The Role of Cardiovascular Disease in Cognitive Impairment

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. 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.