Role of Improved Vascular Health in the Declining Incidence of Dementia

Pase, Matthew P.; Satizabal, Claudia L.; Seshadri, Sudha

doi:10.1161/strokeaha.117.013369

Cited by 42 publications

(54 citation statements)

References 66 publications

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“…A pathogenic role for vascular factors in AD has also been suggested by epidemiological studies indicating that cerebrovascular diseases and AD have similar risk factors (hypertension, diabetes, obesity, etc. ), and that improved cardiovascular health may have contributed to the recently reported reduction in AD incidence (Pase et al, 2017). Indeed, vascular risk factors, such as hypertension, promote amyloid deposition (Gottesman et al, 2017; Petrovitch et al, 2000; Rodrigue et al, 2013), attributable to reduced Aβ clearance and/or enhanced amyloid precursor protein (APP) processing (Carnevale et al, 2012; Faraco et al, 2016a).…”

Section: The Nvu In Neurodegenerative Diseasementioning

confidence: 99%

“…Although ischemic injury is not inconsequential to the clinical expression of AD (Kapasi et al, 2017), there is no definitive evidence of a synergistic interaction, e.g., (Vemuri et al, 2015). However, the reduction in dementia incidence attributed to better cardiovascular health (Pase et al, 2017) suggests a contribution of vascular pathology to neurodegeneration, an attractive hypothesis that requires further testing in randomized clinical trials.…”

Section: Where Do We Go From Here?mentioning

confidence: 99%

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The Neurovascular Unit Coming of Age: A Journey through Neurovascular Coupling in Health and Disease

Iadecola

2017

Neuron

1,663

1,649

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The concept of neurovascular unit (NVU), formalized at the 2001 Stroke Progress Review Group meeting of the National Institute of Neurological Disorders and Stroke, emphasizes the intimate relationship between the brain and its vessels. Since then, the NVU has attracted the interest of the neuroscience community resulting in considerable advances in the field. Here the current state-of-knowledge of the NVU will be assessed, focusing on one of its most vital roles: the coupling between neural activity and blood flow. The evidence supports a conceptual shift in the mechanisms of neurovascular coupling, from a unidimensional process involving neuronal-astrocytic signaling to local blood vessels, to a multidimensional one in which mediators released from multiple cells engage distinct signaling pathways and effector systems across the entire cerebrovascular network in a highly orchestrated manner. The recently appreciated NVU dysfunction in neurodegenerative diseases, although still poorly understood, supports emerging concepts that maintaining neurovascular health promotes brain health.

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Section: The Nvu In Neurodegenerative Diseasementioning

confidence: 99%

Section: Where Do We Go From Here?mentioning

confidence: 99%

The Neurovascular Unit Coming of Age: A Journey through Neurovascular Coupling in Health and Disease

Iadecola

2017

Neuron

1,663

1,649

View full text Add to dashboard Cite

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“…For the present analyses, the total score was the sum of all criteria ranging from 0 to 14, which we also categorized into three groups on the basis of data distribution (0-5, 6-10, and [11][12][13][14] since studies that show associations may not be linear. Only dietary intake of meat, fish, and fruits and vegetables and frequency of intake were collected.…”

Section: Key Pointsmentioning

confidence: 99%

“…Incident dementia was modeled using competing risk regression to adjust for risk of death.Results: The sample included 6.2% participants with poor (0-5), 81.0% with moderate (6-10), and 12.8% with ideal CVH (11)(12)(13)(14). Little is known about this topic among older adults in Latin America, where the number of people living with dementia is rising.…”

mentioning

confidence: 99%

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Cardiovascular health and dementia incidence among older adults in Latin America: Results from the 10/66 study

