The Impact of Cognitive Impairment on Cardiovascular Disease (JACC June 2025-2)-Article: The Impact of Cognitive Impairment on Cardiovascular Disease

Article: The Impact of Cognitive Impairment on Cardiovascular Disease

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The JACC State-of-the-Art Review focuses on the intersection of cognitive impairment (CI) and cardiovascular disease (CVD) in older adults, highlighting how this demographic, which is rapidly growing in the U.S., often experiences both conditions concurrently. CI, including mild cognitive impairment (MCI) and major neurocognitive disorders like dementia, is expected to rise alongside CVD due to shared risk factors such as hypertension, diabetes, and atherosclerosis. The review outlines a bidirectional impact, whereby CVD exacerbates CI through mechanisms like reduced cerebral blood flow and inflammation, while CI complicates CVD management due to issues with health literacy and medication adherence.<br /><br />The authors emphasize the need for comprehensive care, including early diagnosis and management strategies that address both CVD and CI. Cognitive impairment can influence the treatment course, often leading to more conservative care and underrepresentation in clinical trials. However, better management of CVD can sometimes improve cognitive function.<br /><br />CI types prevalent in cardiac patients include both vascular cognitive impairment and Alzheimer's disease, each with distinct pathophysiological pathways but overlapping risk factors. Effective management involves a multidisciplinary approach, integrating geriatric cardiology practices and considering both pharmacologic and non-pharmacologic interventions.<br /><br />For CVD management, optimizing cardiovascular health through the American Heart Association's "Life's Essential 8" can be beneficial. Medications should be carefully prescribed, considering potential cognitive and cardiovascular side effects. The role of digital health technologies in monitoring and managing these conditions is also explored, though challenges like digital literacy and data management remain.<br /><br />The review advocates for personalized care plans that include regular physical activity, diet modifications, and social engagements to support cognitive health in CVD patients. It calls for policy reforms and prospective studies to better guide clinical practices, ultimately aiming for improved outcomes and quality of life for this patient population.

Keywords

cognitive impairment

cardiovascular disease

older adults

risk factors

comprehensive care

multidisciplinary approach

personalized care plans

digital health technologies

vascular cognitive impairment

Alzheimer's disease