Particular aspects in patients with coronary heart disease and vascular cognitive impairment.

Among the patients with cognitive vascular impairment, a particular group is represented by those who have concomitant cerebrovascular and coronary heart disease (CHD). The clinical evolution of some of these patients is dominated apparently by the progressive cognitive impairment and sometimes psychotic episodes and not by evident clinical stroke and/or symptoms of their heart disease, so that they receive the diagnosis of Alzheimer's disease or of a psychiatric disease. Most of these patients have a severe evolution, particularly if their cardiovascular disease is not recognized and die unexpectedly. In the author's clinical experience, the systematic cardiovascular examination in all patients hospitalized with the diagnosis of dementia or cognitive impairment, even if they did not have previously been diagnosed with cerebrovascular and/or coronary heart disease, disclosed in many instances the presence of severe but apparently silent cardiovascular disorders characterized always by concomitant severe CHD and significant large vessel disease of the brain. It is important to emphasize the particular situation in which the progressive cognitive impairment associated or not with psychiatric manifestations could mask severe cardio- and cerebrovascular disorders, which could further be worsened by symptomatic psychiatric treatment, and which evolution is to "unexpected" cardiovascular death.