Hypotension in Subcortical Vascular Dementia, a New Risk Factor – Wasn’t It Hypertension?

The identification of additional genetic susceptibility genes in the etiology of AD and the metabolic mechanisms leading to differences in age of onset and disease pathogenesis are active areas of current susceptibility. Although all the contributing factors may never be known, scientists have identified several common threads. They include: age (more than 65 years old), sex (women are more likely than men are to develop the disease, in part because they live longer), toxicity (such as overexposure to certain trace metals, such as aluminum), head injury (serious traumatic injury to the head, for example, a concussion with a prolonged loss of consciousness) may be a risk factor for Alzheimer's), hormone replacement therapy (the exact role hormone replacement therapy may play in the development of dementia isn't yet clear; throughout the 1980s and '90s, evidence seemed to show that estrogen supplements given after menopause could reduce the risk of dementia; results from the large-scale Women's Health Initiative Memory Study indicated an increased risk of dementia for women taking estrogen after age 65: the verdict is not yet in on whether estrogen affects the risk of dementia if given at an earlier age), lifestyle (the same factors that put you at risk of heart disease, such as high blood pressure and high cholesterol, may also increase the likelihood that you'll develop Alzheimer's disease, poorly controlled diabetes is another risk factor). Atrial fibrillation, systolic hypertension, and angina have been associated with more rapid decline in cognition, while history of coronary artery bypass graft surgery, diabetes, and antihypertensive medications were associated with a slower rate of decline, and may represent modifiable risk factors for secondary prevention in Alzheimer disease. There was an age interaction such that systolic hypertension, angina, and myocardial infarction were associated with greater decline with increasing baseline age. The attenuated decline for diabetes and coronary artery bypass graft surgery may be due to selective survival. Some of these effects appear to vary with age (Mielke et al., 2007). There is an overlap of risk factors between VaD and AD, so much so that it raises some serious questions about vascular contributions to AD. Recognition that cerebrovascular disease causing dementia may be modified by treatment of cerebrovascular risk factors serves as an important tool for investigating various treatments aimed at secondary prevention of