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British Medical Bulletin Advance Access originally published online on June 10, 2009
British Medical Bulletin 2009 91(1):49-59; doi:10.1093/bmb/ldp020
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Preventing dementia: role of vascular risk factors and cerebral emboli

Nitin Purandare*

Psychiatry Research Group, Room 3.319, 3rd Floor East, University Place, University of Manchester, Oxford Road, Manchester M13 9PL, UK

* Correspondence to: Nitin Purandare, Psychiatry Research Group, Room 3.319, 3rd Floor East, University Place, University of Manchester, Oxford Road, Manchester M13 9PL, UK. E-mail: nitin.purandare{at}manchester.ac.uk

Introduction or background: Dementia, Alzheimer's disease and vascular dementia being two main causes, is major and growing health problem. Vascular risk factors are thought to be involved in the causation of both dementias.

Sources of data: A review of the literature was conducted using MedLine to identify current evidence for role of vascular risk factors as potential targets in preventing dementia. Cross-references were hand searched.

Areas of agreement: The evidence from prospective epidemiological studies suggests that optimizing the control of vascular risk factors such as hypertension, high cholesterol, diabetes, smoking and heart disease may prevent dementia. However, this has been proven in randomized placebo-controlled trials (RCT) for only hypertension.

Areas of controversy: Dementia is a secondary outcome in most RCTs and it is not known if there is a therapeutic time window between mid- and late-life when interventions are most effective. Also, we do not know precise mechanisms by which interventions for vascular risk factors offer brain protection.

Growing points: Our research suggests that asymptomatic cerebral emboli, which are preventable, may be involved in the causation of dementia.

Areas timely for developing research: There is a need for RCT targeting multiple vascular risk factors in patients at high risk of dementia such as those with mild cognitive impairment.

Keywords: dementia • Alzheimer's disease • vascular dementia • vascular risk factors • hypertension • emboli

Accepted for publication May 13, 2009.


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