Heart failure, atrial fibrillation, and coronary heart disease associated with cognitive impairment

This scientific statement reviews the latest research investigating the relationship between cardiovascular health and brain health, including cognitive impairment and neuropsychological dysfunction. This statement emphasizes the interconnectedness of the brain and heart and how important this relationship is to overall health.

“Stroke and cognitive decline are both major determinants of brain health and are chronic, disabling conditions with dramatic impacts at individual and societal levels,” said Dr. said Fernando D. Testai, MD. Mr. FAHA is Professor of Neurology and Rehabilitation and Director of the Vascular Neurology Fellowship at the University of Illinois College of Medicine and Chief of Stroke Medicine at the University of Illinois Hospital in Chicago. “Managing heart health from an early age is important to prevent cardiovascular disease and heart events, protect brain health, and reduce the risk of cognitive decline later in life.”

Dr. Testai added: “Dementia is generally seen as an incurable, inexorable disease that cannot be prevented. However, by adopting a healthy lifestyle and identifying and treating vascular risk factors early, Evidence suggests that this may help maintain normal brain function and reduce the burden of Alzheimer's disease.” and other related dementias. ”

heart failure

Heart failure is a significant public health problem with underlying causes such as hypertension, obesity, and type 2 diabetes. Heart failure is associated with cognitive impairment, which affects tasks such as self-care and medication management, especially in older adults. A meta-analysis of past studies found that nearly 50% of heart failure patients experience some type of cognitive impairment that can affect language, memory, and/or executive function. Patients with more severe types of heart failure tend to have higher rates of cognitive impairment.

Heart failure can cause brain damage in a variety of ways. Reduced blood flow can cause mild strokes and silent brain damage. Chronic inflammation and activation of neurohormones that work to maintain the brain's environment can also contribute to brain damage. Obesity and sleep-disordered breathing are common symptoms in patients with heart failure and are also associated with cognitive dysfunction. Brain changes such as decreased gray matter volume and white matter damage are common in heart failure and contribute to decreased brain function. Emerging evidence also indicates that patients with heart failure and neurodegenerative diseases such as Alzheimer's disease may share genetic mutations.

For patients with severe heart failure, cognitive screening is recommended before surgical intervention because of the increased risk of stroke. Stroke is known to be one of the most common causes of cognitive decline.

atrial fibrillation

Atrial fibrillation is the most common heart rhythm disorder in adults, and its prevalence across the United States is projected to increase from 2.7 million people in 2020 to nearly 16 million people by 2050. Although the association between atrial fibrillation and stroke is well known, further research is needed between atrial fibrillation and cognitive decline. A large meta-analysis found that atrial fibrillation increased the risk of cognitive impairment by 39%.

Common risk factors for atrial fibrillation and dementia include high blood pressure, type 2 diabetes, heart failure, smoking, vascular disease, sleep-disordered breathing, and older age. These factors cause structural and functional changes in the brain, leading to a decline in cognitive function. Stroke, a major predictor of cognitive impairment, has a direct relationship with atrial fibrillation. Small brain bleeds, or microbleeds, are also common in patients with atrial fibrillation and are associated with decreased cognitive function.

The reduced cardiac output associated with atrial fibrillation (similar to heart failure) can impair blood flow to key areas of the brain responsible for cognitive function. Both atrial fibrillation and Alzheimer's disease are associated with systemic inflammation, and inflammatory biomarkers are associated with increased risk of blood clots and brain damage. Although further studies are needed to explore this relationship, this observation illustrates the complex interaction between the nervous and cardiovascular systems.

Effective treatment of atrial fibrillation, including the use of anticoagulants, rhythm control, and catheter ablation procedures, may reduce the risk of cognitive decline. Ongoing research is investigating whether restoring a regular heart rhythm through catheter ablation reduces cognitive impairment compared to drug therapy alone.

coronary heart disease

Coronary heart disease significantly increases the risk of dementia and cognitive impairment. A large systematic review of more than 1 million adults shows that people with heart disease have a 27% higher risk of developing dementia than people without heart disease. After a heart attack, up to 50% of people experience a loss of brain function. Data from multiple large studies shows that heart attacks are associated with a rapid decline in cognitive functions such as memory and executive function. Elevated levels of calcium buildup in the arteries are also associated with an increased risk of developing dementia.

Coronary heart disease can negatively impact brain function through various mechanisms. Common risk factors such as high blood pressure and type 2 diabetes cause inflammation that affects the blood-brain barrier, reducing blood flow to the brain and leading to cognitive decline and dementia. Heart disease is also associated with small vessel disease in the brain and decreased cerebral blood flow, resulting in cognitive impairment. These problems are also seen in patients with Alzheimer's disease, and a close link between vascular damage and brain degeneration has been shown. In addition, genetic factors that increase the risk of heart disease may also contribute to brain atrophy and cognitive decline.

Improving vascular risk factors may preserve cognitive performance, but the specific effects in patients with coronary heart disease are not fully established. Intensive blood pressure treatment has shown promise in reducing mild cognitive impairment but is ineffective against dementia. Other studies suggest that managing cardiovascular risk factors through lifestyle interventions such as diet and exercise may help maintain cognitive health.

“New drugs are being developed that could potentially treat Alzheimer's disease, but the medical community is well aware that prevention is better than cure,” Testai said. “Further research is needed to confirm and outline whether this can improve brain health.” Further research is needed to understand how gender, race, and ethnicity influence the brain-heart relationship. ”

“Health care professionals need to approach patients in a holistic way, using approaches to improve heart health throughout the lifespan. It's important to promote heart health early on, and to monitor and manage your heart health through resources like the Association's Life.'' To reduce the risk of cognitive impairment, there are 8 essential It's important. ”

This scientific statement was prepared by a volunteer writing group on behalf of the Stroke Council of the American Heart Association. Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Council on Cardiovascular and Stroke Nursing. and the Hypertension Council. American Heart Association scientific statements help raise awareness about cardiovascular disease and stroke issues and promote informed medical decisions. A scientific statement outlines what is currently known about a topic and areas where additional research is needed. Scientific statements serve to create guidelines, but do not recommend treatments. American Heart Association guidelines provide the association's official clinical practice recommendations.

Co-authors are Vice Chair Philip B. Golick, MD, MPH, FAHA; Pei-Ying Chuang, Ph.D., EMBA, MSN, RN. Shin Dai, MD, Karen L. Furey, MD, FAHA; Rebecca F. Gottsman, MD, FAHA; Jose C. Iturrizaga, MD, FAHA. Ronald M. Lazar, MD, FAHA; Andrea M. Russo, MD, FAHA. Sudha Seshadri, MD, and Elaine Y. Wang, MD, FAHA. Author disclosure information is provided in the manuscript.