Abstract
The term “cardiogenic dementia” was introduced a few decades ago to indicate an alteration of consciousness and cognition due to heart disease. Although this term is now disused, the relationship between cardiovascular disease and cognitive impairment is currently of great interest, not only for its potential therapeutic implications, but also for the recently recognized important role that vascular factors appear to play in Alzheimer’s disease. The aims of this review are therefore 1) to show data supporting the role of cardiac disease — namely congestive heart failure, myocardial infarction and atrial fibrillation — and other vascular risk factors — i.e., hypertension and diabetes — in the development or worsening of cognitive impairment; 2) to highlight recent observations on the relationship between presence and severity of congestive heart failure / myocardial infarction / atrial fibrillation and Alzheimer’s disease; and 3) to uncover the type of studies needed in this field in order to facilitate a more precise algorithm of dementia prevention as well as intervention in demented patients with cardiovascular disease.
Similar content being viewed by others
References
Hodkinson H.M.: Common symptoms of disease in the elderly. Blackwell Scientific Publications, Oxford, 1976.
Livesley B.: Action and ageing. Proceedings of Sandoz Symposium, Basle, 1976.
Editorial: Cardiogenic dementia. Lancet 1: 27–28, 1977.
Rockwood K.: Acute confusion in elderly medical patients. J. Am. Geriatr. Soc. 37: 150–154, 1989.
Rosenberg G.A., Haaland K.Y.: Cardiogenic dementia. Lancet 2: 1171, 1981.
Bennett D.A.: Diabetes and change in cognitive function. Arch. Intern. Med. 160: 141–143, 2000.
Hèbert R., Lindsay J., Verreault R., Rockwood K., Hill G., Dubois M.F.: Vascular dementia. Incidence and risk factors in the Canadian Study of Health and Aging. Stroke 31: 1487–1493, 2000.
Kilander L., Nyman H., Hansson L., Boberg M., Lithell H.: Hypertension and associated metabolic disturbances are related to cognitive impairment. A 20-year follow-up of 999 men. Hypertension 31: 780–786, 1998.
Folstein M.F., Folstein S.E., McHugh P.R.: “Mini Mental State”: a practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12: 189–198, 1975.
Lezak M.: Neuropsychological Assessment. ed. 3. New York, Oxford University Press, 1995.
Wechsler D.: Wechsler Adult Intelligence Scale, revised. The Psychological Corporation, San Antonio, CA, 1981.
Kaplan E., Fein D., Morris R., Delis D.C.: WAIS-R NI. The Psychological Corporation, San Antonio, CA, 1991.
Elias M.F., Wolf P.A., D’Agostino R.B.: Untreated blood pressure level is inversely related to cognitive functioning. The Framingham Study. Am. J. Epidemiol. 138: 353–364, 1993.
Pierce T.W., Elias M.F.: Cognitive function and cardiovascular responsivity in subjects with a parental history of hypertension. J. Behav. Med. 16: 277–294, 1993.
Tzourio C., Dufouil C., Ducimetiere P., Alpèrovitch A., for the EVA Study Group: Cognitive decline in individuals with high blood pressure. Neurology 53: 1948–1952, 1999.
Tzourio C., Anderson C.: Blood pressure reduction and risk of dementia in patients with stroke: rationale of the dementia assessment in PROGRESS (Perindopril Protection Against Recurrent Stroke Study). PROGRESS Management Committee. J. Hypertens. (Suppl. 18): S21–S24, 2000.
Gregg E.W., Yaffe K., Cauley J.A., Rolka D.B., Blackwell T.L., Narayan K.M.V., Cummings S.R., for the Study of Osteo-porotic Fractures Research Group: Is diabetes associated with cognitive impairment and cognitive decline among older women? Arch. Intern. Med. 160: 174–180, 2000.
Hoyer S.: Brain glucose and energy metabolism abnormalities in sporadic Alzheimer disease. Causes and consequences: an update. Exp. Gerontol. 35: 1363–1372, 2000.
Skoog I.: Vascular aspects in Alzheimer’s disease. J. Neural Transm. (Suppl. 59): 37–43, 2000.
