Modifiable vascular markers for cognitive decline and dementia: the importance of arterial aging and hemodynamic factors

Abstract

Uncovering modifiable predictors of cognitive decline and dementia is crucial for early detection and prevention. Although high mid-life brachial blood pressure is considered a risk factor for later-life cognitive impairment, other non-invasive indices of arterial health, closely associated with aging, may improve risk stratification. This review discusses the contribution of vascular aging to cognitive decline, dementia, and brain pathology. Modifiable vascular markers are evaluated with respect to their prognostic value and ease of measurement. The notion of mitigating cognitive decline through improving cardiovascular health is also discussed. Anticipated mechanisms imply causal pathways between large artery stiffness, pulsatile pressures, and cognitive impairment through damage to small cerebral vessels. Accumulating evidence from human clinical studies now supports this mechanistic understanding. Aortic stiffness, measured as carotid-femoral pulse wave velocity, has been shown to predict cognitive decline in numerous studies. Aortic and carotid pulsatile pressures are also associated with cognitive impairment and brain pathology. Clinical evidence linking large arterial aging to dementia and associated pathology is scarce and requires further investigation. Future research is also required to investigate the extent to which the risk of cognitive decline can be perturbed by interventions that improve arterial health.