The potential for prevention of dementia across two decades: the prospective, population-based Rotterdam Study

Abstract

BackgroundCardiovascular factors and low education are important risk factors of dementia. We provide contemporary estimates of the proportion of dementia cases that could be prevented if modifiable risk factors were eliminated, i.e., population attributable risk (PAR). Furthermore, we studied whether the PAR has changed across the last two decades.MethodsWe included 7,003 participants of the original cohort (starting in 1990) and 2,953 participants of the extended cohort (starting in 2000) of the Rotterdam Study. Both cohorts were followed for dementia until ten years after baseline. We calculated the PAR of overweight, hypertension, diabetes mellitus, cholesterol, smoking, and education. Additionally, we assessed the PAR of stroke, coronary heart disease, heart failure, and atrial fibrillation. We calculated the PAR for each risk factor separately and the combined PAR taking into account the interaction of risk factors.ResultsDuring 57,996 person-years, 624 participants of the original cohort developed dementia, and during 26,177 person-years, 145 participants of the extended cohort developed dementia. The combined PAR in the original cohort was 0.23 (95 % CI, 0.05–0.62). The PAR in the extended cohort was slightly higher at 0.30 (95 % CI, 0.06–0.76). The combined PAR including cardiovascular diseases was 0.25 (95 % CI, 0.07–0.62) in the original cohort and 0.33 (95 % CI, 0.07–0.77) in the extended cohort.ConclusionsA substantial part of dementia cases could be prevented if modifiable risk factors would be eliminated. Although prevention and treatment options of cardiovascular risk factors and diseases have improved, the preventive potential for dementia has not declined over the last two decades.

Cognitive Reserve Hypothesis in Frontotemporal Dementia: Evidence from a Brain SPECT Study in a Series of Greek Frontotemporal Dementia Patients

“…Recognition of such a role for CR could result in more appropriate patient selection and interpretation of findings in future clinical trials. Above all, carefully designed studies are required to define the optimal frequency and time spent on specific interventions [37] in order to achieve dementia prevention [38] and ultimately successful aging [39]. …”

Atherosclerosis in the circle of Willis: Spatial differences in composition and in distribution of plaques

“…Many papers associate hypertension and the development of mild cognitive impairment or vascular dementia (VD) and show that they are reduced by antihypertensive drugs [31e35]. Furthermore, recent data from the Rotterdam population-based study suggest that a substantial portion of dementia cases could be prevented if modifiable risk factors, such as hypertension, would be eliminated [36]. Yet, there is no evidence from large randomised controlled trials showing the positive effect of antihypertensive treatment on VD and vascular cognitive impairment [35].…”

Higher Education Is Associated with a Lower Risk of Dementia after a Stroke or TIA. The Rotterdam Study

“…Hence, identification of (modifiable) factors that act as protectors against dementia following a stroke or TIA is of major public health and clinical importance. Finally, given the differences in risk factors [16], education categories [17] and incidence of stroke and dementia in men and women [18,19], the association between stroke or TIA and consequent dementia across education categories needs to be explored for sex differences.…”