Top Things to Know: Vascular Contributions to Cognitive Impairment and Brain Health: Clinical Update and Mechanistic Considerations
Updated: May 26, 2026
Prepared by Anne Leonard, MPH, BSN, RN, FAHA, National Senior Director Science and Medicine, American Heart Association
- This paper updates the 2011 Vascular contributions to cognitive impairment (VCID) and dementia scientific statement.
- The term VCID in this paper captures the role of vascular risks in relation to all types of cognitive impairment or dementia. Vascular cognitive impairment (VCI) refers to a clinical condition representing the spectrum of cognitive impairment from mild to moderate to severe associated with vascular risks.
- Age related cognitive impairment has been established as a multi etiology process driven by interactions between vascular factors and the interconnections of aging.
- Current evidence from single and then multidomain interventions show us that reducing vascular risk factors (VRFs) alone will not fully restore brain health. With this is the understanding there is a need for complementary strategies that halt or reverse the vascular-driven acceleration of aging characteristics.
- This paper proposes that multi-mechanistic origins of VCID and time-appropriate interventions that complement VRFs modification are important to maintaining brain health and preserving cognitive function across the lifespan.
- With multi-mechanistic origins it now requires a deeper understanding of the time-varying mechanisms of cellular injury and its repair in persons susceptible to, resistant against or resilient to VCID.
- This paper discusses two principal areas: The role of VRFs and their modification (the clinical update within this paper) and then the paper gives an overview of the mechanisms where VRFs and vascular disease contribute to accelerated cognitive decline and then worsening brain health.
- Several “mechanisms” are brought forward that may lead to poor brain health: mechanisms of injury, central nervous systems mechanism, the role of proteostasis, endothelial nitric oxide bioavailability, brain processes/organ specific processes, the blood brain barrier, and issues related to white mater connectivity.
- The paper also describes mechanisms responsible for repair and recovery for protection of brain function.
- The recognition that vascular factors are involved not only in VCID by also in Alzheimer’s Disease, has led to the understanding that cognitive impairment as we age is a multiple etiology process (i.e., mixed, or co-existing brain pathologies) and thus must be multi-mechanistic in origin.
Citation
Sorond FA, Gorelick PB, Bae H-J, Carmichael ST, Greenberg SM, Hinman JD, Iadecola C, Iruela-Arispe ML, Leonard A, Valdes E, Waddy SP; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; and Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Vascular contributions to cognitive impairment and brain health: clinical update and mechanistic considerations: a scientific statement from the American Heart Association. Stroke. Published online May 26, 2026. doi: 10.1161/STR.0000000000000524