title: Vascular risk factors and cognitive disorders.
abstract: 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.
authors.affiliation: Department of neurology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Inserm unit U740, université Paris Diderot Paris 7, UFR de médecine Paris Diderot Paris 7 (site Villemin), 10, avenue de Verdun, 75010 Paris, France; Paris 7 university, DHU neurovasc Sorbonne Paris-Cité, 190, avenue de France, 75013 Paris, France; Department of neurology, Framingham heart study, Boston university school of medicine, 72 E Concord St, Boston, MA 02118, USA. Electronic address: sdebette@bu.edu.
authors.forename: S
authors.initials: S
authors.lastname: Debette
mesh_terms: D002561:Cerebrovascular Disorders / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D002986:Clinical Trials as Topic; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology* / Q000628:therapy; D015140:Dementia, Vascular / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D064887:Observational Studies as Topic / Q000706:statistics & numerical data; D012307:Risk Factors
keywords: AVC; Cognition; Dementia; Démence; Facteurs de risque vasculaire; Hypertension; Stroke; Vascular risk factors