Key Points
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Evidence from multidisciplinary research indicates that vascular risk factors (VRFs) present during young adulthood and mid-life are potential aetiological factors for cognitive decline and dementia in later life
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Cardiovascular disease and cognitive ageing (such as cognitive decline and dementia) share similar pathogenetic processes such as atherosclerosis and ischaemia
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VRFs might contribute to the development of neurodegenerative lesions (such as deposition of β-amyloid) in the brain
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Clinical and subclinical cardiovascular diseases can be linked to cognitive decline and dementia by causing cerebral hypoxia and silent brain lesions
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Emerging evidence indicates that dementia in advanced age develops after a lifelong sequence of events beginning with exposure to VRFs in youth, followed by heart disease and cerebrovascular disease
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Current interventional strategies to promote cardiovascular health might be the most promising approach to protect the brain and maintain intact cognitive function in ageing
Abstract
The incidence of dementia and cardiovascular disease (CVD) increases with age. Current evidence supports the role for both atherosclerosis and arteriosclerosis as a common pathophysiological ground for the heart–brain connection in ageing. Cognitive decline and CVDs share many vascular risk factors (VRFs) such as smoking, hypertension, and diabetes mellitus; furthermore, CVDs can contribute to cognitive decline by causing cerebral hypoperfusion, hypoxia, emboli, or infarcts. Mixed dementia, resulting from both cerebrovascular lesions and neurodegeneration, accounts for the majority of dementia cases among very old individuals (≥75 years). An accumulation of multiple VRFs, especially in middle age (40–59 years of age), can substantially increase dementia risk. The suggested declining trend in dementia risk, occurring in parallel with the decreasing incidence of cardiovascular events in high-income countries, supports the role of cardiovascular burden in dementia. Accordingly, strategies to promote cardiovascular health, especially if implemented from early life, might help to delay the onset of dementia. In this Review, we discuss the literature investigating the association of cardiovascular burden with cognitive decline and dementia over the life-course.
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Acknowledgements
The authors' work was supported by grants from the Swedish Research Council, the Swedish Research Council for Health, Working Life and Welfare, and the Karolinska Institutet, Stockholm, Sweden.
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C.Q. researched data for the article. Both authors contributed substantially to discussion of its content, and to writing, reviewing, and editing the manuscript before submission.
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Qiu, C., Fratiglioni, L. A major role for cardiovascular burden in age-related cognitive decline. Nat Rev Cardiol 12, 267–277 (2015). https://doi.org/10.1038/nrcardio.2014.223
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DOI: https://doi.org/10.1038/nrcardio.2014.223
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