Cognitive impairment and cardiovascular disease can have a bidirectional relationship, but much of the attention tends to focus on how cardiovascular aging can cause dysfunction in brain tissue. Mechanisms involved include a declining supply of nutrients to the brain, the rupture of small blood vessels due to hypertension, leakage of the blood-brain barrier that provokes neuroinflammation, and so forth. In principle, cognitive impairment can aggravate the situation via reduced the level of exercise, degree to which medical care is utilized, and so forth, making cardiovascular aging worse, and so the cycle progresses. Picking apart specific contributions and assigning relative importance to them remains challenging, however.
Both cognitive impairment and cardiovascular diseases have a high incidence in the elderly population, increasing the burden of care and reducing the quality of life. Studies have suggested that cognitive impairment interacts with cardiovascular diseases such as coronary heart disease, abnormal blood pressure, heart failure, and arrhythmia.
On one hand, cognitive impairment in the elderly influences the progression and self-management of cardiovascular diseases and increases the risk of cardiovascular-related adverse events. On the other hand, coronary heart disease, heart failure, higher blood pressure variability, orthostatic hypotension, and atrial fibrillation may aggravate cognitive impairment. The role of blood pressure levels on cognition remains controversial.
Several shared biological pathways have been proposed as the underlying mechanism for the association. Cardiovascular diseases may lead to cognitive decline even dementia through cerebral perfusion damage, brain structural changes, inflammation, β-amyloid deposition, and neuroendocrine disorders. It is of great significance to study the interaction and put forward effective interventions in an overall perspective to reduce care burden and improve the quality of life of the elderly patients.