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Review
. 2025 Jul 1;85(25):2472-2491.
doi: 10.1016/j.jacc.2025.04.057.

The Impact of Cognitive Impairment on Cardiovascular Disease

Yasser Jamil  1 , Ashok Krishnaswami  2 , Ariela R Orkaby  3 , Marnina Stimmel  4 , Charles H Brown Iv  5 , Adam P Mecca  6 , Daniel E Forman  7 , Michael W Rich  8 , Michael G Nanna  9 , Abdulla A Damluji  10
Affiliations
Review

The Impact of Cognitive Impairment on Cardiovascular Disease

Yasser Jamil et al. J Am Coll Cardiol. .

Abstract

The older adult population is the fastest-growing segment of the U.S. population. Cardiovascular disease is common among older patients, which leads to excess morbidity, mortality, and health care utilization. Cognitive impairment is also common in older adults with cardiovascular disease and is expected to increase in parallel with cardiovascular disease because both conditions share the same underlying risk factors. Cardiovascular disease also exacerbates cognitive impairment through hypertension, cerebral hypoperfusion, inflammation, arrhythmia, emboli, and medication adverse events. Moreover, cognitive impairment can undermine the treatment of patients with cardiovascular disease because of changes in health literacy, adherence, and even the likelihood that guideline-directed medical and/or interventional management are under-prescribed. Patients with cognitive impairment are also more likely to endure delays in care and reduced participation in formative cardiovascular trials. In this State-of-the-Art review, we aim to: 1) examine the distinct types of cognitive impairment prevalent among cardiac patients; 2) explore the 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 to mitigate cognitive impairment in patients with cardiovascular diseases.

Keywords: aging; cardiovascular diseases; cardiovascular interventions; cognitive impairment; primary prevention; secondary prevention.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Nanna has received current research support from the American College of Cardiology Foundation supported by the George F. and Ann Harris Bellows Foundation, the Patient-Centered Outcomes Research Institute, the Yale Claude D. Pepper Older Americans Independence Center (P30AG021342), and the National Institute on Aging (K76AG088428); and has received personal fees from Heart- “ow, Inc, Merck, and Novo Nordisk. Dr Damluji has received research funding from the Pepper Scholars Program of the Johns Hopkins University Claude D. Pepper Older Americans Independence Center funded by the NIA P30-AG021334; a mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute K23-HL153771-01. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

FIGURE 1
FIGURE 1. Care Pathway for Cardiovascular Disease and Cognitive Impairment
Outline of the diagnostic and treatment steps necessary for detection, diagnosis, and management of cognitive impairment in older adults with cardiovascular disease. AB42 = amyloid-beta 42; AD8 = Alzheimer’s Dementia 8-item questionnaire; B12 = vitamin B12; CBC = complete blood count; CT = computed tomography; CV = cardiovascular; FDG-PET = fluorodeoxyglucose positron emission tomography; FAQ = Functional Activities Questionnaire; FAST = Functional Assessment Staging Tool; MMSE = Mini-Mental State Examination; MoCA = Montreal Cognitive Assessment; MRI = magnetic resonance imaging; NCD = neurocognitive disorder; PET = positron emisison tomography; SLUMS = Saint Louis University Mental Status; TSH = thyroid-stimulating hormone.
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Interventions for Cognitive Impairment in Cardiovascular Disease
Summary of various interventions aimed at managing cognitive impairment in patients with cardiovascular disease. BP = blood pressure; OAC = oral anticoagulant; GDMT = guideline-directed medical therapy; NMDA = N-methyl-D-aspartate; SSRI = selective serotonin reuptake inhibitor.
See this image and copyright information in PMC

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