Kalaria R.N.: The role of cerebral ischemia in Alzheimer’s disease. Neurobiol. Aging 21: 321–330, 2000.
Ryan C.M., Geckle M.: Why is learning and memory dysfunction in type 2 diabetes limited to older adults? Diabetes Metab. Res. Rev. 16: 308–315, 2000.
Bent N., Rabbitt P., Metcalfe D.: Diabetes mellitus and the rate of cognitive ageing. Br. J. Clin. Psychol. 39: 349–362, 2000.
Sinclair A.J., Girling A.J., Bayer A.J.: Cognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self-management and use of care services. Diabetes Res. Clin. Pract. 50: 203–212, 2000.
Kilander L., Andrèn B., Nyman H., Lind L., Boberg M., Lithell H.: Atrial fibrillation is an independent determinant of low cognitive function. A cross-sectional study in elderly men. Stroke 29: 1816–1820, 1998.
Furberg C.D., Psaty B.M., Manolio T.A.: Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am. J. Cardiol. 74: 236–241, 1994.
Farina E., Magni E., Ambrosini F., Manfredini R., Binda A., Sina C., Mariani C.: Neuropsychological deficits in asymptomatic atrial fibrillation. Acta Neurol. Scand. 96: 310–316, 1997.
Sabatini T., Frisoni G.B., Barbisoni P., Bellelli G., Rozzini R., Trabucchi M.: Atrial fibrillation and cognitive disorders in older people. J. Am. Geriatr. Soc. 48: 387–390, 2000.
Zito M., Muscari A., Marini E., Di Iorio A., Puddu G.M., Abate G.: Silent lacunar infarcts in elderly patients with chronic non valvular atrial fibrillation. Aging Clin. Exp. Res. 8: 341–346, 1996.
de Leeuw F.E., de Groot J.C., Oudkerk M., Kors J.A., Hof-man A., van Gijn J., Breteler M.M.B.: Atrial fibrillation and the risk of cerebral white matter lesions. Neurology 54: 1795–1800, 2000.
Rengo F., Acanfora D., Trojano L., Scognamiglio P., Ciaburri F., Ceriello A., Bollella O.F., Lanzillo T., Papa A.: Congestive heart failure and cognitive impairment in the elderly. Arch. Gerontol. Geriatr. 20: 63–68, 1995.
Acanfora A.D., Trojano L., Iannuzzi G.L., Furgi G., Picone C., Rengo C., Abete P., Rengo F. for the CHF Italian Study Investigators: The brain in congestive heart failure. Arch. Gerontol. Geriatr. 23: 247–256, 1996.
Cacciatore F., Abete P., Ferrara N., Calabrese C., Napoli C., Maggi S., Varricchio M., Rengo F., for the Osservatorio Geriatrico Campano Study Group: Congestive heart failure and cognitive impairment in an older population. J. Am. Geriatr. Soc. 46: 1343–1348, 1998.
Zuccalà G., Cattel C., Manes-Gravina E., Di Niro M.G., Coc-chi A., Bernabei R.: Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J. Neu-rol. Neurosurg. Psychiatry 63: 509–512, 1997.
Bornstein R.A., Starling R.C., Myerowitz P., Haas G.J.: Neu-ropsychological function in patients with end-stage heart failure before and after cardiac transplantation. Acta Neurol. Scand. 91: 260–265, 1995.
Schall R.R., Petrucci R.J., Brozena S.C., Cavarocchi N.C., Jes-sup M.: Cognitive function in patients with symptomatic dilated cardiomyopathy before and after cardiac transplantation. J. Am. Coll. Cardiol. 14: 1666–1672, 1989.
Breteler M.M.B., Claus J.J., Grobbee D.E., Hofman A.: Cardiovascular disease and distribution of cognitive function in elderly people: the Rotterdam Study. BMJ 308: 1604–1608, 1994.
Legault S.E., Joffe R.T., Armstrong P.W.: Psychiatric morbidity during the early phase of coronary care for myocardial infarction: association with cardiac diagnosis and outcome. Can. J. Psychiatry 37: 316–325, 1992.
