The older adult population is the fastest-growing segment of the United States population. Cardiovascular disease is common among older patients, leading to excess morbidity, mortality, and healthcare utilization. Cognitive impairment is also common in older cardiovascular patients and is expected to increase in parallel to cardiovascular disease, as both conditions share the same underlying risk factors and pathophysiologic mechanisms. Patients with cardiovascular disease face an increased risk of developing cognitive impairment and the presence of cognitive impairment has also been associated with adverse outcomes in patients with cardiovascular disease. Cognitive impairment affects the patient's primary health literacy, adherence to healthy lifestyles, and guideline directed medical therapy. Further, patients with cognitive impairment are more likely to receive conservative management strategies, delays in care, and are less likely to be included in pivotal cardiovascular trials. In this state-of-the-art review, we aim to (1) examine distinct types of cognitive impairment prevalent among cardiac patients, (2) explore fundamental pathophysiology and mechanisms of cognitive impairment in adults with cardiovascular disease, (3) delineate the bidirectional impact of cognitive impairment and cardiovascular disease, and (4) discuss evidence-based management strategies for cognitive impairment in patients with cardiovascular diseases.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
Dustin Hillerson, MD
Important Dates
Date of Release: June 23, 2025
Term of Approval/Date of CME/MOC Expiration: June 22, 2026