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Review
. 2013 Nov;33(11):1696-706.
doi: 10.1038/jcbfm.2013.159. Epub 2013 Sep 11.

Vascular aspects of cognitive impairment and dementia

Maximilian Wiesmann  1 , Amanda J Kiliaan, Jurgen A H R Claassen
Affiliations
Review

Vascular aspects of cognitive impairment and dementia

Maximilian Wiesmann et al. J Cereb Blood Flow Metab. 2013 Nov.

Abstract

Hypertension and stroke are highly prevalent risk factors for cognitive impairment and dementia. Alzheimer's disease (AD) and vascular dementia (VaD) are the most common forms of dementia, and both conditions are preceded by a stage of cognitive impairment. Stroke is a major risk factor for the development of vascular cognitive impairment (VCI) and VaD; however, stroke may also predispose to AD. Hypertension is a major risk factor for stroke, thus linking hypertension to VCI and VaD, but hypertension is also an important risk factor for AD. Reducing these two major, but modifiable, risk factors-hypertension and stroke-could be a successful strategy for reducing the public health burden of cognitive impairment and dementia. Intake of long-chain omega-3 polyunsaturated fatty acids (LC-n3-FA) and the manipulation of factors involved in the renin-angiotensin system (e.g. angiotensin II or angiotensin-converting enzyme) have been shown to reduce the risk of developing hypertension and stroke, thereby reducing dementia risk. This paper will review the research conducted on the relationship between hypertension, stroke, and dementia and also on the impact of LC-n3-FA or antihypertensive treatments on risk factors for VCI, VaD, and AD.

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Figures

Figure 1
Figure 1
Proposed connections between risk factors, dementia, and possible therapies affecting the major vascular risk factors for Alzheimer's disease (AD) and vascular dementia (VaD), hypertension, and stroke. Hypertension and stroke are major risk factors for dementia, in particular AD and VaD, whereas hypertension itself is also a risk factor for stroke. Despite all research and drug development efforts, no curative pharmacological therapies are available for dementia and also no definitive treatments are attainable for VaD. In human and animal studies, long-chain omega-3 polyunsaturated fatty acids (LC-n3-FA) and the manipulation of factors involved in the renin–angiotensin system (RAS) have shown to be beneficial for lowering the risk of developing dementia like AD and VaD.
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