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risk factors & protective factors for vascular dementia

Risk factors: 1) ischemic stroke(s) a) multi-infarct dementia b) strategic infarcts 1] angular gyrus syndrome 2] caudate infarction 3] globus pallidus infarction 4] thalamic infarction c) small vessel disorders 1] lacunar infarcts 2] leukoaraiosis 3] Binswanger's disease d) embolic stroke - high incidence of cerebral emboli (not from carotids) [9] - atrial fibrillation [8] 2) hemorrhagic stroke(s) 3) atherosclerosis, coronary artery disease [2,3] - myocardial infarction, heart failure, atrial failure 4) high blood pressure - systolic blood pressure variation [4] 5) cerebral amyloid angiopathy 6) primary CNS angiitis 7) diabetes 8) obesity 9) hypercholesterolemia 10) cigarette smoking 11) ultraprocessed foods [6] 12) osmotic laxative use & multiple different laxatives use associated with increased risk for all-cause dementia (RR=1.64) & vascular dementia (RR=1.97) [10] 13) the most consistent associations across 13 years are an - abnormal electrocardiogram, cardiac dysrhythmias, cerebrovascular disease, non-epithelial skin cancer, depression, hearing loss [7] * vascular risk factors when present in midlife are associated with increased risk of vascular dementia in later life [5] Protective factors 1) supplementary vitamin E 2) physical exercise

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vascular dementia

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risk factors for dementia

References

  1. Kristi Wagner Steh, West Los Angeles VA, GRECC, Dec 2003 - Cummings JL, The Neuropsychiatry of Alzheimer's Disease and Related Dementias, Martine Dunitz LTD, Taylor & Francis Group, London (2003) - Mendez MF & Cummings JL, Dementia: A Clinical Approach, Butterworth & Heinemann, Philadelphia (2003)
  2. van Oijen M et al, Atherosclerosis and risk for dementia. Ann Neurol 2007, 61:403 PMID: 17328068
  3. Selnes OA et al, Cognition 6 years after surgical or medical therapy for coronary artery disease. Ann Neurol 2008, 63:581 PMID: 18481292 - Yaffe K and Covinsky KE Coronary bypass surgery and long-term cognitive decline. Ann Neurol 2008, 63:547 PMID: 18481289
  4. Oishi E, Ohara T, Sakata S et al Day-to-day blood pressure variability and risk of dementia in a general Japanese elderly population: the hisayama study. Circulation 2017 PMID: 28784822 - Merkler A et al Rollercoaster blood pressure, an Alzheimer disease risk factor? Circulation. 2017 Aug 8;136(6):516-525. PMID: 28784823
  5. Gottesman RF, Albert MS, Alonso A et al Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort JAMA Neurol. Published online August 7, 2017. PMID: 28783817 http://jamanetwork.com/journals/jamaneurology/article-abstract/2646624
  6. Li H et al. Association of ultraprocessed food consumption with risk of dementia: A prospective cohort study. Neurology 2022 Jul 27; 99:e1056. PMID: 35896436 https://n.neurology.org/content/99/10/e1056
  7. George J Earlier Health Conditions Tied to Subsequent Dementia. Alzheimer's disease, vascular dementia links are time-dependent. MedPage Today January 5, 2023 https://www.medpagetoday.com/neurology/dementia/102521 - Beason-Held LL, Kerley CI, Chaganti S et al Health Conditions Associated with Alzheimer's Disease and Vascular Dementia. Ann Neurol. 2022. Dec 26 PMID: 36571386 https://onlinelibrary.wiley.com/doi/10.1002/ana.26584
  8. Friberg L, Rosenqvist M. Less dementia with oral anticoagulation in atrial fibrillation. European Heart Journal. Oct 24, 2017 PMID: 29077849 https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehx579 - Styles S Cutting Dementia Risk in Atrial Fibrillation: Does Rhythm Control Strategy Matter? Medscape. April 29, 2022 https://www.medscape.com/viewarticle/972967
  9. Purandare N et al. Association of cerebral emboli with accelerated cognitive deterioration in Alzheimer's disease and vascular dementia. Am J Psychiatry 2012 Mar 1; 169:300. PMID: 22193532 - Doraiswamy PM. Silent cerebrovascular events and Alzheimer's disease: An overlooked opportunity for prevention? Am J Psychiatry 2012 Mar 1; 169:251. PMID: 22407112
  10. Yang Z, Wei C, Li X et al Association Between Regular Laxative Use and Incident Dementia in UK Biobank Participants. Neurology. 2023, Feb 22 PMID: 36813729 https://n.neurology.org/content/early/2023/02/22/WNL.0000000000207081