The Cardiovascular-Cognitive Health Initiative

Cardiovascular disease (CVD) and cognitive impairment frequently coexist in aging populations and accelerate each other's deterioration through shared vascular and neurobiological pathways.

Primary objectives:

i. To determine the prevalence and profile of cognitive impairment in patients with cardiovascular disease

ii. For the RCT, to compare the proportion of patients who demonstrate improvement in cognitive test scores by 24 weeks between intervention and usual care arms.

Secondary objectives:

i. To evaluate changes in neuropsychological domains (e.g. memory, processing speed), mental health, frailty, and quality of life over time.

ii. To study the association between cognitive status and cardiovascular treatment plan categories.

Inclusion criteria

Main Study:

• Age ≥ 21 years.
• Able and willing (or via legally acceptable representative, LAR, where appropriate) to provide informed consent.

RCT Sub-Study (Mild cognitive impairment (MCI) arm):

• Meets main study criteria.
• Mild cognitive impairment defined by: (i) Montreal cognitive assessment (MoCA) <26 but ≥21; and/or (ii) impairment in at least one domain on standardized neuropsychological testing and/or (iii) MMSE <28 but ≥24.

Exclusion criteria

• Neurodegenerative disorders or major psychiatric illnesses that substantially impair cognition.
• Terminal illness or advanced major organ disease limiting participation with expected survival of less than 1 year.
• Severe depression, anxiety, or stress where participation may be inappropriate.
• Any condition which, in the investigator's opinion, would compromise safety or study integrity.

Note: Pregnant and breast-feeding women may not take part in this study.