Vascular risk factors and dementia in the general population aged &gt;85 years

Rastas, Sari; Pirttilä, Tuula; Mattila, Kimmo; Verkkoniemi, Auli; Juva, Kati; Niinistö, Leena; Länsimies, Esko; