atlanta, GA, United States of America; Goizuetta Alzheimer's Disease Research Center, Emory University School of Medicine, Atlanta, GA, United States of America. 5. Atlanta VA Medical Center, Decatur, GA, United States of America; Department of Radiology and Imaging Sciences, Emory University School of Medicine, United States of America; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America. 6. Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America. 7. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America; Emory Clinical Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America. Electronic address: viola.vaccarino@emory.edu.
Abstract
OBJECTIVE: To understand if presence of mental stress-induced myocardial ischemia (MSIMI) is associated with higher prevalence of cognitive impairment at baseline and its decline over time. METHODS: A cohort of participants with stable coronary atherosclerosis underwent acute mental stress testing using a series of standardized speech/arithmetic stressors. The stress/rest digital vasomotor response to mental stress (sPAT) was assessed to measure microvascular constriction during mental stress. Patients received 99mTc-sestamibi myocardial perfusion imaging at rest, with mental stress and with conventional (exercise/pharmacological) stress. Cognitive function was assessed both at baseline and at a 2 year follow-up using the Trail Making Test parts A and B and the verbal and visual memory subtests of the Wechsler Memory Scale. RESULTS: We studied 486 individuals (72% male, 32.1% Black, 62 ± 9 (mean ± SD) years old). After multivariable adjustment for baseline demographics, risk factors, and medication use, presence of MSIMI was associated with 21% and 20% slower completion of Trail-A and Trail-B, respectively (p for all <0.01). After a 2-year follow-up period, presence of MSIMI was associated with a 33% slower completion of Trail-B, denoting cognitive decline (B = 0.33, 95% CI, 0.04, 0.62). A lower sPAT, indicating greater vasoconstriction, mediated the association between MSIMI and worsening Trail-B performance by 18.2%. Ischemia with a conventional stress test was not associated with any of the cognitive tests over time. CONCLUSION: MSIMI is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.
OBJECTIVE: To understand if presence of mental stress-induced myocardial ischemia (MSIMI) is associated with higher prevalence of cognitive impairment at baseline and its decline over time. METHODS: A cohort of participants with stable coronary atherosclerosis underwent acute mental stress testing using a series of standardized speech/arithmetic stressors. The stress/rest digital vasomotor response to mental stress (sPAT) was assessed to measure microvascular constriction during mental stress. Patients received 99mTc-sestamibi myocardial perfusion imaging at rest, with mental stress and with conventional (exercise/pharmacological) stress. Cognitive function was assessed both at baseline and at a 2 year follow-up using the Trail Making Test parts A and B and the verbal and visual memory subtests of the Wechsler Memory Scale. RESULTS: We studied 486 individuals (72% male, 32.1% Black, 62 ± 9 (mean ± SD) years old). After multivariable adjustment for baseline demographics, risk factors, and medication use, presence of MSIMI was associated with 21% and 20% slower completion of Trail-A and Trail-B, respectively (p for all <0.01). After a 2-year follow-up period, presence of MSIMI was associated with a 33% slower completion of Trail-B, denoting cognitive decline (B = 0.33, 95% CI, 0.04, 0.62). A lower sPAT, indicating greater vasoconstriction, mediated the association between MSIMI and worsening Trail-B performance by 18.2%. Ischemia with a conventional stress test was not associated with any of the cognitive tests over time. CONCLUSION: MSIMI is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.
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