Dementia: new vistas and opportunities
Over the past four decades, Alzheimer disease has become near synonymous with dementia and the amyloid/tau hypothesis as its dominant explanation. However, this monorail approach to etiology has failed to yield a single disease-modifying drug. Part of the explanation stems from the fact that most dementias in the elderly result from interactive Alzheimer and cerebrovascular pathologies. Stroke and dementia share the same risk factors and their control is associated with a decrease in stroke and some dementias. Additionally, intensive control of risk factors and enhancement of protective factors improve cognition. Moreover, anticoagulation of atrial fibrillation patients decreases their chance of developing dementia by 48%. Preliminary data suggest that treating blood pressure to a target of 120 mmHg systolic compared to a target of 140 mmHg decreases the chances of mild cognitive impairment by 19%. The Berlin Manifesto establishes the scientific bases of “preventing dementia by preventing stroke.” Enlarging our vista of dementia to include cerebrovascular disease offers the opportunity of preventing not only stroke, but some dementias, beginning now.
KeywordsStroke Alzheimer disease Cerebrovascular disease Prevention
This article is based on a lecture delivered at the XLIX Congresso Societa Italian di Neurologia. Rome, Italy, October 27, 2018.
Compliance with ethical standards
Conflict of interest
The author declare that there is no conflict of interest.
Research involving human participants and/or animals
No human or animals were involved.
Not applicable. This is not a study.
- 1.The Global Burden of Disease Study 2017 (2018) Lancet 392:10159Google Scholar
- 12.Chen H, Kwong JC, Copes R, Tu K, Villeneuve PJ, van Donkelaar A, Hystad P, Martin RV, Murray BJ, Jessiman B, Wilton AS, Kopp A, Burnett RT (2017) Living near major roads and the incidence of dementia, Parkinson’s disease, and multiple sclerosis: a population-based cohort study. Lancet 389:718–726CrossRefGoogle Scholar
- 13.Livingston G, Sommerlad A. Orgeta V. Costafreda SG, Huntley J, Ames D, Ballard C et al (2017) Dementia prevention, intervention and care. The Lancet Commissions. LancetGoogle Scholar
- 18.Hachinski V (2019) Dementia: a radical rethink. Alzheimers Dement in pressGoogle Scholar
- 21.Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, Lindley RI, O'Brien JT, Barkhof F, Benavente OR, Black SE, Brayne C, Breteler M, Chabriat H, Decarli C, de Leeuw FE, Doubal F, Duering M, Fox NC, Greenberg S, Hachinski V, Kilimann I, Mok V, Oostenbrugge Rv, Pantoni L, Speck O, Stephan BC, Teipel S, Viswanathan A, Werring D, Chen C, Smith C, van Buchem M, Norrving B, Gorelick PB, Dichgans M, STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1) (2013) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1). Lancet Neurol 12:822–838CrossRefGoogle Scholar
- 27.Savva GM, Stephan BCM, the Alzheimer’s Society Vascular Dementia Systematic Review Group (2010) Epidemiological studies of the effect of stroke on incident dementia. A Systematic Review. Stroke 41:e41–e46Google Scholar
- 29.Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R, Bäckman L, Hänninen T, Jula A, Laatikainen T, Lindström J, Mangialasche F, Paajanen T, Pajala S, Peltonen M, Rauramaa R, Stigsdotter-Neely A, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M (2015) A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet 385:2255–2263CrossRefGoogle Scholar
- 33.Hachinski V, Ganten D, Lackland D, Kreutz R, Tsioufis K, Hacke W, on behalf of the World Stroke Organization, the World Heart Federation, the World Hypertension League and the European Society of Hypertension (2018) Implementing the proclamation of stroke and potentially preventable dementias. Int J Stroke 13:780–786CrossRefGoogle Scholar