Magazine article Clinical Psychiatry News

Midlife Cardiovascular Risk Bolsters Dementia Risk: Smoking, Hypertension, Hypercholesterolemia, and Diabetes Were Assessed in This Prospective Study

Magazine article Clinical Psychiatry News

Midlife Cardiovascular Risk Bolsters Dementia Risk: Smoking, Hypertension, Hypercholesterolemia, and Diabetes Were Assessed in This Prospective Study

Article excerpt

SAN FRANCISCO -- The presence of multiple cardiovascular risk factors in midlife markedly increases the risk of developing dementia late in life, Dr. Kristine Yaffe said at the annual meeting of the American Academy of Neurology.

This finding from a large new prospective cohort study of Kaiser Permanente HMO members raises an important question. Will aggressive modification of these risk factors in early- or midadult life result in lower rates of dementia decades later?

"Think about it: When does the clock start ticking?" asked Dr. Yaffe, chief of geriatric psychiatry at the San Francisco Veterans Affairs Medical Center.

She noted that neuropathologic studies have shown that neurodegenerative processes begin years before clinically identifiable dementia, suggesting that the window of opportunity for prevention may be open widest long before individuals achieve senior citizen status.

Earlier studies have persuasively shown that the presence of cardiovascular risk factors late in life is associated with increased rates of both Alzheimer's dementia and vascular dementia, but the late neurocognitive impact of cardiovascular risk factors present in midlife hasn't previously been systematically examined, she continued.

Dr. Yaffe reported on 11,341 Kaiser members who were aged 40-44 years when they underwent a detailed health evaluation during 1964-1973 and who remained with the HMO through 2003. By 2003, 7.8% of study participants had been diagnosed with non-HIV-associated dementia.

The midlife cardiovascular risk factors assessed in this prospective study were smoking, hypertension, hypercholesterolemia, and diabetes. The presence of any one of these risk factors in midlife was associated with a modest increase in dementia risk an average of 27 years later--on the order of 25%-35% increased risk, with the exception of smoking, which had a weaker effect. …

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