Is Erectile Dysfunction a Risk Factor for Dementia?

Last Updated: November 2025

Dr. Jessica Knape of HealthSpan Internal Medicine in Boulder, CO, explains how erectile dysfunction can be an early sign of vascular stress affecting both sexual and brain health. She highlights that ED, poor circulation, inflammation, and hormonal imbalances share common root causes, and that treating ED through metabolic and hormonal repair also supports memory, focus, and long-term cognitive vitality.

Many men think of erectile dysfunction (ED) as a private or quality-of-life issue. But recent research tells a different story: ED is often an early clue that blood vessels — including those in the brain — are under stress.

At HealthSpan Internal Medicine in Boulder, CO, we teach that what’s good for vascular health is good for brain health — and that ED and cognitive decline often share the same root causes: poor circulation, inflammation, and hormonal imbalance.

The good news? When you address ED through lifestyle, hormone, and metabolic repair, you’re also protecting your memory, focus, and long-term brain vitality.

BrainSpan Insight

• Erectile dysfunction is often the first visible symptom of vascular disease.

• The same processes that reduce blood flow to the penis can reduce blood flow to the brain.

• Treating the underlying causes — not just the symptoms — lowers risk for cognitive decline and dementia.

1. The Shared Pathways Between ED and Dementia

Both conditions are driven by endothelial dysfunction — damage to the inner lining of blood vessels.
The endothelium produces nitric oxide (NO), a molecule that signals blood vessels to relax and increase circulation.

When inflammation, oxidative stress, or metabolic syndrome disrupt this process, nitric oxide production drops. The result?

• Impaired blood flow to the penis (ED)

• Impaired blood flow to the brain (cognitive decline)

In both cases, reduced circulation means reduced oxygen and nutrient delivery — starving the tissues that depend on it most.

2. ED as a Marker for Vascular Health

Studies show that erectile dysfunction often appears 5–10 years before other signs of cardiovascular disease or stroke.

Because penile arteries are smaller than coronary or carotid arteries, they are the “canary in the coal mine” for vascular damage.
If you’re having trouble maintaining an erection, it may signal early atherosclerosis, even if your heart tests are normal.

That same vascular stiffness can quietly reduce cerebral blood flow, a known driver of vascular dementia and Alzheimer’s disease.

3. The Evidence Linking ED and Dementia

• A 2023 study in The Journal of Sexual Medicine found men with ED were 1.7 times more likely to develop dementia within 10 years compared to men without ED.

• Another large study of over 230,000 men in the Journal of Alzheimer’s Disease found that those with ED had higher rates of vascular dementia, Alzheimer’s, and mild cognitive impairment (MCI).

• MRI imaging studies show that men with chronic ED often have lower gray matter perfusion — meaning less blood flow to brain regions tied to memory and mood.

Researchers now view ED as part of the vascular-cognitive continuum — the same inflammatory and metabolic damage affects the whole body, from arteries to neurons.

4. Hormonal Connections: Testosterone and Brain Function

Low testosterone (hypogonadism) doesn’t just affect libido — it affects neuronal repair, dopamine signaling, and mood regulation.

Testosterone:

• Increases nitric oxide synthesis (improving blood flow)

• Reduces inflammation and insulin resistance

• Supports hippocampal function (memory and motivation)

• Enhances mitochondrial energy production in neurons

Low testosterone is associated with both ED and higher risk of Alzheimer’s disease.
Restoring optimal levels — especially when done safely under medical supervision — often improves energy, cognition, and sexual function simultaneously.

5. The Role of Metabolic Syndrome

ED and dementia both rise sharply in men with:

• High blood pressure

• Insulin resistance or diabetes

• Obesity

• Elevated triglycerides or low HDL cholesterol

These conditions damage the endothelium and small vessels, reducing nitric oxide and promoting chronic inflammation.

High blood sugar and insulin spikes also fuel oxidative stress — which further impairs nitric oxide signaling.
The same oxidative stress drives amyloid buildup and neuroinflammation in the brain.

Addressing these metabolic factors can improve both sexual and cognitive vitality.

6. Psychological and Sleep Factors

Depression, anxiety, and poor sleep all worsen both ED and brain function.
Sleep apnea, in particular, is a major but under-recognized link.
Oxygen dips during sleep damage blood vessels, lower testosterone, and impair glymphatic brain detox (see our Sleep Apnea FAQ).

Treating sleep apnea often improves both erectile function and memory clarity — proof of how interconnected these systems are.

