Karen Alexander, MD, is a professor of medicine at Duke University Medical Center.

Karen Alexander, MD

A new statement from the American College of Cardiology (ACC) aims to evaluate the intersection between cognitive impairment, frailty, and 

 later in life to provide practical approaches to care in an aging population.

ACC Statement Examines Frailty, Cognitive Impairment in Older Patients in Cardiac Settings

Roughly 1 in 3 patients seen in cardiology clinics have some level of cognitive impairment. Frailty affects nearly 50% of community-dwelling older adults and 2 in 3 of older adults undergoing percutaneous coronary intervention. Given the significant proportion of patients experiencing these issues, as well as the growing prevalence of older adults in clinic, the ACC came together to more properly define methods for cardiovascular care among this underrepresented population.

“A lot of the guidelines that come out are focused specifically on the evidence for treatment, and there are gaps where we realize that the patients that we see, and the situations we deal with as clinicians, can be broader than what is able to be addressed by these guidelines,” Karen Alexander, MD, professor of medicine at Duke University Medical Center and chair of the statement’s writing committee, told 

 in an exclusive interview. “That’s exactly the case for this statement, which is really helping to bring forward this population that we treat and figuring out what we need to be doing to treat them as well as we possibly can.”

The risk factors for cognitive impairment and cardiovascular disease are intrinsically intertwined. Both cardiovascular disease risk and cognitive impairment risk increase dramatically with age. Inflammation is also a major player in both conditions, as it contributes directly to plaque instability, thrombosis, and endothelial dysfunction in the cardiovascular system and can produce inflammatory cytokines, which can pass through the blood-brain barrier and trigger neuroinflammation to accelerate cognitive decline. Given this natural association with aging, the ACC statement suggests that cardiovascular disease in older adults should be interpreted in the broader context of biological aging.

Additionally, the team suggests clinicians implement a degree of screening for cognitive impairment and frailty in outpatient settings, primarily focusing on Alzheimer’s disease and dementia. However, the document also notes the challenges inherent in such an approach, such as many patients being unaware of their impairment and appearing superficially normal. The inherent high volume of most primary care clinics is also a substantial barrier to this process. To combat this, Alexander and colleagues recommend simpler screening strategies, such as questionnaires or assessments.

Alexander and colleagues also note the need for further research into several aspects of these recommendations. Prior trials, upon which many of these suggestions were based, have predominantly examined individual ethnic or socioeconomic groups, rendering the data more difficult to extrapolate to other populations. Additionally, the aforementioned high-volume clinics typically facing these issues need more effective screening methods for these cognitive issues, which further studies may be able to provide.

“For so many of us who are seeing these situations in practice and are trying to assemble an approach, the reality is that it’s very hard to get this done because we’re on the clock and we have to see a lot of people,” Alexander said. “Getting it into our training pathways in fellowship would be great – the geriatric toolset 101 for the cardiology fellow. That would be a great start.”

Editors’ Note: Alexander reports no relevant disclosures.

American College of Cardiology. Cardiovascular care for older adults should account for cognitive impairment and frailty. 

 August 10, 2026. Accessed August 14, 2026. 

https://www.eurekalert.org/news-releases/1138835

Alexander K, Damluji A, Erqou S. et al. Cognitive Impairment and Frailty in Older Adults With Cardiovascular Disease: 2026 ACC Scientific Statement: A Report of the American College of Cardiology. 

. null2026, 0 (0). August 10, 2026. Accessed August 14, 2026. 

https://doi.org/10.1016/j.jacc.2026.07.009

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Karen Alexander, MD, discusses the recent statement evaluating the interconnected relationship between biological aging and cardiovascular risk.

Karen Alexander, MD

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