This review attempts to examine two key elements in the evolution of cognitive impairment in the elderly who develop heart failure. First, major left side heart parts can structurally and functionally deteriorate from aging wear and tear to provoke hemodynamic instability where heart failure worsens or is initiated; second, heart failure is a major inducer of cognitive impairment and Alzheimer’s disease in the elderly. In heart failure, when the left ventricular myocardium of an elderly person does not properly contract, it cannot pump out adequate blood to the brain, raising the risk of cognitive impairment due to the intensification of chronic brain hypoperfusion. Chronic brain hypoperfusion originates from chronically reduced cardiac output which progresses as heart failure worsens. Other left ventricular heart parts, including atrium, valves, myocardium, and aorta can contribute to the physiological shortfall of cardiac output. It follows that hemodynamic instability and perfusion changes occurring from the aging heart’s blood pumping deficiency will, in time, damage vulnerable brain cells linked to specific cognitive regulatory sites, diminishing neuronal energy metabolism to a level where progressive cognitive impairment is the outcome. Could cognitive impairment progress be reversed with a heart transplant? Evidence is presented detailing the errant hemodynamic pathways leading to cognitive impairment during aging as an offshoot of inefficient structural and functional heart parts and their contribution to heart failure.

中文翻译：

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心力衰竭的血流动力学不稳定加剧了年龄依赖性的认知下降。

这项审查试图检查发展为心力衰竭的老年人认知障碍的演变中的两个关键因素。首先，左侧主要心脏部分会因磨损的老化而在结构和功能上恶化，从而引发心脏衰竭恶化或引发的血流动力学不稳定。其次，心力衰竭是老年人认知障碍和阿尔茨海默氏病的主要诱因。在心力衰竭中，当老年人的左心室心肌未适当收缩时，它无法向大脑泵出足够的血液，从而由于慢性脑灌注不足的加剧而增加了认知障碍的风险。慢性脑灌注不足源于心输出量的长期减少，其随着心力衰竭的恶化而发展。其他左心室心脏部分，包括心房，瓣膜，心肌和主动脉可导致心输出量的生理下降。随之而来的是，随着年龄增长的心脏血液泵送不足而发生的血液动力学不稳定和灌注变化，将及时损害与特定认知调节位点相关的脆弱脑细胞，从而将神经元能量代谢降低至导致进行性认知障碍的水平。心脏移植能否逆转认知障碍？提供的证据详细描述了衰老过程中导致认知功能障碍的错误血液动力学途径，这是无效的结构和功能性心脏部位及其对心力衰竭的影响的分支。随之而来的是，随着年龄增长的心脏血液泵送不足而发生的血液动力学不稳定和灌注变化，将及时损害与特定认知调节位点相关的脆弱脑细胞，从而将神经元能量代谢降低至导致进行性认知障碍的水平。心脏移植能否逆转认知障碍？提供的证据详细描述了衰老过程中导致认知功能障碍的错误血液动力学途径，这是无效的结构和功能性心脏部位及其对心力衰竭的影响的分支。因此，随着年龄的增长，心脏血液泵送不足而引起的血液动力学不稳定和灌注变化将及时损害与特定认知调节位点相关的脆弱脑细胞，从而将神经元能量代谢降低至导致进行性认知障碍的水平。心脏移植能否逆转认知障碍？提供的证据详细描述了衰老过程中导致认知功能障碍的错误血液动力学途径，这是无效的结构和功能性心脏部位及其对心力衰竭的影响的分支。心脏移植能否逆转认知障碍？提供的证据详细描述了衰老过程中导致认知功能障碍的错误血液动力学途径，这是无效的结构和功能性心脏部位及其对心力衰竭的影响的分支。心脏移植能否逆转认知障碍？提供的证据详细描述了衰老过程中导致认知功能障碍的错误血液动力学途径，这是无效的结构和功能性心脏部位及其对心力衰竭的影响的分支。