RISK-FACTORS FOR CEREBRAL DEGENERATIVE CHANGES AND DEMENTIA

It is concluded that the most important determinants for cerebral neur odegenerative changes and cognitive decline during aging are neuronal shrinkage and/or loss, which are accelerated by certain risk factors: e.g. TIAs, hypertension, heart disease, hyperlipidemia, smoking, heavy alcohol consumption, male gender, low educational status, family hist ory of cerebrovascular disease and absence of estrogen replacement the rapy among women. Some of these risk factors are remediable by therape utic interventions, including prevention of TIAs and medications that control hypertension, heart disease, hyperlipidemia and estrogen repla cement in postmenopausal women, as well as abstention from abuse of to bacco and alcohol. Cerebral neurodegenerative changes measured by neur oimaging appear to be premorbid markers for depleted neuronal and syna ptic reserves which predispose to the onset of dementias of both VAD a nd DAT types. Normal subjects at risk for cognitive decline include th ose with TIAs, hypertension and heart disease since these risk factors measurably accelerate cerebral atrophy, ventricular enlargement, leuk oaraiosis, and decline in cortical perfusion.