Cognitive Dysfunction after Heart Disease: A Manifestation of the Heart-Brain Axis

Abstract

The functions of the brain and heart, which are the two main supporting organs of human life, are closely linked. Numerous studies have expounded the mechanisms of the brain-heart axis and its related clinical applications. However, the effect of heart disease on brain function, defined as the heart-brain axis, is less studied even though cognitive dysfunction after heart disease is one of its most frequently reported manifestations. Hypoperfusion caused by heart failure appears to be an important risk factor for cognitive decline. Blood perfusion, the immune response, and oxidative stress are the possible main mechanisms of cognitive dysfunction, indicating that the blood-brain barrier, glial cells, and amyloid-β may play active roles in these mechanisms. Clinicians should pay more attention to the cognitive function of patients with heart disease, especially those with heart failure. In addition, further research elucidating the associated mechanisms would help discover new therapeutic targets to intervene in the process of cognitive dysfunction after heart disease. This review discusses cognitive dysfunction in relation to heart disease and its potential mechanisms.

The Heart Is at Risk: Understanding Stroke-Heart-Brain Interactions with Focus on Neurogenic Stress Cardiomyopathy—A Review

“…94 Moreover, brain hypoperfusion also has a notorious effect on the volume of gray matter-probably due to the latter's high metabolic demands-and is associated with dysfunction of various cortical areas, resulting in cognitive deterioration. 95 These findings are consistent with the hypothesis of a "head to heart" link in patients with Alzheimer`s disease and support the connection between cerebral hypoperfusion and cognitive impairment. 96 As mentioned previously, the brain receives 15% of cardiac output, 89,90 is highly vascularized, and consumes about 20% of the total oxygen budget.…”

“…114 Moreover, it has been convincingly demonstrated that several heart diseases (e.g., myocarditis, myocardial infarction, and heart failure) are associated with activation of inflammatory and immune responses triggered by myocardial injury. 95,115 Moreover, impaired cardiac function may be associated with cerebral hypoperfusion that exacerbates brain inflammatory reactions and excites the cardiac sympathetic system, and this may be related to the development of cognitive impairments in heart failure patients. 116 These findings are further supported by several experimental studies.…”

The Relationship Between Pre-existing Coronary Heart Disease and Cognitive Impairment Is Partly Explained by Reduced Left Ventricular Ejection Fraction in the Subjects Without Clinical Heart Failure: A Cross-Sectional Study

“…All of the above may independently and collectively contribute to cognitive impairment. Hence, chronic cerebral hypoperfusion may be a key point connecting cardiac dysfunction and cognitive impairment ( Xu et al, 2021 ). Besides, common vascular risk factors, such as hypertension can also impair the cerebral vascular autoregulation function ( Iadecola et al, 2016 ), which can make the subjects more susceptible to the systemic blood flow disturbance.…”

The Emerging Role of Metabolism in Brain-Heart Axis: New Challenge for the Therapy and Prevention of Alzheimer Disease. May Thioredoxin Interacting Protein (TXNIP) Play a Role?

“…Notably, Aβ accumulation in cardiomyocytes parallels cardiac diastolic dysfunction in early onset AD, while in late-onset AD it is associated to thickening of the left ventricle wall, suggesting a bidirectional link between AD and cardiac dysfunction [ 17 ]. In agreement, recent studies underline a connection between neurodegenerative and cardiovascular diseases, defining the so-called brain-heart axis [ 18 ].…”