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Int J Cardiol. 2014 Jul 15;175(1):21-9. doi: 10.1016/j.ijcard.2014.05.004. Epub 2014 May 9.

Cognitive impairment and cardiovascular disease: so near, so far.

Author information

1
Institute of Clinical Physiology, CNR, Pisa, Italy.
2
Institute of Clinical Physiology, CNR, Pisa, Italy. Electronic address: rosam.bruno@gmail.com.
3
Institute of Clinical Physiology, CNR, Rome, Italy.
4
Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy.

Abstract

In the spectrum of cognitive impairment, ranging from "pure" vascular dementia to Alzheimer's disease (AD), clinical interest has recently expanded from the brain to also include the vessels, shifting the pathophysiological focus from the leaves of synaptic dysfunction to the sap of cerebral microcirculation and the roots of cardiovascular function. From a diagnostic viewpoint, a thorough clinical evaluation of individuals presenting cognitive impairment might systematically include the assessment of the major cardiovascular rings of the chain linking regional perfusion to brain function: 1) lung (with assessment of asthma, chronic obstructive pulmonary disease, obstructive sleep apnea syndrome); 2) heart function (with clinical examination and echocardiography) and cardiovascular risk factors; 3) orthostatic hypotension (with medical history and measurement of heart rate and blood pressure in supine and upright positions); 4) aorta and large artery stiffness (with assessment of pulse wave velocity); 5) large cerebro-vascular vessel status (with neuroimaging techniques); 6) assessment of microcirculation (with cerebrovascular reactivity testing with transcranial Doppler sonography or MRI perfusion imaging); and 7) assessment of venous cerebral circulation. The apparent difference in approaches to "brain" and "vascular" environmental enrichment with physical, cognitive and sensorial training is conceptually identical to that of a constant gardener caring for an unhealthy tree, watering the leaves ("train the brain") or simply the roots ("mind the vessel"). The therapeutic difference probably consists in the amount and quality of water added to the tree, rather than by where one pours it, with either a top-down (leaves to roots) or bottom-up (roots to leaves) approach.

KEYWORDS:

Atherosclerosis; Brain; Dementia; Vessels

PMID:
24856805
DOI:
10.1016/j.ijcard.2014.05.004
[Indexed for MEDLINE]
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