%0 Journal Article
%T Cardiovascular Prevention of Cognitive Decline
%A Jean-Jacques Monsuez
%A Aude Gesqui¨¨re-Dando
%A Sofia Rivera
%J Cardiology Research and Practice
%D 2011
%I Hindawi Publishing Corporation
%R 10.4061/2011/250970
%X Midlife cardiovascular risk factors, including diabetes, hypertension, dyslipemia, and an unhealthy lifestyle, have been linked to subsequent incidence, delay of onset, and progression rate of Alzheimer disease and vascular dementia. Conversely, optimal treatment of cardiovascular risk factors prevents and slows down age-related cognitive disorders. The impact of antihypertensive therapy on cognitive outcome in patients with hypertension was assessed in large trials which demonstrated a reduction in progression of MRI white matter hyperintensities, in cognitive decline and in incidence of dementia. Large-scale database correlated statin use and reduction in the incidence of dementia, mainly in patients with documented atherosclerosis, but clinical trials failed to reach similar conclusions. Whether a multitargeted intervention would substantially improve protection, quality of life, and reduce medical cost expenditures in patients with lower risk profile has not been ascertained. This would require appropriately designed trials targeting large populations and focusing on cognitive decline as a primary outcome endpoint. 1. Introduction As a result of the increased life expectancy, the proportion of older people with cognitive impairment increases continuously. Alzheimer disease, which affects about 35 million people worldwide today, is estimated to afflict more than 100 million people by 2050 [1¨C3]. Amnestic mild cognitive impairment is found in about 20% of people older than 85 years with a conversion rate to Alzheimer disease of 10%¨C15% per year [4]. As a consequence, management of patients with cognitive disorders is quite common in daily cardiology practice. More recently, several studies have highlighted the deleterious role of cardiovascular risk factors on the incidence and progression of cognitive disorders in elderly people. This endorses the potential protection provided by therapeutic cardiovascular risk control. 2. Vascular Dementia and Alzheimer Disease Besides Alzheimer disease, which account for about 60%¨C80% of cases of dementia in the elderly, vascular dementia has been increasingly recognized over the past decades as a late consequence of previous symptomatic [5] or clinically silent [6] stroke in patients with cerebrovascular disease, multifocal atherosclerosis, and cardiovascular risk factors. The spectrum of vascular dementia has subsequently expanded to include patients without stroke past history in whom brain magnetic resonance imaging (MRI) showed subcortical lesions such as white matter hyperintensities (Figure 1), lacunar
%U http://www.hindawi.com/journals/crp/2011/250970/