Perales‐Puchalt

Vidoni

Rodriguez

et al. 2019

Int J Geriat Psychiatry

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Objectives Growing evidence shows that cardiovascular health (CVH) is associated with brain health. Little is known about this topic among older adults in Latin America, where the number of people living with dementia is rising. This study aimed to assess the longitudinal association between CVH and dementia in six Latin American countries. Methods We analyzed longitudinal data from the 10/66 study that included nondementia residents at baseline aged 65+ in six Latin American countries (n = 6447) and were followed up for 3 years. An index of modifiable CVH factors (ranging from 0 to 14) was calculated. Incident dementia was modeled using competing risk regression to adjust for risk of death. Results The sample included 6.2% participants with poor (0‐5), 81.0% with moderate (6‐10), and 12.8% with ideal CVH (11‐14). At follow‐up, 9.4% had developed dementia and 13.1% had died. Compared with those with poor CVH, participants with moderate and ideal levels of CVH had a significantly lower risk of dementia in both the unadjusted (subhazard ratio for moderate, 0.77; ideal, 0.59) and adjusted models (moderate, 0.73; ideal, 0.66). Conclusion Moderate and ideal levels of CVH in old age may protect against dementia incidence. These findings may inform health promotion efforts within dementia national plans adopted recently in some Latin American countries.

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Association of Multimorbidity, Disease Clusters, and Modification by Genetic Factors With Risk of Dementia

et al. 2022

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ImportanceIndividual conditions have been identified as risk factors for dementia; however, it is important to consider the role of multimorbidity, as conditions often co-occur.ObjectiveTo investigate whether multimorbidity is associated with incident dementia and whether associations vary by different clusters of disease and genetic risk for dementia.Design, Setting, and ParticipantsThis population-based prospective cohort study used data from the UK Biobank cohort, with baseline data collected between 2006 and 2010 and with up to 15 years of follow-up. Participants included women and men without dementia and aged at least 60 years at baseline. Medical conditions were captured as part of nurse-led verbal interviews conducted at baseline assessment centers. Data were analyzed from October 2020 to July 2022.ExposuresThe presence of at least 2 long-term conditions from a preselected list of 42 conditions was used to define multimorbidity. High genetic risk for dementia was based on presence of 1 or 2 apolipoprotein (APOE) ε4 alleles.Main Outcomes and MeasuresThe main outcome, incident dementia, was derived from hospital inpatient and death registry records. Associations of multimorbidity with dementia were assessed with Cox proportional hazards models.ResultsA total of 206 960 participants (mean [SD] age, 64.1 [2.9] years, 108 982 [52.7%] women) were included in the final sample, of whom 89 201 participants (43.1%) had multimorbidity. Over a mean (SD) of 11.8 (2.2) years of follow-up, 6182 participants (3.0%) developed dementia. The incidence rate was 1.87 (95% CI, 1.80-1.94) per 1000 person-years for those without multimorbidity and 3.41 (95% CI, 3.30-3.53) per 1000 person-years for those with multimorbidity. In Cox proportional hazards models adjusted for age, sex, ethnicity, education, socioeconomic status, and APOE-ε4 carrier status, multimorbidity was associated with an increased risk of incident dementia (hazard ratio [HR], 1.63 [95% CI, 1.55-1.71]). The highest dementia risk was observed for the hypertension, diabetes, and coronary heart disease cluster (HR, 2.20 [95% CI, 1.98-2.46]) and pain, osteoporosis, and dyspepsia cluster (HR, 2.00 [95% CI, 1.68-2.37]) in women and in the diabetes and hypertension cluster (HR, 2.24 [95% CI, 1.97-2.55]) and coronary heart disease, hypertension, and stroke cluster (HR, 1.94 [95% CI, 1.71-2.20]) in men, compared with no multimorbidity. The associations between multimorbidity and dementia were greater in those with a lower genetic risk of dementia (HR, 1.96 [95% CI, 1.81-2.11]) than in those with a higher genetic risk of dementia (HR, 1.39 [95% CI, 1.30-1.49]). Similar findings were observed when stratifying diseases clusters by genetic risk for dementia.Conclusions and RelevanceThese findings suggest that multimorbidity was associated with an increased risk of dementia. The associations varied by clusters of disease and genetic risk for dementia. These findings could help with the identification of individuals at high risk of dementia as well as the development of targeted interventions to reduce or delay dementia incidence.

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Role of Improved Vascular Health in the Declining Incidence of Dementia

Cited by 42 publications

References 66 publications

The Neurovascular Unit Coming of Age: A Journey through Neurovascular Coupling in Health and Disease

The Neurovascular Unit Coming of Age: A Journey through Neurovascular Coupling in Health and Disease

Cardiovascular health and dementia incidence among older adults in Latin America: Results from the 10/66 study

Association of Multimorbidity, Disease Clusters, and Modification by Genetic Factors With Risk of Dementia

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