Ahto M., Isoaho I., Puolijoki H., Laippala P., Sulkava R., Kivelä S.L.: Cognitive impairment among elderly coronary heart disease patients. Gerontology 45: 87–95, 1999.
Grubb N.R., O’Carroll R.E., Cobbe S.M., Sirel J., Fox K.A.A.: Chronic memory impairment after cardiac arrest outside hospital. BMJ 313: 143–146, 1996.
Grubb N.R., Fox K.A.A., Smith K., Best J., Blane A., Ebmeier K.P., Glabus M.F., O’Carroll R.E.: Memory impairment in out-of-hospital cardiac arrest survivors is associated with global reduction in brain volume, not focal hippocampal injury. Stroke 31: 1509–1514, 2000.
Cervilla J.A., Prince M., Mann A.: Smoking, drinking, and incident cognitive impairment: a cohort community based study included in the Gospel Oak project. J. Neurol. Neurosurg. Psychiatry 68: 622–626, 2000.
Nordberg M., Winblad B., Fratiglioni L., Basun H.: Lead concentrations in elderly urban people related to blood pressure and mental performance: results from a population study. Am. J. Ind. Med. 38: 290–294, 2000.
Knopman D., Boland L.L., Mosley T., Howard G., Liao D., Szklo M., McGovern P., Folsom A.R. for the Atherosclerosis Risk in Communities (ARIC) Study Investigators: Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology 56: 42–48, 2001.
Skoog I., Lernfelt B., Landahl S., Palmertz B., Andreasson L.A., Nilsson L., Persson G., Odèn A., Svanborg A.: 15-year longitudinal study of blood pressure and dementia. Lancet 347: 1141–1145, 1996.
Skoog I., Palmertz B, Andreasson L.A.: The prevalence of white matter lesions on computed tomography of the brain in demented and non-demented 85-year olds. J. Geriatr. Psychiatry Neurol. 7: 169–175, 1994.
Forette F., Seux M.L., Staessen J.A., Thijs L., Birkenhäger W.H., Babarskiene M.R., Babeanu S., Bossini A., Gil-Ex-tremera G., Girerd X., Laks T., Lilov E., Moisseyev V., Tuomilehto J., Vanhanen H., Webster J., Yodfat Y., Fagard R., on behalf of the Syst-Eur Investigators: Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 352: 1347–1351, 1998.
Launer L.J., Ross G.W., Petrovitch H., Masaki K., Foley D., White L.R., Havlik R.J.: Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol. Aging 21: 49–55, 2000.
Ott A., Stolk R.P., Hofman A., van Harskamp F., Grobbee D.E., Breteler M.M.B.: Association of diabetes mellitus and dementia: The Rotterdam Study: Diabetologia 39: 1392–1397, 1996.
Ott A., Breteler M.M.B., de Bruyne M.C., van Harskamp F., Grobbee D.E., Hofman A.: Atrial fibrillation and dementia in a population-based study. The Rotterdam Study: Stroke 28: 316–321, 1997.
Aronson M.K., Ooi W.L., Morgenstern H., Hafner A., Masur D., Crystal H., Frishman W.H., Fisher D., Katzman R.: Women, myocardial infarction, and dementia in the very old. Neurology 40: 1102–1106, 1990.
Sparks D.L., Hunsaker J.C. III, Scheff S.W., Kryscio R.J., Henson J.L., Markesbery W.R.: Cortical senile plaques in coronary artery disease, aging and Alzheimer’s disease. Neu-robiol. Aging 11: 601–607, 1990.
Loscalzo J.: The oxidant stress of hyperhomocyst(e)inemia. J. Clin. Invest. 98: 5–7, 1996.
Bots M.L., Launer L.J., Lindemans J., Hofman A., Grobbee D.E.: Homocysteine, atherosclerosis and prevalent cardiovascular disease in the elderly: The Rotterdam Study. J. Intern. Med. 242: 339–347, 1997.
Kalmijn S., Launer L.J., Lindemans J., Bots M.L., Hofman A., Breteler M.M.B.: Total homocysteine and cognitive decline in a community-based sample of elderly subjects. The Rotterdam Study. Am. J. Epidemiol. 150: 283–289, 1999.
