Vascular disease is an important cause of cognitive decline and dementia. Approximately 20% of patients with a stroke develop dementia within a year after the event. Even more often, cerebrovascular disease is involved in cognitive decline or dementia in people without an obvious history of stroke. Autopsy studies identify vascular pathology in the majority of patients with dementia, also in those with a clinical diagnosis of Alzheimer’s disease. The concept “Vascular cognitive impairment” (VCI) has been introduced as an umbrella term to capture all forms of cognitive impairment – regardless of severity or cognitive profile - that are associated with and presumably caused by cerebrovascular disease. Hence, VCI is heterogeneous, both with regard to aetiology and course of development, ranging, for example, from an acute strategic brain infarct to insidious diffuse white matter pathology.

Importantly, causes of VCI may not be restricted to vascular brain lesions. Abnormalities in vascular function, resulting in altered cerebral haemodynamics, may also be involved, and might represent a potentially modifiable cause of cognitive dysfunction. Currently, the role of haemodynamics in VCI is addressed in a Dutch multidisciplinary research program, called “The Heart-Brain connection”. This program addresses the following questions. 1) To what extent do hemodynamic changes contribute to VCI? 2) What are the mechanisms involved? 3) Does improvement of the hemodynamic status lead to improvement of cognitive dysfunction?

In my presentation I will provide background on VCI, review evidence for links between haemodynamics and cognition and introduce the research program of the Heart-Brain connection consortium.