Obesity-induced cognitive impairment in older adults: a microvascular perspective

Am J Physiol Heart Circ Physiol. 2021 Feb 1;320(2):H740-H761. doi: 10.1152/ajpheart.00736.2020. Epub 2020 Dec 18.


Over two-thirds of individuals aged 65 and older are obese or overweight in the United States. Epidemiological data show an association between the degree of adiposity and cognitive dysfunction in the elderly. In this review, the pathophysiological roles of microvascular mechanisms, including impaired endothelial function and neurovascular coupling responses, microvascular rarefaction, and blood-brain barrier disruption in the genesis of cognitive impairment in geriatric obesity are considered. The potential contribution of adipose-derived factors and fundamental cellular and molecular mechanisms of senescence to exacerbated obesity-induced cerebromicrovascular impairment and cognitive decline in aging are discussed.

Keywords: aging; endothelial dysfunction; metabolic syndrome; neurovascular coupling; senescence.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Animals
  • Blood-Brain Barrier / metabolism
  • Blood-Brain Barrier / physiopathology*
  • Cognition*
  • Cognitive Aging
  • Cognitive Dysfunction / epidemiology
  • Cognitive Dysfunction / physiopathology*
  • Cognitive Dysfunction / prevention & control
  • Cognitive Dysfunction / psychology
  • Endothelium, Vascular / metabolism
  • Endothelium, Vascular / physiopathology*
  • Female
  • Humans
  • Male
  • Microcirculation
  • Microvessels / metabolism
  • Microvessels / physiopathology*
  • Neurovascular Coupling*
  • Obesity / epidemiology
  • Obesity / physiopathology*
  • Obesity / psychology
  • Obesity / therapy
  • Risk Assessment
  • Risk Factors