title: The influence of vascular risk factors on cognitive decline in patients with dementia: a systematic review.
abstract: OBJECTIVE
  Vascular risk factors (VRF) are associated with a higher incidence of dementia. However, the relationship with disease progression is unclear. This review examined the association of VRF (hypertension, hypercholesterolemia, diabetes mellitus, overweight, smoking or multiple VRF) and cognitive decline in patients suffering from dementia.
  
  
  METHODS
  Literature was searched in four databases (Pubmed, Embase, Cochrane, PsychInfo) and 1779 articles were identified. This resulted in a total of 20 articles which were included.
  
  
  RESULTS
  Twelve studies on hypertension (HT) were inconsistent about the association with cognitive decline. For hypercholesterolemia (HC) 2 (out of 7) studies were associated with increased cognitive decline, as were both (2/2) studies which researched LDL-cholesterol. Articles were inconclusive about the effect of diabetes mellitus (DM): five (out of 13) found less cognitive decline, 2 found more cognitive decline, and 6 found no significant effect of DM. Overweight (BMI>25 kg/m(2)) was associated in 2/4 studies with a slower rate of cognitive decline, while the other 2 studies found no effect. All studies (5/5) that researched smoking did not find a significant effect. Four studies (out of 7) that looked at multiple VRF found faster cognitive decline, and 3/7 found no effect.
  
  
  CONCLUSIONS
  The results of this review suggest an association between LDL-cholesterol and the progression of dementia, while inconsistent results were found for other VRF. Additional prospective cohort studies and experimental studies should be performed to better understand the causal contribution of VRF on cognitive decline in dementia.
authors.affiliation: Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands. k.blom-2@umcutrecht.nl
authors.forename: Kim
authors.initials: K
authors.lastname: Blom
authors.forename: Mariëlle H
authors.initials: MH
authors.lastname: Emmelot-Vonk
authors.forename: Huiberdina L
authors.initials: HL
authors.lastname: Koek
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D003072:Cognition Disorders / Q000503:physiopathology*; D003704:Dementia / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: Alzheimer Disease; Dementia; Diabetes mellitus; Hypercholesterolemia; Hypertension; Vascular risk factors