%0 Journal Article
%T Cardiovascular Risk Factors Promote Brain Hypoperfusion Leading to Cognitive Decline and Dementia
%A Jack C. de la Torre
%J Cardiovascular Psychiatry and Neurology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/367516
%X Heart disease is the major leading cause of death and disability in the world. Mainly affecting the elderly population, heart disease and its main outcome, cardiovascular disease, have become an important risk factor in the development of cognitive decline and Alzheimer¡¯s disease (AD). This paper examines the evidence linking chronic brain hypoperfusion induced by a variety of cardiovascular deficits in the development of cognitive impairment preceding AD. The evidence indicates a strong association between AD and cardiovascular risk factors, including ApoE4, atrial fibrillation, thrombotic events, hypertension, hypotension, heart failure, high serum markers of inflammation, coronary artery disease, low cardiac index, and valvular pathology. In elderly people whose cerebral perfusion is already diminished by their advanced age, additional reduction of cerebral blood flow stemming from abnormalities in the heart-brain vascular loop ostensibly increases the probability of developing AD. Evidence also suggests that a neuronal energy crisis brought on by relentless brain hypoperfusion may be responsible for protein synthesis abnormalities that later result in the classic neurodegenerative lesions involving the formation of amyloid-beta plaques and neurofibrillary tangles. Insight into how cardiovascular risk factors can induce progressive cognitive impairment offers an enhanced understanding of the multifactorial pathophysiology characterizing AD and ways at preventing or managing the cardiovascular precursors of this dementia. 1. Introduction It has been known since the Ebers papyrus [1] in 1552 BC, and probably even before then, that the brain and heart are intimately connected. The ancient Greeks and Aristotle in particular believed that the function of the brain was to ¡°cool¡± the blood while the heart was the source of memory. This belief was consolidated by religious and scientific dogma for centuries. It took the most significant achievements in medicine in the 16th and 17th centuries by the Belgian anatomist Andreas Vesalius and the English physician William Harvey to challenge that prevailing dogma and describe a more accurate account of the cerebral circulation as well as the heart¡¯s continuous pumping action inside a very precise circuit. Fast-forwarding to the 20th century, several researchers in the late 1970s became aware of an intriguing link between a sick heart and the start of cognitive deterioration that often led to vascular dementia (VaD) [2]. This link came to be known as ¡°cardiogenic dementia¡±, and although it remained largely ignored
%U http://www.hindawi.com/journals/cpn/2012/367516/