title: The influence of vascular risk factors on cognitive decline in patients with Alzheimer's disease.
abstract: BACKGROUND
  The influence of vascular risk factors (VRFs) on the rate of cognitive decline in patients with established dementia is unclear. This study aims to examine the association between VRFs and the rate of cognitive decline in patients with Alzheimer's disease (AD).
  
  
  METHODS
  Data were obtained from patients visiting a memory clinic between 2004 and 2012. VRFs were determined at baseline and included hypertension, hypercholesterolemia, diabetes mellitus, overweight and smoking. Continuous values of blood pressure, total cholesterol, glucose level and body mass index were also obtained. Mini-Mental State Exam (MMSE) scores were obtained at baseline and during follow-up visits. The association between VRFs and the annual change in MMSE scores was analysed with a multivariable linear mixed model adjusted for age, sex and the aforementioned VRFs.
  
  
  RESULTS
  From 174 patients (mean age 78.3 years), with a follow-up time up to 5.8 years (mean 1.1 year), in total 447 MMSE scores were obtained. The multivariable analyses showed an association between age as well as systolic blood pressure and a decline in annual rates of change in MMSE scores of -0.05 (95% confidence interval (CI): -0.09 to 0.00) and -0.01 (CI: -0.03 to 0.00), respectively. For all other VRFs, including sex, patients did not show a significant difference.
  
  
  CONCLUSIONS
  This study did not find an association between preventable vascular risk factors and cognitive decline in patients with AD, except for systolic blood pressure. As the association between systolic blood pressure and decline in MMSE was small, clinical relevance may be limited.
authors: Department of Geriatrics, University Medical Center Utrecht, PO Box 85500, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Kim
authors: K
authors: Blom
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Ilonca
authors: I
authors: Vaartjes
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Sanne A E
authors: SA
authors: Peters
authors: Department of Geriatrics, University Medical Center Utrecht, PO Box 85500, Utrecht, The Netherlands. Electronic address: h.l.koek@umcutrecht.nl.
authors: Huiberdina L
authors: HL
authors: Koek
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications*; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology*; D015331:Cohort Studies; D003704:Dementia / Q000150:complications; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D008609:Mental Status Schedule; D050177:Overweight / Q000150:complications; D012307:Risk Factors; D012907:Smoking; D014652:Vascular Diseases / Q000150:complications*
chemical_list: D001786:Blood Glucose; D002784:Cholesterol
keywords: Alzheimer's Disease; Diabetes mellitus; Hypercholesterolemia; Hypertension; Overweight; Smoking.