COGNITIVE decline may start years before a heart attack, stroke, or heart failure admission, with older adults showing faster deterioration in several cognitive domains well before cardiovascular disease events.
Why Cognitive Decline May Signal Vascular Risk
Cognitive decline after cardiovascular disease is well recognised, yet whether deterioration begins before events has remained uncertain. Researchers examined if older adults who later developed cardiovascular disease already showed steeper cognitive decline than peers without events. Clarifying this relationship could improve earlier cardiovascular risk detection and preventive care strategies.
Assessing Cognitive Decline
This nested case-control analysis used data from the ASPREE randomised trial and ASPREE-XT observational extension in Australia and the US. Community-dwelling adults aged 65 years or older without prior cardiovascular disease were enrolled between March 2010 and December 2014, with follow-up through December 2022. Over 11 years, 1,934 cardiovascular events occurred among 19,114 participants. Investigators matched 1,887 of 1,934 case patients (97.6%) to 7,548 controls, creating a cohort of 9,435 participants with median age 75.7 years (IQR 72.4 to 80.0), including 4,970 males (52.7%). Outcomes included trajectories on Modified Mini-Mental State Examination, Hopkins Verbal Learning Test-Revised, Symbol Digit Modalities Test, and Controlled Oral Word Association Test. Linear mixed-effects models compared pre-event cognitive decline.
Results Show Earlier and Faster Cognitive Decline
Participants with incident cardiovascular events had lower cognitive function beginning 3 to 8 years before events versus controls. Faster declines were observed in global cognition (β, −0.19 [95% CI, −0.33 to −0.06]), episodic memory (β, −0.04 [95% CI, −0.11 to −0.03]), processing speed (β, −0.28 [95% CI, −0.48 to −0.07]), and verbal fluency (β, −0.15 [95% CI, −0.27 to −0.04]). Composite global cognition declined faster (β, −0.11 [95% CI, −0.17 to −0.06]), as did executive function (β, −0.07 [95% CI, −0.11 to −0.03]), while memory composite decline was not significant. Processing speed diverged earliest, approximately 8 years before events.
Clinical Implications and Future Directions
These findings suggest cognitive decline, especially slowing processing speed, may act as an early marker of future cardiovascular disease. Incorporating cognitive monitoring into geriatric risk assessment could help identify vulnerable individuals sooner. Future studies should test whether targeted cardiovascular prevention can modify these preclinical cognitive trajectories and reduce later events.
Reference
Vishwanath S et al. Cognitive decline preceding incident cardiovascular events in older adults. JAMA Netw Open. 2026;9(4):e267841.
Featured image: velishchuk on Adobe Stock
