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The Role of Cardiovascular Disease in Cognitive Impairment

Abstract

Purpose of the Review

With no disease-modifying treatments for Alzheimer’s disease (AD) currently established, a priority for public health is prevention of cognitive decline and dementia. Treatment and prevention of cardiovascular disease (CVD) may provide such an opportunity.

Recent Findings

While the pathology of athero- and arteriolosclerotic cerebrovascular disease was once thought of as distinct from AD pathobiology, accumulating evidence suggests that there is more overlap in vascular and AD-related pathologies than previously recognized. CVD and its risk factors are associated with cognitive decline and dementia, in multiple studies. Given that CVD is prevalent among older adults, understanding the contributions of vascular disease to dementia is an important area of research.

Summary

While the exact relationship remains to be defined, several mechanisms linking CVD to dementia have been proposed: [1] CVD and dementia have shared risk factors, which might alter clearance of brain toxins or otherwise increase neurodegeneration; [2] CVD might lead to clinical or subclinical strokes, leading to cognitive impairment; and [3] CVD might directly alter cerebral perfusion. Most prior work has focused on risk factors for CVD, but the relationship between end-organ CVD itself and dementia is of extreme importance in considering prevention. Earlier intervention might be the most beneficial since CVD risk appears to have strongest relationships with cognition when measured years before the onset of dementia. The practicing physician should see such evidence as an impetus to aggressively address both symptomatic CVD and CVD risk factors, not only in their elderly patients but importantly in those of middle age.

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Correspondence to Michelle C. Johansen.

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Conflict of Interest

Dr. Gottesman reports her role as Associate Editor of American Academy of Neurology’s Neurology journal.

Dr. Johansen reports grants from American Heart Association, outside the submitted work.

Dr. Langton-Frost declares no conflict of interest.

Human and Animal Rights and Informed Consent

There are several references for the ARIC study, which is a longitudinal cohort study that has answered many of the questions raised by this article. It is human subjects research and both Dr. Johansen and Dr. Gottesman have done work with this group.

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Johansen, M.C., Langton-Frost, N. & Gottesman, R.F. The Role of Cardiovascular Disease in Cognitive Impairment. Curr Geri Rep 9, 1–9 (2020). https://doi.org/10.1007/s13670-020-00309-7

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Keywords

  • Cognitive impairment
  • Vascular cognitive impairment
  • Geriatrics
  • Ischemic stroke
  • Dementia