Possible Role of Vascular Risk Factors in Alzheimer's Disease and Vascular Dementia
W. Victor R. Vieweg.
The contribution of vascular risk factors to Alzheimer-vascular spectrum dementias is increasingly being recognized. We provide
an overview of recent literature on this subject. Overweight and obesity as well as underweight during midlife predict cognitive decline
and dementia later in life. Hypertension during midlife is also associated with dementia later in life and the association is stronger
for untreated hypertension. Calcium channel blockers, angiotensin converting enzyme inhibitors, and angiotensin-1 receptor-blockers
may be particularly beneficial in diminishing the risk of dementia associated with hypertension. Studies have fairly consistently shown
that type 2 diabetes is a risk factor for dementia. Episodes of hypoglycemia add to this risk. Regular physical exercise during any point in
the lifespan protects against cognitive decline and dementia. Most benefit is realized with physical exercise during early and midlife.
Dyslipidemia also increases the risk of dementia but the findings are less consistent. Findings on the possible benefit of lipid-lowering
agents (statins) are conflicting. Earlier studies identified smoking as protective of dementia but recent better designed studies have consistently
shown that smoking increases the risk of dementia. The association of vascular risk factors with dementia is more robust for
vascular dementia than Alzheimer’s disease. Heterogeneity of studies and lack of trials specifically designed to assess cognition as an
endpoint make firm conclusions difficult. But considering the expected global burden of dementia and projected attributable risk of vascular
risk factors to it, there is sufficient evidence to promote vascular risk factor reduction strategies as dementia prevention interventions.
Keywords: Adiposity, Alzheimer's disease, diabetes mellitus, dyslipidemia, hypertension, physical activity, vascular dementia, vascular risk
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