Dementia Japan 29:571-579, 2015

Impact of congestive heart failure on the pathophysiology underlying Alzheimer's disease

Takashi Yamazaki, Ken Nagata

Department of Neurology, Research Institute for Brain and Blood Vessels

    According to the recent epidemiological studies, there are common vascular risk factors in cerebrovascular disease including vascular dementia and Alzheimer's disease (AD).  Among the various vascular risk factors, congestive heart failure (CHF) is now considered as one of the key pathogenetic mechanisms not only in vascular dementia but also in Alzheimer's disease in elderly patients.  Reduced cardiac output due to the severe CHF causes cerebral hypoperfusion, especially in elderly patients in whom cerebral autoregulation is impaired.  25-50% of CHF patients were reportedly diagnosed as having dementia including AD, and more than 50% of those with moderate to severe CHF were diagnosed as having mild cognitive impairment.  CHF is associated not only with cerebral hypoperfusion but also with the breakdown of blood brain barrier which causes accumulation of amyloid-β that is a hallmark feature of AD.  Aggressive treatment of CHF, especially in elderly patients, may represent an important avenue of approach to help slow or prevent the onset and progression of dementia including AD.

Address correspondence to Dr. Takashi Yamazaki, Department of Neurology, Research Institute for Brain and Blood Vessels (6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan)