Article

Delaying the onset of dementia by just a few years could have a major impact on
the prevalence of the disease at the population level. Vascular risk factors are
modifiable and may offer an important opportunity for preventive approaches.
Several studies have shown that diabetes, hypertension, obesity, and smoking are
associated with an increased risk of cognitive decline and dementia, but other
groups have not observed such a relation. Positive associations were observed
mainly in studies where risk factors were assessed in midlife, suggesting that
age is an important modulator in the relation between vascular risk factors and
cognition. The population attributable risk of dementia is particularly high for
hypertension. Associations of vascular risk factors with cognitive decline and
dementia are probably mediated largely by cerebrovascular disease, including both
stroke and covert vascular brain injury, which can have additive or synergistic
effects with coexisting neurodegenerative lesions. To date, randomized trials
have not convincingly demonstrated that treating vascular risk factors is
associated with a reduction in cognitive decline or dementia risk. Of eight
randomized trials testing the effect of antihypertensive agents on dementia risk,
only one was positive, and another in a subgroup of individuals with recurrent
stroke. In most trials, cognition and dementia were secondary outcomes, follow-up
was short and treatment was initiated at an older age. No effect on cognitive
decline or dementia could be demonstrated for statins and intensive glycemic
control. Future areas of investigation could include differential class effects
of antihypertensive drugs on cognitive outcomes and identification of high risk
individuals as target population for clinical trials initiated in midlife.
CI - Copyright (c) 2013. Published by Elsevier Masson SAS.

Langue : ANGLAIS