Midlife Vascular Factors May Signal Later Dementia



Patients aged in their 40s and 50s can lower their risk of dementia by paying attention to a variety of modifiable vascular risk factors, say researchers from Kaiser Permanente in Oakland and University of California-San Francisco, both in California; University Medical Centre Utrecht in the Netherlands; and Karolinksa University in Sweden.

They conducted a study to validate the risk score developed in the CAIDE (Cardiovascular Risk Factors, Aging and Dementia) study, and to determine whether adding other risk factors would improve predictability of dementia development. To the CAIDE risk factors (eg, hypertension, obesity, and hyperlipidemia), they added diabetes, depressed mood, head trauma, central obesity, lung function, and smoking.

In their study of 9,480 members of a large health care delivery system, 2,767 were diagnosed with dementia, on average 37 years after their midlife multiphasic examination. Of those, 1,011 received a medical specialist-confirmed diagnosis of Alzheimer disease or vascular dementia.

Using the CAIDE score the researchers were able to not only assess the risk of dementia accurately, but stratify patients into those with a low (9%) and high (29%) risk. Patients who developed dementia tended to be older female smokers with central obesity and poor pulmonary function.

“Surprisingly,” the researchers say, adding the new midlife risk factors did not enhance the predictability of the risk score. One reason, they postulate, is that some of the new risk factors are really affiliated with the “old” risk factors, such as central obesity with high body mass index, high systolic blood pressure, and high cholesterol.

One of the strengths of the current study, the researchers feel, is that their cohort had > 12 years to ascertain a dementia diagnosis, in contrast to the CAIDE cohort, who were evaluated at one time point in later life.

Even though dementia usually becomes apparent in later life, the researchers note that more and more evidence underscores the idea that it is a “disease of a lifetime.” Long-term maintenance of vascular health may delay or even prevent dementia, they say. Applying the risk score could make it easier to identify patients at risk sooner and allow them to be selected for clinical trials and early interventions.

Exalto LG, Quesenberry CP, Barnes D, Kivipelto M, Jan Biessels G, Whitmer RA. Alzheimers Dement. 2014:10(5):562-570.
doi: 10.1016/j.jalz.2013.05.1772.

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