Cognitive Decline in Atherosclerotic Diseases: Mechanisms and Potential Solutions

Atherosclerosis has been increasingly recognized as a contributor to cognitive decline through mechanisms such as cerebral hypoperfusion, oxidative stress, and chronic inflammation. These mechanisms include cerebral hypoperfusion, which limits oxygen and nutrient supply to the brain; microvascular damage, which impairs small vessel function and blood-brain barrier integrity; chronic inflammation, which promotes neurodegeneration through sustained immune activation; and oxidative stress, which accelerates neuronal aging via mitochondrial dysfunction. This narrative review synthesizes findings from epidemiological studies, mechanistic research, and clinical trials to examine the interplay between atherosclerotic diseases and cognitive impairment. Shared risk factors, including hypertension, diabetes, hyperlipidemia, and smoking, accelerate neurovascular dysfunction and increase susceptibility to dementia. Advances in neuroimaging and biomarker research offer improved diagnostic precision, facilitating early detection and intervention. Preventive strategies, including lifestyle modifications, pharmacological therapies such as statins and antihypertensives, and cognitive rehabilitation, have the potential to mitigate cognitive deterioration associated with atherosclerosis. Despite accumulating evidence, vascular contributions to dementia remain underdiagnosed in clinical settings, highlighting the need for a multidisciplinary approach that integrates cardiovascular and neurological care. A comprehensive strategy encompassing risk stratification, early therapeutic intervention, and long-term monitoring is essential for improving cognitive outcomes in at-risk populations. Future research should focus on refining diagnostic methodologies, optimizing prevention and treatment protocols, and identifying high-risk individuals for targeted interventions. Given the rising global burden of both cardiovascular disease and dementia, a proactive approach addressing modifiable risk factors is critical to reducing morbidity and enhancing quality of life.