Early Signs of Dementia in Older Adults: The Cardiovascular Connection

Patient Advocacy

Jan 19

Recognizing the early signs of dementia in older adults can be challenging, especially when symptoms are subtle. Research increasingly shows a strong link between cardiovascular disease and dementia, making early detection even more critical for patients with heart conditions.

Recognizing Early Signs of Dementia: A Personal Story

Subtle signs of dementia often appear years before it becomes obvious to family members. Looking back, my grandmother showed those signs long before anyone recognized them for what they were.

Around 2010, she became convinced she was moving from Tennessee to Virginia. She had moving boxes everywhere, stacked two and three high in every room of her newly built, modest two-bedroom home.

The boxes were filled with the most random items. I remember my mom and I opening one and finding it completely full of takeout silverware. We didn’t dare throw anything away. She kept everything.

There was no concrete plan. No realtor, no house hunting, no timeline. At the time, we chalked it up to stubbornness. She was in her early 70s, physically healthy, and fiercely independent, so we let it go.

Those boxes stayed exactly where they were for nearly a decade, until we moved her in with her sister when it was no longer safe for her to live alone.

Looking back, those boxes were some of the very first clues.

The older population is the fastest-growing segment in the United States.

The Link Between Cardiovascular Disease and Dementia

In 2020, one in six Americans was over the age of 65. By 2050, nearly 23 percent of the population will be 65 or older.

As we age, the risk of dementia increases, particularly in the presence of chronic disease.

One of the most significant and often overlooked risk factors for cognitive impairment in older adults is cardiovascular disease. The relationship between cardiovascular disease and dementia is well documented. Between 75 and 90 percent of adults over the age of 65 have some form of cardiovascular disease.

Cardiovascular disease worsens cognitive function through hypertension, reduced cerebral blood flow, chronic inflammation, embolic events, and medication side effects.

A 2023 journal article found that one in three cardiology clinic patients had measurable cognitive impairment.

Are We Screening Cardiac Patients for Cognitive Impairment?

If you, your parent, or a loved one has cardiovascular disease, an important question to ask is whether your provider is screening for early signs of dementia in cardiac patients.

Routine cognitive screening is recommended for patients with cardiac disease, yet it is often overlooked.

There are several validated, quick screening tools that can identify subtle cognitive changes long before symptoms are obvious to families. These include the Montreal Cognitive Assessment, the Trail Making Test, and the Stroop Test. These brief exams can detect impairments that directly affect medication management, decision-making, follow-up care, and overall safety.

Early Warning Signs of Dementia

Early warning signs of dementia include:

memory loss affecting daily life (usually reported by family members)
difficulty with planning and problem solving
impaired judgment
confusion with familiar tasks
language difficulties
mood and personality changes

Dementia Risk Factors

When cardiovascular disease and cognitive impairment coexist, the risks multiply.

Cognitive changes can lead to poor medication adherence, missed appointments, difficulty understanding care plans, and unsafe decision-making. These issues are often dismissed as normal aging, allowing preventable complications to occur.

Other risk factors for dementia include: female, advanced age, family history, obesity, diabetes, physical inactivity, smoking, depression, traumatic brain injuries, and hearing and vision loss.

Reducing Dementia Risk in Older Adults with Heart Disease

There is growing evidence that targeted interventions can reduce risk. Maintaining a systolic blood pressure below 120 may lower the risk of cognitive decline. Oral anticoagulants have been associated with up to a 29 percent reduction in cognitive impairment in appropriate patients. Lifestyle interventions such as a Mediterranean diet, cognitive training, and social engagement also play a meaningful role. Make sure that any comorbid medical conditions are also being closely monitored and treated, such as diabetes, weight control, and cholesterol levels.

However, none of these strategies work if they are not implemented, monitored, and followed consistently.

Why Patient Advocacy Is Essential for Older Adults

This is where patient advocacy becomes critical, especially for older adults navigating both cardiovascular disease and cognitive impairment.

An expert nurse patient advocate helps ensure that cognitive screening is not overlooked, treatment plans are realistic and being followed, medications are managed safely, and early warning signs are recognized before crises occur.

Patient advocacy bridges the gap between what should happen in healthcare and what actually does.

For families, advocacy provides peace of mind. It means knowing someone is asking the right questions, coordinating care, and protecting a loved one who may not be able to fully advocate for themselves.

Dementia rarely arrives suddenly. It slowly progressives and can hide silently for years before family members, providers, and individuals make the realization it’s cognitive decline.

What Families Can do

Recognizing the early clues, and having someone in your corner to act on them, can make all the difference. If you or a loved one are concerned about cognitive decline, here are some suggestions for future care.

Make sure that you have a partner, loved one, and/or trusted friend at doctors appointments to help provide context and information.
Request cognitive screenings with your PCP.
Review your medication list with your pharmacist for any medications or interactions that increase cognitive impairment.
Prepare financial and legal documents before cognitive decline is advanced.
Keep family members engaged, social, and active, if able.
Consider patient advocacy services.

If you’re concerned about early signs of dementia in a loved one with cardiovascular disease, or need help ensuring proper screening and care coordination, I’m here to help. Book a free 15 minute consultation to discuss your family’s situation.

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