Cognition matters in cardiovascular disease and heart failure

This editorial refers to ‘Cognitive and brain changes associated with ischaemic heart disease and heart failure’†, by O.P. Almeida et al. , on page 1769 and ‘Cognitive impairment and risk of cardiovascular events and mortality’‡, by M. O'Donell et al. , on page 1777 ARTICLE In 1977 the term ‘cardiogenic dementia’ was coined, suggesting that this disorder might at least in some instances be secondary to cardiovascular disease (CVD).1 To date, various smaller studies have sought to clarify this issue, but results have not always been consistent. Since in the elderly, cognitive impairment (CI), CVD, and heart failure (HF) frequently co-occur, the precise mechanisms underlying CI have remained difficult to disentangle. Neurobiology of important disorders such as depression and dementia has proposed exciting hypotheses,2 but has so far not thoroughly clarified the biological links with CVD. In experimental animals post-myocardial infarction, neurohumoral ‘remodelling’ was observed in multiple brain areas, and reduction of hypothalamic inflammation appeared to prevent heart failure.3,4 In humans, an association between the total burden of CVD and cognitive deterioration was reported.5,6 Further, the degree of CI correlated with the severity of left ventricular systolic dysfunction in HF patients.7 Reduced brain perfusion as a consequence of hypotension or low cardiac output was found to be implicated in cerebral dysfunction,8,9 and patients with impaired cerebrovascular reactivity due to old age, recent stroke, or carotid occlusive disease appeared at particular risk for brain ischaemia and atrophy due to hypoperfusion.10 Atrial fibrillation as a frequent complication of CVD and HF was found associated with both Alzheimer's disease and vascular dementia.11 Vice versa, cortical and autonomic nerve dysfunction and the brainstem appear also to affect cardiac electrophysiology and arrhythmias.12 Close associations between CI and other neuropsychological or functional perturbations, …