Polidori M.C., Mecocci P., Cecchetti R., Cherubini A., Senin U.: Plasma homocysteine and vitamin status in very old patients with vascular and Alzheimer dementia. Proceedings of the First International Congress on Vascular Dementia, Geneva, October 3-6, 1999 (Abstract).
Van der Cammen T.J.M., Vershoor C.J., Van Loon C.P.M.: Risk of left ventricular dysfunction in patients with probable Alzheimer’s disease with APOE4 allele. J. Am. Geriatr. Soc. 46: 962–967, 1998.
Sagnella G.A., Rothwell M.J., Onipinla A.K., Wicks P.D., Cook D.G., Cappuccio F.P.: A population study of ethnic variations in the angiotensin-converting enzyme I/D polymorphism: relationships with gender, hypertension and impaired glucose metabolism. J. Hypertens. 17: 657–664, 1999.
Skoog I., Nilsson L., Palmertz B., Andreasson L., Svanborg A.: A population-based study of dementia in 85-year olds. N. En-gl. J. Med. 328: 153–158, 1993.
Larson E.B.: Illnesses causing dementia in the very elderly. N. Engl. J. Med. 328: 203–205, 1993.
Snowdon D.A., Greiner L.H., Mortimer J.A., Riley K.P., Greiner P.A., Markesbery W.R.: Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA 277: 813–817, 1997.
Heyman A., Fillenbaum G.G., Welsh-Bomer K.A., Gearing M., Mirra S.S., Mohs R.C., Peterson B.L., Pieper C.F.: Cerebral infarcts in patients with autopsy-proven Alzheimer’s disease. CERAD, part XVIII. Neurology 51: 159–162, 1998.
Nagata K., Kondoh Y., Atchison R., Sato M., Satoh Y., Watahi-ki Y., Hirata Y., Yokoyama E.: Vascular and metabolic reserve in Alzheimer’s disease. Nuerobiol. Aging 21: 301–307, 2000.
Kudo T., Imaizumi K., Tanimukai H., Katayama T., Sato N., Nakamura Y., Tanaka T., Kashiwagi Y., Jinno Y., To-hyama M., Takeda M.: Are cerebrovascular factors involved in Alzheimer’s disease? Neurobiol. Aging 21: 215–224, 2000.
Farkas E., De Vos R.A.I., Steur E.N.H.J., Luiten P.G.M.: Are Alzheimer’s disease, hypertension, and cerebrocapillary damage related? Neurobiol. Aging 21: 235–243, 2000.
De la Torre J.C.: Critically attained threshold of cerebral hy-poperfusion: the CATCH hypothesis of Alzheimer’s patho-genesis. Neurobiol. Aging 21: 331–342, 2000.
Solerte S.B., Ceresini G., Ferrari E., Fioravanti M.: Hemorhe-ological changes and overproduction of cytokines from immune cells in mild to moderate dementia of the Alzheimer’s type: adverse effects on cerebromicrovascular system. Neurobiol. Aging 21: 271–281, 2000.
Mecocci P., MacGarvey U., Kaufman A.E., Koontz D., Shoffn-er J.M., Wallace D.C., Beal M.F.: Oxidative damage to mi-tochondrial DNA shows marked age-dependent increases in human brain. Ann. Neurol. 34: 609–616, 1993.
Polidori M.C., Mecocci P., Briviba K., Reimann A., Cec-chetti R., Stahl W., Sies H., Senin U.: Plasma lipid peroxidation and vitamin C status in healthy centenarians. J. Am. Geriatr. Soc. 47: 1038–1039, 1999 (Letter).
Mecocci P., Polidori M.C., Troiano L., Cherubini A., Cecchetti R., Pini G., Straatman M., Monti D., Stahl W., Sies H., Franceschi C., Senin U.: Plasma antioxidants and longevity: a study on healthy centenarians. Free Rad. Biol. Med. 28: 1243–1248, 2000.
