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• W2000725630 abstract "There is much concern about the high prevalence of dementia in old age.1,2 The East Boston Study revealed that in persons over the age of 85 years the prevalence of dementia approximates 50%.3 In our acute geriatrics service, we recently observed that of 11 patients over 75 years old with permanent pacemakers, eight were cognitively disabled, prompting us to look for this connection further in the literature of the last 5 years. Although cardiologists are often involved with rescuing patients from sudden demise,1, 2 little has been written regarding what happens to these patients cognitively. Fourteen years ago, it was thought that because the aging brain is sensitive to hypoxia, cardiac pacemakers could actually prevent this process.4,5 Although it is expected that more and more old patients will need advice regarding the benefit/risk and cost-effectiveness of pacemakers,6-9 no mention is usually made of how these patients live out their lives after pacemaker placement. Sasaki et al reviewed the death of 103 patients, and dementia was not mentioned as an underlying disease.10 Muller et al analyzed 2256 patients with pacemakers11; dementia was not mentioned, but 37% of their patients died from other or unknown causes, i.e., causes unrelated to sudden death, heart failure, or cancer. Cobler et al discussed the insertion of pacemakers in six centenarians and mentioned in passing that two of them developed dementia and one was admitted to a nursing home because of a “non-cardiac problem.”12 Matsuura et al. are the only observers who have commented on this problem.13 They followed 110 patients with pacemakers and reported that the cause of death was “senility” in 62% of those over 80 years of age. In the younger age groups, 61-70 years and 71-80 years, the percentages were 14% and 32%, respectively. These percentages are much higher than those reported in the community.3 Matsuura et al reviewed 12 papers in which “senility” does not appear among the causes of death. It seems that cardiologists are less interested in the cognitive outcome of their patient, and that the generalists are not aware that the lives of some of their patients might have been prolonged at a reduced level of quality with pacemakers. Further, there is some evidence that some of the pacemakers do not restore optimal cerebral perfusion.14,15 Patients and their relatives may need to be cautioned about this possible outcome, i.e., that prolongation of life may bring with it a change in the quality of life and the way of dying." @default.
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• W2000725630 date "1990-12-01" @default.
• W2000725630 modified "2023-09-23" @default.
• W2000725630 title "Permanent Pacemakers and Dementia;" @default.
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• W2000725630 doi "https://doi.org/10.1111/j.1532-5415.1990.tb03462.x" @default.
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