RISK-FACTORS FOR VASCULAR DEMENTIA - A REVIEW

In recent years, interest in vascular causes of dementia has increased and it has been proposed that vascular dementia (VAD) may be more com mon than previously supposed. This may have important implications, be cause VAD at present may be more amenable to prevention and treatment than Alzheimer's disease (AD). Several vascular factors have been rela ted to cognitive decline and dementia in the elderly, including stroke and white matter disease. However, while numerous case-control studie s have been concerned with the risk factors for AD, studies on risk fa ctors for VADs are rare. The problems inherent in the diagnostic crite ria make it difficult to interpret the results from the few studies th at have been performed. Generally, risk factors for multi-infarct deme ntia are supposed to be the same as those for stroke, and include hype rtension, diabetes mellitus, advanced age, male sex, smoking and cardi ac diseases. White matter dementia has mainly been related to hyperten sion. Recent research suggests that vascular factors may also be impor tant in AD, especially in the late-onset type. In stroke patients, dem entia has been associated with higher age, less formal education, cere bral atrophy, left-sided or bilateral infarcts, volume of macroscopic infarcts, bilateral symptoms, previous stroke and white matter lesions . The pathogenetic mechanism through which these factors cause dementi a is still not clear. Furthermore, it is not known if risk factors for VAD differ from those found in stroke patients. There is now an urgen t need for further research on risk factors for VAD and on factors rel ated to dementia in subjects with cerebrovascular disorders.