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Pacemakers Common for Those With Dementia and Irregular Heartbeats
Date:7/28/2014

s published July 28 online in JAMA Internal Medicine.

For the study, Fowler's team collected data on more than 16,000 patients from 33 Alzheimer's disease centers. The participants were seen between September 2005 and December 2011 and added to the National Alzheimer's Coordinating Center Uniform Data Set.

At the start of the study, almost half the of participants had no signs of dementia, 21 percent had a mild dementia and nearly 33 percent had dementia.

The researchers found that people with dementia were older and more likely to be men, and to have heart disease and a history of stroke.

As to why those with dementia and irregular heart rhythms were more likely to get a pacemaker, Fowler speculates that people suffering from dementia typically aren't making medical decisions themselves. "Older adults with dementia often have other people helping them make decisions or making decisions for them," she said.

Or, doctors may treat patients with dementia more aggressively. "There is also evidence to show that family members have a tendency to be more aggressive when patients are seriously ill," Fowler said.

One reason could be that doctors may feel that patients with dementia aren't able to care for themselves, and placing a pacemaker takes away the need for patients to be responsible for medications or comply with other treatments, she said.

Doctors may feel more comfortable choosing conservative treatments in people without dementia because they can provide a more complete medical history, and are better able to care for themselves, she said.

Interestingly, there was no difference in the rates of implanted defibrillators between those with and without dementia, Fowler's group noted. Implanted defibrillators can shock the heart to get it beating regularly again.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, thinks the decision to use a pacemaker should be based o
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