The prevalence of dementia and cardiovascular disease (CVD) are rising in the United States. Though difficult to quantify, the prevalence of concurrent dementia and CVD is also likely rising. In a recent poll, ACC.org readers examined Mr. K, who is an established patient, for his chronic ischemic cardiomyopathy and new reports of forgetfulness (see full clinical vignette).

While all answers are reasonable approaches to Mr. K's cardiovascular care, we believe (and respondents overwhelmingly agreed [93%]) that a baseline cognitive assessment would be of high importance as its impact will affect multiple other domains.

The prevalence of both dementia, particular Alzheimer's dementia, and CVD are rising. Both diseases are leading causes of death. Both diseases share common pathophysiology and risk factors such as hypertension, hypotension, diabetes, hyperlipidemia, and atherosclerosis.¹ Patients with both dementia and CVD are particularly high risk given compounded complexity in medical management. It is important to screen for dementia in CVD patients to assess potential impact on self-management and decision-making capacity. However, the diagnosis of dementia, especially in early stages, can be challenging due to lack of biomarkers and recommended screening tools. Cognitive assessments such as the Mini-Mental State Exam (MMSE), Mini Cog^©, and MoCA may be helpful in screening for dementia.² Patients with both dementia and CVD would benefit from early palliative care integration in their care to address advance care planning, to support medical decision-making, and to facilitate appropriate transitions to hospice care (Figure 1).

References

1. Santos CY, Snyder PJ, Wu WC, Zhang M, Echeverria A, Alber J. Pathophysiologic relationship between Alzheimer's disease, cerebrovascular disease, and cardiovascular risk: a review and synthesis. Alzheimer's Dement (Amst) 2017;7:69-87.
2. Galvin JE, Sadowsky CH. Practical guidelines for the recognition and diagnosis of dementia. J Am Fam Med 2012;25:367-82.

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Hypertension, Sleep Apnea, Geriatric Cardiology

Keywords: Cardiovascular Diseases, Hospice Care, Palliative Care, Hyperlipidemias, Prevalence, Alzheimer Disease, Mental Status and Dementia Tests, Hypertension, Mass Screening, Risk Factors, Diabetes Mellitus, Advance Care Planning, Hypotension, Clinical Decision-Making, Atherosclerosis, Biomarkers, Cognition, Decision Making, Cardiomyopathies, Heart Failure, Dementia

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