Cognitive Decline May Begin Up to 8 Years Before CVD Events in Older Adults

Cognitive decline in older adults may start years before the onset of cardiovascular disease (CVD), according to new findings.¹ Researchers observed significantly faster deterioration across multiple cognitive domains—particularly processing speed—beginning as early as 8 years prior to a first CVD event, raising the possibility that early cognitive changes could help identify individuals at heightened cardiovascular risk before clinical disease manifests.

This large, nested case-control study is published in JAMA Network Open.

“The present study aims to compare the longitudinal cognitive trajectories preceding a CVD event with those of a matched control group without an event, using data from a large clinical trial of community-dwelling older adults who had no prior CVD events or major cognitive impairment at the time of study enrollment,” wrote the researchers of the study.

A broader body of research supports the idea that cardiovascular health and cognitive decline are tightly linked long before clinical dementia or major cardiovascular events occur.² A longitudinal analysis from the CARDIA Study found that midlife cardiovascular risk factors such as hypertension, diabetes, and smoking were associated with accelerated declines in processing speed and global cognition over time, even in relatively young adults.

The ASPREE (NCT01038583) trial followed community-dwelling adults aged 65 years or older in the US and Australia with no prior history of CVD at baseline.¹ Participants who experienced an adjudicated CVD event—including coronary heart disease, myocardial infarction (MI), stroke, or hospitalization for heart failure—were matched to control individuals without CVD by age, sex, and education level. Cognitive function was assessed using validated tools measuring global cognition, memory, processing speed, and verbal fluency, and models were applied to compare cognitive trajectories between groups over time, including the years preceding CVD events.

The study found that older adults who went on to experience a CVD event exhibited significantly faster cognitive decline across multiple domains compared with matched controls, beginning approximately 3 to 8 years before the event.

Declines were observed in global cognition (β, −0.19; 95% CI, −0.33 to −0.06), episodic memory (β, −0.04; 95% CI, −0.11 to −0.03), processing speed (β, −0.28; 95% CI, −0.48 to −0.07), and verbal fluency (β, −0.15; 95% CI, −0.27 to −0.04). Processing speed showed the earliest divergence, with significant differences emerging up to 8 years prior to a CVD event. Additionally, composite measures of global cognition (β, −0.11; 95% CI, −0.17 to −0.06) and executive function (β, −0.07; 95% CI, −0.11 to −0.03) declined more rapidly in those with incident CVD, while similar patterns were observed across most event types except nonfatal MI, where trends were comparable to controls.

However, the researchers noted the findings should be interpreted in light of several limitations. The cohort was relatively healthy at baseline due to strict eligibility criteria and was largely drawn from Australia, which may limit generalizability to more diverse populations. In addition, the cognitive battery may not have been optimal for detecting subtle executive dysfunction, and attrition and missing follow-up assessments may have introduced bias, particularly among participants with poorer health and higher cardiovascular risk. Finally, modeling cognitive trajectories with a quadratic term may not fully capture more complex nonlinear patterns of cognitive change over time.

Despite these limitations, the researchers believe the study suggests that preclinical vascular processes may be closely linked with early cognitive changes, potentially positioning cognitive decline as an early marker of future cardiovascular risk.

“These findings underscore the importance of early cognitive monitoring in older adults and support further research into cognitive trajectories before CVD onset, particularly across diverse populations,” wrote the researchers.

References

1. Vishwanath S, Wu Z, Tonkin A, et al. Cognitive decline preceding incident cardiovascular events in older adults. JAMA Netw Open. 2026;9(4):e267841. doi:10.1001/jamanetworkopen.2026.7841

2. Yaffe K, Bahorik AL, Hoang TD, et al. Cardiovascular risk factors and accelerated cognitive decline in midlife: the CARDIA study. Neurology. 2020;95(7):e839-e846. doi:10.1212/WNL.0000000000010078