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An interdisciplinary study examines undefined cardiovascular contributions to dementia and disorders of cognition.

The scope and diversity of the underlying mechanisms driving Alzheimer’s disease remain unclear. The Jona Goldrich Center for Alzheimer’s and Memory Disorders has devoted new focus to the “heart-brain” axis to better elucidate cardiovascular contributions to dementia.

A collaborative study with the Smidt Heart Institute at Cedars-Sinai found that among more than 80,000 patients admitted to Cedars-Sinai, those whose blood pressure fluctuated during acute-care hospitalization were more likely to develop dementia within five years of discharge than those whose blood pressure did not fluctuate. The novel findings, published in Frontiers in Neurology, indicate an opportunity to identify and follow patients who have elevated risk.

The partnership extends to pilot studies, co-led by Smidt Heart Institute investigators, that seek to define the connection between heart disease and dementia. One project aims to evaluate whether community-based interventions shown to reduce hypertension also effectively reduce cognitive decline in Black men in the long term. Another study is measuring cognition in middle-aged women who are at high risk of cardiovascular disease to determine how microvascular injury manifests in the brain and whether early-onset Alzheimer’s can be detected with neuroimaging.

PATIENT SPOTLIGHT

A Dedicated Program for Alzheimer’s Caregivers

Christine McCarthy’s husband, Michael McCormick, was diagnosed with early-onset Alzheimer’s disease in November 2021, several years after his family noticed a decline in his executive function. Outwardly, the recently retired Pasadena resident, now 67, seemed healthy, but McCarthy and the couple’s adult children had long noticed concerning changes in his personality.

Often, families faced with an Alzheimer’s diagnosis must handle medical and financial logistics while confronting distressing behavior by their loved one. These caregivers do their best to keep patients safe and honor their independence while managing their own sadness and stress.

Cedars-Sinai’s CARES Dementia Care Management Program—a project pioneered by experts at the Jona Goldrich Center for Alzheimer’s and Memory Disorders—provides wraparound medical services for patients and comprehensive support for caregivers and families. Each CARES patient meets with a trained dementia nurse practitioner (NP) who co-manages their treatment with primary care physicians, neurologists and psychiatrists. The dedicated NP also manages behavioral symptoms and provides education and resources for caregivers.

Initial research indicates that the CARES program’s novel electronic health record alert is associated with better healthcare utilization, improved quality of care and lower caregiver stress.

“Through CARES, we help patients understand the diagnosis and navigate the future,” said Sarah Kremen, MD, McCormick’s physician. “As the condition progresses, it requires patients, families and caregivers to evaluate, assess and pivot. Clinicians can generally predict how the disease will manifest and the hardships to come, and CARES gives families and patients social and emotional support, resources, and education to help them make decisions.”

Kremen was instrumental in helping the family understand McCormick’s behavioral changes and make difficult decisions about his care and safety, McCarthy said. He now takes medications to manage symptoms of dementia and remains social in an assisted living facility.