Table 1.

Cardiovascular conditions, mechanism, and cognitive consequence

Condition	Dominant mechanism	Cognitive consequence	Key evaluation	Intervention	Key controversy
Chronic hypertension	Chronic direct: pulsatility, endothelial dysfunction, SVD	WMH, lacunes, dysexecutive and slowed-processing decline	Midlife and current BP, orthostatic vitals, MRI SVD markers	BP control, individualized targets	Late-life BP lowering, J-curve, timing of benefit
Atrial fibrillation	Acute direct embolic plus chronic substrate	Overt and covert infarcts, cognitive decline independent of recognized stroke	Rhythm monitoring, MRI for covert infarction, LA structure/function	Anticoagulation when indicated, rate/rhythm control	BRAIN-AF negative; tension with MR mediation through stroke/low CO
Atrial cardiopathy	Mixed direct and indirect	Cognitive decline or embolic risk without documented AF	ECG, rhythm monitoring, LA size/function, emerging biomarkers	Risk-factor treatment; anticoagulation uncertain	Whether atrial disease is causal independent of AF
Heart failure	Chronic direct hypoperfusion plus indirect neurohormonal/inflammatory	Brain fog, slowed processing, attentional and executive dysfunction	EF, HF phenotype, orthostatics, sleep apnea, renal function	GDMT, perfusion optimization, rehabilitation	Reversibility; HFpEF versus HFrEF mechanisms
Coronary disease and MI	Mixed: shared substrate, inflammation, hypoperfusion, procedural injury	Post-MI cognitive change, accelerated long-term decline	Vascular risk profile, delirium screen, cognitive baseline	Secondary prevention, cardiac rehabilitation	Shared burden versus hypoperfusion versus microembolism
Aortic stenosis and TAVR	Chronic hypoperfusion plus acute procedural embolic injury	Pre-procedural impairment; possible improvement or decline after intervention	Echo, frailty/cognition baseline, pre/post neuroimaging	Valve replacement, cerebral embolic protection	Whether intervention improves cognition net of embolic risk
Carotid stenosis	Chronic hypoperfusion plus microembolic injury	Modest contribution to dysexecutive decline	Carotid imaging, cerebral perfusion, cognitive baseline	Intensive medical therapy; revascularization on stroke-risk grounds	CREST-2: no cognitive benefit in asymptomatic stenosis
Cardiac surgery/bypass	Acute direct embolic and hypoperfusion plus delirium	Perioperative neurocognitive disorder, delirium, long-term decline	Baseline cognition, delirium risk, vascular burden	Perfusion/anesthesia management, delirium prevention	Attribution of post-CABG decline versus expected aging
Cardiac arrest	Acute direct hypoxic-ischemic injury	HIE, amnestic and executive deficits	Exam, EEG, MRI, biomarkers, serial neuroprognostication	Post-arrest care, TTM, rehabilitation	Prognostic accuracy and selective regional vulnerability