When I was 12, I learned that love is more than a feeling; it’s a verb. That year, my mom moved
her father, my grandfather, to live with us after he was diagnosed with Alzheimer’s disease. The
quiet and kind man I knew transformed as the disease took hold. Alzheimer’s doesn’t just affect
the person diagnosed; it deeply impacts the family as well. Watching my grandfather slip away
was a profound lesson in the pain of Alzheimer’s—both the patient’s awareness of their decline
and the heartbreak of loved ones who care for someone who is no longer fully present.
As I grew older and became a cardiologist, I learned more about the connections between
Alzheimer’s disease (AD) and cardiovascular disease (CVD). Studies show that factors affecting
heart health, like hypertension, inflammation, and dyslipidemia, are also linked to Alzheimer’s.
This connection, known as the heart-brain axis, reveals that CVD risk factors can predict the
future development of AD. Both diseases develop over decades, with CVD often appearing
years before Alzheimer’s, highlighting the importance of early intervention.
While aging remains the greatest risk factor for AD, lifestyle choices play a significant role too.
Smoking, lack of exercise, high cholesterol, and high blood pressure are all modifiable risk
factors that affect both heart and brain health. Recent studies suggest that subclinical CVD in
midlife can be associated with dementia in later life. For instance, atherosclerosis, which subtly
reduces blood flow in the brain, can lead to cognitive dysfunction and nerve damage without
causing obvious strokes or lesions. The MIND diet ( “Mediterranean-DASH Intervention for
Neurodegenerative Delay”) emphasizes fruits, vegetables, whole grains, and polyunsaturated
fats and has been shown to reduce the risk of Alzheimer’s disease by up to 53%.
My grandfather’s experience also underscored the racial disparities in health outcomes. In the
United States, non-Hispanic Black adults face higher rates of CVD and Alzheimer’s. They
experience more CVD morbidity and mortality, fewer early diagnoses of Alzheimer’s, lower
quality of care, and higher related mortality rates than White adults. This disparity is troubling,
especially considering that race is a social construct without clear genetic underpinnings. For
example, the ApoE4 gene, often associated with AD, is more prevalent in White than Black
Americans.
Understanding these connections and disparities highlights the importance of managing
vascular risk factors to potentially mitigate the impact of Alzheimer’s and related dementias.
Alterations in both cerebral and systemic vessels often coexist with Alzheimer’s pathology,
leading to cerebrovascular insufficiency that contributes to cognitive decline.
Alzheimer’s disease is the leading cause of age-related dementia and the fifth leading cause of
death worldwide. My grandfather’s struggle taught me about the personal pain of this disease,
and my subsequent learning revealed the broader connections between heart health and brain
health. By controlling vascular risk factors, we might reduce the burden of Alzheimer’s,
providing hope for families like mine who have watched a loved one fade away.
In honoring my grandfather’s memory, I recognize the importance of love as an action—caring
for our health and the health of our loved ones to prevent the devastating effects of Alzheimer’s.
