Issimdar Iqrah A, Mudegowdar Rohit, Gupta Anchal R, Patel Keval B, Elshoura Anas, Bhanushali Vidhi Mahendra, Joseph Joshua R, Meiyalagan Varalakshmi Aishwarrya, Sahotra Monika, Kashif Mazin, Binny Vivasvat, Pathan Nahila A, Siddiqui Humza F
Health and Agriculture, University College Dublin, Dublin, IRL.
Internal Medicine, JJM Medical College, Davanagere, IND.
Cureus. 2025 May 28;17(5):e84957. doi: 10.7759/cureus.84957. eCollection 2025 May.
The association between cognitive impairment (CI) and myocardial infarction (MI) has been highlighted in recent years. Several studies have reported an increased incidence of cognitive decline (CD) following MI, emphasizing the need for early identification and intervention in such patients. Previous research findings have been inconsistent due to the presence of various unaccounted factors potentially contributing to CD and disparities in the methods utilized to assess cognition such as the Mini-Mental State Examination, Mini-Cog and self-evaluation questionnaires. This emphasizes the potential for a more standardized tool of assessment to investigate the onset of CD amongst MI patients in a reliable manner. This literature review delineates the correlation between MI and CI, exploring the pathogenesis, risk factors, management and preventive strategies. Cerebral hypoperfusion, underlying atherosclerosis and neuroinflammation are crucial in the development of CD after MI. Hence, it is important to consider the 'heart-brain axis' for targeted therapy of CD in MI patients. Old age is a common risk factor for CD and MI. However, the impact of variables including gender and comorbidities is underreported, which can potentially alter the relationship between cognitive outcomes and MI. The implementation of multidisciplinary-oriented cardiac rehabilitation programs and a universal screening tool to follow up on patients with established CI post-MI has shown favorable outcomes and has reduced the risk of adverse health consequences. Optimizing medical management and regular monitoring of serum brain natriuretic peptide (BNP) and hemoglobin levels are essential in preventing CD after MI. Psychological evaluation and counselling also help attenuate CD. Additionally, preventive strategies addressing modifiable risk factors and implementing anti-inflammatory diets have proven beneficial. Ongoing research is focused on the study of novel interventions targeting the neuroinflammatory process. Recently a new member of the C-reactive protein family, pentraxin 3, has been identified as a specific vascular inflammatory biomarker produced by cells in atherosclerotic lesions that can potentially aid in recognizing CD. It is imperative to establish uniform guidelines to recognize and manage CI among patients following MI to improve quality of life among the elderly population.
近年来，认知障碍（CI）与心肌梗死（MI）之间的关联已受到关注。多项研究报告称，心肌梗死后认知功能下降（CD）的发生率有所增加，强调对此类患者进行早期识别和干预的必要性。由于存在各种可能导致认知功能下降的未考虑因素，以及用于评估认知的方法（如简易精神状态检查表、简易认知测试和自我评估问卷）存在差异，以往的研究结果并不一致。这凸显了采用更标准化评估工具以可靠方式研究心肌梗死患者认知功能下降发病情况的潜力。这篇文献综述阐述了心肌梗死与认知障碍之间的相关性，探讨了其发病机制、危险因素、管理及预防策略。脑灌注不足、潜在的动脉粥样硬化和神经炎症在心肌梗死后认知功能下降的发展过程中至关重要。因此，在针对心肌梗死患者认知功能障碍进行靶向治疗时，考虑“心脑轴”很重要。老年是认知功能下降和心肌梗死的常见危险因素。然而，包括性别和合并症等变量的影响报道较少，这可能会改变认知结果与心肌梗死之间的关系。实施多学科导向的心脏康复计划以及采用通用筛查工具对心肌梗死后已确诊认知障碍的患者进行随访，已显示出良好效果，并降低了不良健康后果的风险。优化医疗管理并定期监测血清脑钠肽（BNP）和血红蛋白水平对于预防心肌梗死后认知功能下降至关重要。心理评估和咨询也有助于减轻认知功能下降。此外，针对可改变的危险因素采取预防策略并实施抗炎饮食已被证明是有益的。正在进行的研究集中在针对神经炎症过程的新型干预措施的研究上。最近，C反应蛋白家族的一个新成员——五聚素3，已被确定为动脉粥样硬化病变细胞产生的一种特定血管炎症生物标志物，它可能有助于识别认知功能下降。必须制定统一的指南，以识别和管理心肌梗死后患者的认知障碍，从而提高老年人群的生活质量。
