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Cognitive Decline Preceding Incident Cardiovascular Events in Older Adults
Swarna Vishwanath1, Zimu Wu1, Andrew Tonkin1
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
JAMA Network Open
|April 20, 2026
Summary
Cognitive decline precedes cardiovascular disease (CVD) events in older adults, indicating a potential link. This decline impacts global cognition, memory, processing speed, and verbal fluency years before an event.
Area of Science:
- Neurology
- Cardiology
- Gerontology
Background:
- Cardiovascular disease (CVD) events are known to increase the risk of cognitive decline and dementia.
- The timing of cognitive changes relative to CVD events remains unclear, specifically whether decline precedes the event.
Purpose of the Study:
- To compare cognitive trajectories in older adults before and after a cardiovascular disease (CVD) event versus a matched control group without a CVD event.
Main Methods:
- A nested case-control study using data from the Aspirin in Reducing Events in the Elderly (ASPREE) trial and its extension (ASPREE-XT).
- Included community-dwelling older adults (≥65 years) without prior CVD.
- Matched participants with adjudicated CVD events (fatal CHD, nonfatal MI, stroke, HHF) to controls without CVD events.
- Analyzed cognitive function using validated tests and linear mixed-effects models.
Main Results:
- Individuals experiencing CVD events showed significantly lower cognitive function starting 3-8 years prior to the event compared to controls.
- Faster declines were observed in global cognition, episodic memory, processing speed, and verbal fluency preceding CVD events.
- Composite global cognition and executive function also declined faster before CVD events, with similar patterns for fatal CHD, stroke, and HHF, but not nonfatal MI.
Conclusions:
- Cognitive deterioration is prominent in the years leading up to cardiovascular disease events in older adults.
- These findings suggest that cognitive decline may be an early marker or contributing factor to subsequent CVD events.
- Further research is warranted to elucidate the association between cognitive changes and CVD development.
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