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When my mother was diagnosed with vascular dementia 10 years ago, a well-trained nurse gave her and the family clear, useful information about the condition and its prognosis. When my father had signs of heart failure (HF) this year, no such information was available. Face to face, the consultant told my father that his heart was not failing, although the letter that followed contradicted this. I can only suppose that he did not want to increase my father's evident anxiety, though how we were to account for his symptoms was less clear. Nobody mentioned possible mental or psychological effects, and it was not until I read this book that I realized that my father had a chronic cardiovascular condition which could have accounted for his declining mental state – a decline which worried him enormously but was not acknowledged by any of the doctors he saw.
When most non-medical people think of cardiovascular problems they associate shortness of breath, and difficulties walking long distances or up hills or stairs. They do not associate damage to the brain. If anything, they might have a vague suspicion that the brain protects itself from the impact of cardiovascular problems. This book leaves the reader with a far clearer view. It describes the many ways in which such protection can break down, and gathers together numerous studies which correlate dysfunctions of the cardiovascular system with impairments in the capacities to think, to function, to remember.
Widespread ignorance of these matters is explained by the fact that it is only recently that advances in medication have allowed substantial numbers of people to survive with chronic or mild cardiovascular diseases: in the USA, these are now the leading cause of hospitalization in people older than 65 (p. 410). Amongst this population, estimates of cognitive impairments range from 25% to 75%. It was only 30 years ago that the term “cardiogenic dementia” was introduced, and it is only recently that evidence has emerged t