Heart-brain connections in vascular cognitive impairment: The contribution of cardiovascular factors along the heart-brain axis to Vascular Cognitive Impairment

Abstract

As people age, health issues like cardiovascular diseases, memory problems, and dementia become more common. These conditions are closely linked along the ‘heart-brain axis’. Cognitive impairments include problems with memory, language, math, information processing, attention, concentration, planning, and decision-making. Dementia involves severe impairments that hinder daily activities, while mild cognitive impairment has less severe effects. Vascular Cognitive Impairment (VCI) encompasses all cognitive issues related to vascular brain damage, from subjective memory decline to dementia. Vascular damage, including strokes and cerebral small vessel disease, contributes to VCI. Disrupted cerebral blood flow, influenced by factors like heart function, blood pressure, and vessel stiffness, also may play a key role. This thesis aimed to study cardiovascular factors along the heart-brain axis contributing to VCI. It focused on: 1. Identifying heart failure patients at risk for VCI: VCI is common in heart failure patients, but identifying those at risk is challenging with routine patient characteristics. 2. Exploring the role of sex and hemoglobin in VCI: Men and women show different patterns of brain vascular injury and cognitive functioning. Lower hemoglobin levels are linked to worse cognitive performance in patients with carotid artery occlusion. 3. Investigating biological processes underlying VCI: Clusters of blood-based cardiovascular biomarkers related to coagulation, extracellular matrix organization, inflammation, angiogenesis, and signal transduction appear to be involved in VCI. The findings in this thesis contribute to a better understanding of VCI. If future research can confirm the results of this thesis, the findings could be used for (sex-specific) prevention and treatment of patients with VCI.