7. How to Protect Both Sexual and Brain Health

At HealthSpan, we focus on root-cause optimization — improving circulation, reducing inflammation, and supporting hormones naturally.

Here’s how:

A. Improve Vascular and Nitric Oxide Function

• Exercise regularly: Aerobic and resistance training both boost nitric oxide and blood flow.

• Eat nitrate-rich foods: Beets, arugula, and pomegranate increase natural nitric oxide levels.

• Avoid smoking and excess alcohol: Both damage endothelial cells.

• Manage blood pressure: Even mild hypertension impairs erectile and cerebral circulation.

B. Balance Hormones

• Test testosterone, DHT, estradiol, and SHBG.

• Optimize testosterone with lifestyle, micronutrients (zinc, magnesium, vitamin D), and—if indicated—bioidentical hormone therapy.

• Maintain balance: too much or too little testosterone can increase cardiovascular risk.

C. Support Mitochondrial and Brain Energy

• CoQ10, acetyl-L-carnitine, and alpha-lipoic acid improve cellular energy and reduce oxidative stress.

• Glycine and arginine support nitric oxide synthesis.

• B vitamins and omega-3 fatty acids protect endothelial and neural function.

D. Prioritize Sleep and Stress Recovery

• Sleep 7–9 hours for hormone repair and glymphatic clearance.

• Use breathwork, meditation, or yoga to lower cortisol.

• Address sleep apnea, a major but reversible cause of both ED and cognitive decline.

E. Strengthen Connection and Purpose

Chronic isolation and emotional stress worsen both ED and cognition.
Community, emotional intimacy, and physical affection support oxytocin, parasympathetic balance, and long-term resilience.

8. Medical Treatments — Pros and Cons

Phosphodiesterase inhibitors (PDE5 drugs like sildenafil and tadalafil) improve nitric oxide signaling and are safe for most men.
Emerging research suggests they may reduce dementia risk by improving cerebral perfusion.

However, medication should complement — not replace — vascular, hormonal, and metabolic optimization.
Addressing the root causes ensures lasting results and broader health benefits.

Bottom Line

Erectile dysfunction isn’t just about performance — it’s a vascular and metabolic signal that something deeper needs attention.
The same biology that supports strong blood flow to the penis supports oxygen delivery and repair in the brain.

Treating ED holistically — through exercise, hormone balance, nutrition, and stress regulation — is one of the most effective ways to protect long-term cognitive health. There is a role for medications as well.

At HealthSpan Internal Medicine in Boulder, CO, we view ED as an opportunity — not a failure — to restore circulation, vitality, and brain resilience.

If you are ready to explore your Brain and Sexual Health, book a discovery call with Dr. Knape today!

Sources

• 🧠 Increased Risk of Dementia in Patients With Erectile Dysfunction
  Yang CM et al., PLoS ONE, 2015
  Large cohort study showing men with ED had a significantly higher risk of developing dementia over 7 years.
  Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC4616558/

• 🔍 Erectile Function, Sexual Satisfaction & Cognitive Decline
  Slayday RE et al., The Gerontologist, 2022
  Longitudinal study demonstrating that worsening erectile function is associated with greater cognitive decline from midlife into older age.
  Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC9960031/

• ⚡ Erectile Dysfunction, Vascular Risk & Cognitive Dysfunction
  Moore CS et al., Vietnam Era Twin Study of Aging, 2014
  ED correlated with reduced cognitive performance (speed, attention, executive function), likely indicating underlying vascular dysfunction.
  Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC4850828/

• 📘 Clinical Review: Erectile Dysfunction & Cognitive Decline
  HealthyMale.org.au, 2023
  Overview explaining how ED may be an early marker for metabolic, vascular, and neurological changes linked to dementia risk.
  Link: https://healthymale.org.au/research-reviews/erectile-dysfunction-and-cognitive-decline/

• 💊 PDE5 Inhibitors Linked to Lower Alzheimer’s Disease Risk
  Neurology, 2024
  Men treated with PDE5 inhibitors had a lower risk of Alzheimer’s compared to men with untreated ED, suggesting a possible therapeutic benefit.
  Link: https://www.neurology.org/doi/10.1212/WNL.0000000000209131

Medically reviewed by
Dr. Jessica Knape, MD, MA Board Certified in Internal Medicine and Integrative and Holistic Medicine
Healthspan Internal Medicine — serving patients in Boulder, CO

Book a Discovery Call | About Dr. Knape

This content is for educational purposes and does not replace personalized medical advice.