The Heart-Brain Connection: A Multidisciplinary Approach Targeting a Missing Link in the Pathophysiology of Vascular Cognitive Impairment

Issue title: Alzheimer's Disease: Detection, Prevention, and Preclinical Treatment

Guest editors: Jack C. de la Torre

Article type: Review Article

Authors: van Buchem, Mark A.^a | Biessels, Geert Jan^c | Brunner la Rocca, Hans Peter^d | de Craen, Anton J.M.^b | van der Flier, Wiesje M.^g | Ikram, M. Arfan^{h; j} | Kappelle, L. Jaap^c | Koudstaal, Peter J.ⁱ | Mooijaart, Simon P.^b | Niessen, Wiro^j | van Oostenbrugge, Robert^e | de Roos, Albert^a | van Rossum, Albert C.^f | Daemen, Mat J.A.P.^{k; *}

Affiliations: [a] Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands | [b] Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands | [c] Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands | [d] Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands | [e] Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands | [f] Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands | [g] Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands | [h] Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands | [i] Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands | [j] Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands | [k] Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands

Correspondence: [*] Correspondence to: Mat J.A.P. Daemen, MD PhD, Professor of Pathology, Department of Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel.: +31 20 5664937; Fax: +31 20 5664927; E-mail: [email protected].

Abstract: While both cardiac dysfunction and progressive loss of cognitive functioning are prominent features of an aging population, surprisingly few studies have addressed the link between heart and brain function. This is probably due to the monodisciplinary approach to these problems by cardiologists, neurologists, and geriatricians. Recent data indicate that autoregulation of cerebral flow cannot always protect the brain from hypoperfusion when cardiac output is reduced or atherosclerosis is prominent. This suggests a close link between cardiac function and large vessel atherosclerosis on the one hand and brain perfusion and cognitive functioning on the other. In a national research program, we will test the hypothesis that impaired hemodynamic status of both heart and brain is an important and potentially reversible cause of vascular cognitive impairment (VCI) offering promising opportunities for treatment. Using a multidisciplinary approach, we will address the following questions: 1) To what extent do hemodynamic changes contribute to VCI? 2) What are the mechanisms involved? 3) Does improvement of the hemodynamic status lead to improvement of cognitive dysfunction? To this end we will perform clinical studies in elderly patients with clinically manifest VCI, carotid occlusive disease, or heart failure and evaluate their cardiac and large vascular function, atherosclerotic load, and cerebral perfusion with a comprehensive magnetic resonance imaging protocol and thoroughly test their cognitive function. We will also analyze epidemiological data from the Rotterdam Study.

Keywords: Atherosclerosis, heart, magnetic resonance imaging, vascular cognitive impairment

DOI: 10.3233/JAD-141542

Journal: Journal of Alzheimer's Disease, vol. 42, no. s4, pp. S443-S451, 2014