Hypercholesterolaemia and vascular dementia

Abstract

Correspondence: Philip Bath (Philip.bath@nottingham.ac.uk) Vascular dementia (VaD) is the second commonest cause of dementia. Stroke is the leading cause of disability in adults in developed countries, the second major cause of dementia and the third commonest cause of death. Traditional vascular risk factors -diabetes, hypercholesterolaemia, hypertension and smoking -are implicated as risk factors for VaD. The associations between cholesterol and small vessel disease (SVD), stroke, cognitive impairment and subsequent dementia are complex and as yet not fully understood. Similarly, the effects of lipids and lipid-lowering therapy on preventing or treating dementia remain unclear; the few trials that have assessed lipid-lowering therapy for preventing (two trials) or treating (four trials) dementia found no evidence to support the use of lipid-lowering therapy for these indications. It is appropriate to treat those patients with vascular risk factors that meet criteria for lipid-lowering therapy for the primary and secondary prevention of cardiovascular and cerebrovascular events, and in line with current guidelines. Managing the individual patient in a holistic manner according to his or her own vascular risk profile is recommended. Although the paucity of randomized controlled evidence makes for challenging clinical decision making, it provides multiple opportunities for on-going and future research, as discussed here.

Hallmarks of Brain Aging: Adaptive and Pathological Modification by Metabolic States

“…Dyslipidemia (elevated blood concentrations of low-density lipoproteins and triglycerides) is a risk factor for stroke and vascular dementia, and may also increase one’s risk for AD (Appleton et al, 2017). Within the brain, the metabolism of multiple lipid species is altered during aging as indicated by the accumulation of long-chain ceramides (Cutler et al, 2004) and lipid-laden cells (Shimabukuro et al, 2016), and a decline in brain tissue levels of omega-3 fatty acids (Denis et al, 2013).…”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice?

“…Blood pressure Higher mid-life blood pressure was associated with higher dementia risk 16 and cognitive decline 17 Blood glucose Diabetes was associated with increased dementia risk 18 and cognitive decline 19 Lipids Higher total serum cholesterol was associated with higher VaD and AD risk 20,21 Clinical cardiovascular or cerebrovascular disease Stroke Stroke is associated with increased dementia risk 22,23 AF AF is associated with increased dementia risk 24,25 Vascular/peripheral arterial disease Carotid arterial disease is associated with incident dementia risk and cognitive decline 26,27 Lower ankle brachial index is associated with increased dementia risk 28 Sleep apnoea Sleep-disordered breathing is associated with an increased risk of cognitive impairment and a small worsening in executive function. 29 ABCA7, ATP-binding cassette transporter A7; AD, Alzheimer's disease; AF, atrial fibrillation; C9ORF72, chromosome 9 open reading frame 72; GRN, granulin; MAPT, microtubule-associated protein tau; VaD, vascular dementia.…”

Introductory Chapter: Concept of Neuroprotection - A New Perspective

“…Since body metabolism is important, diet control is also important to reduce any risk factors leading to the development of neurodegenerative diseases, such as diabetes, hyperlipidemia, or hypercholesterolemia. All of these risk factors are related to vascular components, which may further add on vascular dementia [12][13][14]. Apart from exercise, it is well-known that, maintaining social activity is essential to keep our brain healthy [15].…”