The heart of the matter: a link between troponin and dementia?

This editorial refers to ‘High-sensitivity cardiac troponin T and cognitive function and dementia risk: the atherosclerosis risk in communities study’, by A.L.C. Schneider et al . on page doi:10.1093/eurheartj/ehu124. The term ‘cardiogenic dementia’ was first introduced in the Lancet some 25 years ago and was used to describe reduced cognitive function in the presence of cardiac failure.1 Schneider and colleagues now present novel data on the association of cardiac troponin T (cTnT) and cognitive function. High-sensitivity cTnT (hs-cTnT) assays were used to detect even minor elevations indicating subclinical myocardial damage.2 The authors evaluated serum samples available from 9472 individuals (mean age 63 years) of the ‘Atherosclerosis Risk in Communities (ARIC)’ population cohort without coronary heart disease, myocardial infarction, heart failure, or stroke at baseline. Strikingly, as many as two-thirds of all participants had hs-cTNT levels above the lower limit of detection (≥3 ng/L) while only 7% reached the higher pre-defined concentration (≥14 ng/L). The study combines two separate designs (i.e. cross-sectional and prospective) with the following two major findings: (i) elevations in hs-cTnT were associated with lower scores in memory and executive function tests independent of traditional risk factors; (ii) elevated hs-cTNT was also predictive for incident hospitalization with an ICD-9 (International Classificiation of Diseases 9th revision) code for dementia during a median of 13 years of follow-up. These findings were robust through several elaborate sensitivity analyses and adjustments for several potential confounders.2 The authors have to be commended for their work. They present data on a large patient sample, used specific and highly sensitive assays, state-of-the-art statistical evaluation, and comprehensive measurement …