could treatment of common heart disease prevent dementia?
it’s one of the most common cardiovascular diseases in ...
mar 15 2021
4 minute read
dr. paul khairy, co-lead of the study.
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the montreal heart institute foundation
this story was created by content works, postmedia’s commercial content division, on behalf of a client.
it’s one of the most common cardiovascular diseases in older adults and is associated with the risk of both dementia and stroke. now, a groundbreaking study will determine if treating patients with atrial fibrillation (af) before they develop overt cognitive symptoms like memory loss could reduce their risk of developing cognitive impairment, while at the same time reducing the risk of stroke.
“if we can treat people with af and prevent cognitive decline and stave off dementia, it’s a huge step forward for our field,” says dr. paul khairy, co-lead of the study, professor of medicine and research chair at université de montréal, and cardiologist and arrhythmia specialist at the montreal heart institute. the ultra-specialized hospital centre is dedicated to care, research, education, prevention, rehabilitation and the assessment of new technologies in cardiology.
in 2019-2020, the montreal heart institute foundation raised $25.7 million for innovative projects at the montreal heart institute, the first specialized hospital in cardiology in canada and one of the largest and most prominent in the world. the brain-af (blinded randomized trial of anticoagulation to prevent ischemic stroke and neurocognitive impairment) trial is the first in the world to test the hypothesis that a blood thinner can prevent cognitive decline in younger patients – those aged under 65 years – with af.
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af a common heart disease
about 200,000 canadians suffer from af, which is an irregular and often rapid heart rhythm in which the upper chambers of the heart beat irregularly. the heart’s ineffective pumping can cause blood to clot, which can in turn interrupt or reduce blood flow to the brain. this can result in a stroke or even a ‘silent stroke’ – so named because it shows no signs or symptoms and therefore often goes undetected. without oxygen and nutrients, brain cells begin to die within minutes.
factors commonly associated with af are high blood pressure, an overactive thyroid, angina or infarction, defects in the heart muscle or heart valves, sleep apnea, recent heart surgery or a severe infection. symptoms often include heart palpitations, shortness of breath and weakness.
dr. lena rivard, the principal investigator.
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af treatment includes two components: treating the irregular heart rhythm disorder and preventing the formation of clots. “for over 30 years now, blood thinners have been prescribed to protect patients with af who also have risk factors for stroke, which includes older ages,” khairy says. “because the stroke risk is much lower in younger patients, blood thinners aren’t currently recommended in the absence of conventional risk factors.”
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blood thinners a preventive strategy?
khairy goes on to describe that based on clinical experience and observational research, af may not be as benign as once thought because “tiny clots” can form and be sent to the brain.
“the small clots may be too insignificant to cause an overt stroke but over time, they can lead to cognitive decline and dysfunction that can progress to dementia,” he says.
more than 747,000 canadians are living with alzheimer’s disease or other forms of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life, according to the alzheimer’s association . alzheimer’s is a progressive disease and though it’s not a normal part of aging, the greatest known risk factor is increasing age.
while a growing body of evidence has found af is a significant risk factor for dementia, brain-af is the first study to test anticoagulant therapy in young af patients. dr. lena rivard, the principal investigator, and khairy want to know if taking blood thinners to prevent blood clots at a younger age will lower the risk of developing cognitive impairment down the road. “although drugs exist to improve dementia symptoms, to my knowledge there’s currently no pharmacological therapy that prevents cognitive impairment so this could be a first,” khairy says.
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about 500 patients with af enrolled in the feasibility phase of the brain-af study in 2015, which revealed a crucial finding. “while performing cognitive tests before beginning any therapies, we found a high degree of cognitive dysfunction in our patient population,” khairy reports. “that reinforced the importance of proceeding with the larger phase of the trial to find an answer to our important question and, hopefully, prevent a deterioration in cognitive function.”
patients ‘thankful’
to date, about 40 per cent of the 2,180 patients needed to address that question have already been enrolled in the brain-af trial. those patients have been recruited from about 44 healthcare centres across canada. thanks to a grant from the canadian institutes of health research, the study will be able to expand its recruitment efforts. both recruitment and monitoring can be done remotely. interested participants must make a three-year commitment to the study and can contact brainaf@icm-mhi.org to learn more.
“some studies are harder to conduct than others in terms of people agreeing to participate but, in general, when we talk about af and the increasing evidence that it can cause cognitive decline, people with af tend to be quite receptive and interested in being a part of the study,” khairy says. “some are thankful that we’re working on therapies like this to help improve their long-term outcomes.”
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this story was created by content works , postmedia’s commercial content division, on behalf of the montreal heart institute foundation.
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