Cardiologists urge taking cognitive impairments into account when treating elderly patients

According to experts, about a third of patients in cardiology clinics experience some form of cognitive impairment. Fragility is observed in approximately half of elderly people living at home and in two‑thirds of patients undergoing percutaneous coronary interventions. These conditions are closely linked to cardiovascular diseases: they share common biological mechanisms — vascular dysfunction, chronic inflammation, and a gradual decline in the body’s physiological reserve. Their presence significantly affects the tolerability of treatment, adherence to medical recommendations, recovery after procedures, and ultimately, a person’s ability to maintain independence and their usual standard of living.

The authors of the document propose moving from the traditional model, which focuses exclusively on combating the disease, to an approach that takes into account biological aging and the patient’s functional status. For many older people, the key outcome of treatment is not only the prevention of cardiovascular events but also the maintenance of cognitive health, physical activity, and independence.

Under the new approach, doctors should assess a patient’s condition taking into account their biological age, not just their chronological age. Special attention should be paid to common modifiable risk factors, such as monitoring blood pressure, glucose levels, and lipids, and also taking into account social and living conditions that affect health. An important step is the introduction of screening for cognitive impairment and frailty. It is advisable to carry it out in outpatient practice, as well as after hospitalization, if possible. If abnormalities are detected, timely in‑depth diagnostics and referral to specialized professionals are necessary.

To strengthen the body’s resilience, experts recommend comprehensive measures: cardiac rehabilitation programs, multidomain physical activity, dietary optimization, and careful selection of medications to avoid polypharmacy — the simultaneous use of a large number of medications, which can worsen well‑being and cognitive functions.

At the same time, the statement highlights significant gaps in current knowledge. There is currently no single, practical method for assessing frailty that could be easily integrated into a cardiologist’s work. There is insufficient data on the long‑term effectiveness of preventive strategies aimed at preserving cognitive functions in patients with a high cardiovascular risk. Furthermore, the link between multiple medication use and impaired brain function has been studied primarily based on observations rather than rigorous clinical trials.

The authors argue that it is necessary to more actively include older people in cardiological studies and shift the focus to those outcomes that are particularly important for the patients themselves: maintaining mobility and independence, preserving cognitive abilities, and reducing the burden on those who care for loved ones. At the same time, practical issues—such as the organization of work processes in the clinic, the criteria for referring patients to specialists, or mechanisms for financial support—remain outside the scope of the document and require further elaboration.