Abstract
Background: Impairment in orientation to time and place is commonly observed in community-dwelling older individuals. Nevertheless, the clinical significance of this has been not fully explored. In this study, we investigated the link between performance in orientation domains and future risk of cardiovascular events and mortality in a non-hospital setting of the oldest old adults.Methods: We included 528 subjects free of myocardial infarction (Group A), 477 individuals free of stroke/transient ischemic attack (Group B), and 432 subjects free of both myocardial infarction and stroke/transient ischemic attack (Group C) at baseline from the population-based Leiden 85-plus cohort study. Participants were asked to answer five questions related to orientation to time and five questions related to orientation to place. 5-year risks of first-time fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, as well as cardiovascular and non-cardiovascular mortality, were estimated using the multivariate Cox regression analysis.Results: In the multivariable analyses, adjusted for sociodemographic characteristics and cardiovascular risk factors, each point lower performance in “orientation to time” was significantly associated with higher risk of first-time myocardial infarction (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.09–1.67, P = 0.007), first-time stroke (HR 1.35, 95% CI 1.12–1.64, P = 0.002), cardiovascular mortality (HR 1.28, 95% CI 1.06–1.54, P = 0.009) and non-cardiovascular mortality (HR 1.37, 95% CI 1.20–1.56, P < 0.001). Similarly, each point lower performance in “orientation to place” was significantly associated with higher risk of first-time myocardial infarction (HR 1.67, 95% CI 1.25–2.22, P = 0.001), first-time stroke (HR 1.39, 95% CI 1.05–1.82, P = 0.016), cardiovascular mortality (HR 1.35, 95% CI 1.00–1.82, P = 0.054) and non-cardiovascular mortality (HR 1.45, 95% CI 1.20–1.77, P < 0.001).Conclusions: Lower performance in orientation to time and place in advanced age is independently related to higher risk of myocardial infarction, stroke and mortality. Impaired orientation might be an early sign of covert vascular injuries, putting subjects at greater risk of cardiovascular events and mortality.
Highlights
Current evidence indicates that impaired cognitive function is associated with cardiovascular events and mortality (O’Donnell et al, 2012)
In the fully adjusted model, one point lower score of orientation to time was associated with 1.35-fold higher risk of myocardial infarction in Group A and 1.35-fold higher risk of stroke in Group B
One point lower score in orientation to place was associated with 1.67fold higher risk of myocardial infarction in Group A and about 1.39-fold higher risk of stroke in Group B
Summary
Current evidence indicates that impaired cognitive function is associated with cardiovascular events and mortality (O’Donnell et al, 2012). An increasing body of evidence from neuroimaging studies has shown that older subjects with cognitive dysfunction have a greater load of subclinical brain vascular abnormalities including white matter lesions, silent infarcts and microbleeds. Such brain vascular pathologies can predispose individuals to future cerebrovascular events and mortality (Schmidt et al, 2005; Bokura et al, 2006). Most of the studies that investigated the association of cognitive impairment with future risk of cardiovascular events were performed in middle-aged and young old people (de Galan et al, 2009; Wiberg et al, 2010; O’Donnell et al, 2012). We investigated the link between performance in orientation domains and future risk of cardiovascular events and mortality in a non-hospital setting of the oldest old adults
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