Polidori M.C., Frei B., Cherubini A., Nelles G., Rordorf G., Keaney J.F.K. Jr., Schawamm L., Mecocci P., Koroshetz W.J., Beal M.F.: Increased plasma levels of lipid hydroperoxides in patients with ischemic stroke. Free Rad. Biol. Med. 25: 561–567, 1998.
Polidori M.C., Mecocci P., Stahl W., Parente B., Cecchetti R., Cherubini A., Cao P., Sies H., Senin U.: Plasma levels of lipophilic antioxidants in very old patients with type 2 diabetes. Diabetes Metab. Res. Rev. 16: 15–19, 2000.
Polidori M.C., Mecocci P., Cecchetti R., Alunni G., Savino K., Corea L., Senin U.: Plasma antioxidant status in elderly subjects with congestive heart failure and type 2 diabetes. Proceedings of the IV European Congress of Gerontology, “Aging in Europe - European Aging”, Berlin, Germany, July 7–11, 1999. Zeitschrift fuer Gerontologie und Geriatrie, 32 S 2: 124, 1999 (Abstract).
Polidori M.C., Stahl W., Eichler O., Niestroj I., Sies H.: An-tioxidant profiles in human plasma. Free Rad. Biol. Med. 30: 456–462, 2001.
Cherubini A., Polidori M.C., Bregnocchi M., Pezzuto S., Cecchetti R., Ingegni T., Di Iorio A., Senin U., Mecocci P.: Plasma antioxidant profile and early outcome in elderly stroke patients. Stroke 31: 2295–2300, 2000.
Mecocci P., MacGarvey U., Beal M.F.: Oxidative damage to mitochondrial DNA is increased in Alzheimer’s disease. Ann. Neurol. 36: 747–751, 1994.
Mecocci P., Polidori M.C., Ingegni T., Cherubini A., Chionne F., Cecchetti R., Senin U.: Oxidative damage to DNA from AD patients. Neurology 51: 1014–1017, 1998.
Mecocci P., Polidori M.C., Mattioli P., Cecchetti R., Ingegni T., Cherubini A., Catani M., Senin U.: Plasma antioxidants and ox-idative DNA damage in lymphocytes from normal aged people and Alzheimer disease patients. Proceedings of the World Alzheimer Congress 2000, Washington D.C., July 9-18, 2000. Neurobiol. Aging 21 (Suppl. 1): 273, 2000 (Abstract).
Butterfield D.A., Varadarajan S., Aksenova M., Link C., Yatin S.M.: On methionine and Alzheimer’s amyloid -peptide (1-42)-induced oxidative stress. Neurobiol. Aging 20: 339–342, 1999.
Lin B., Schmidt-Kastner R., Busto R., Ginsberg M.D.: Progressive parenchymal deposition of -amyloid precursor protein in rat brain following global cerebral ischemia. Acta Neuropathol. 97: 359–368, 1999.
Misonou H., Morishima-Kawashima M., Ihara Y.: Oxidative stress induces intracellular accumulation of amyloid protein (Abeta) in human neuroblastoma cells. Biochemistry 39: 6951–6959, 2000.
Shi J., Yang S.H., Stubley L., Day A.L., Simpkins J.W.: Hypoperfusion induces over expression of -amyloid precursor protein mRNA in a focal ischemic rodent model. Brain Res. 853: 1–4, 2000.
Selhub J., Bagley L.C., Miller J., Rosenberg I.H.: B vitamins, homocysteine, and neurocognitive function in the elderly. Am. J. Clin. Nutr. 71: 614S–620S, 2000.
Kukull W.A.: The association between smoking and Alzheimer’s disease: effects of study design and bias. Biol. Psychiatry 49: 194–199, 2001.
Mattson M.P.: Existing data suggest that Alzheimer’s disease is preventable. Ann. N.Y. Acad. Sci. 924: 153–159, 2000.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Polidori, M.C., Marvardi, M., Cherubini, A. et al. Heart disease and vascular risk factors in the cognitively impaired elderly: Implications for Alzheimer’s dementia. Aging Clin Exp Res 13, 231–239 (2001). https://doi.org/10.1007/BF03351481
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03351481