Slower thinking, weaker recall, and a quieter grasp of everyday words may be the earliest signs of trouble to come, and that trouble may lie with the heart rather than the brain. A study of more than 19,000 older adults published in JAMA Network Open in 2026 found that measurable cognitive decline began three to eight years before a major cardiovascular event.
The analysis drew on ASPREE-XT, the long-term extension of the ASPREE (Aspirin in Reducing Events in the Elderly) trial. Participants were age 65 or older, free of cardiovascular disease at enrollment, and followed for up to 11 years. During that time, nearly 2,000 developed a cardiovascular event, including coronary heart disease, stroke, or heart failure.
What the researchers actually measured
Cognition was tracked with a battery of standard tests, not a single memory check. Processing speed diverged the earliest, showing measurable decline as much as eight years before a cardiovascular event. Episodic memory and overall cognition slipped roughly five years ahead of the event, and verbal fluency about three years ahead, according to a summary of the findings from HMP Global Learning Network.
Michael Ernst, a clinical professor at the University of Iowa College of Pharmacy who contributed to the work, was among the researchers pointing to a shared underlying process. Cognitive changes, the group suggested, may not simply be a consequence of cardiovascular disease but could reflect a pathway that develops years before a clinical event.
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The pattern held for fatal coronary heart disease, stroke, and heart failure hospitalizations. The association was less pronounced for nonfatal heart attacks.
A two-way street between heart and brain
A separate study, published in May 2026 in Stroke, followed 20,923 adults for a median of 10 years and found the reverse direction of the same relationship. People who had already survived a heart attack faced about 5 percent higher annual odds of developing cognitive impairment than those who had not.
"Having had a heart attack in the past may speed up the decline in memory and thinking over time," Mohamed Ridha, M.D., assistant professor of neurology at The Ohio State University and the study's lead author, said in a statement released by the American Heart Association.
Taken together, the two studies suggest a two-way link. Vascular problems that damage the heart appear to affect the brain, and shifts in cognition may signal that those vascular problems are underway before they surface as chest pain or a stroke.
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What it means for readers
Neither study can prove that cognitive changes cause cardiovascular disease, or the reverse. They are observational, and everyday memory lapses are common with age and usually nothing more than that. Poor sleep, stress, medication side effects, and thyroid problems can all slow thinking.
Still, the researchers say the findings underline the value of watching both heart and brain health as people grow older. Anyone noticing a persistent change in memory, concentration, or mental sharpness, particularly alongside cardiovascular risk factors such as high blood pressure, high cholesterol, or diabetes, should raise it with a doctor rather than wait.
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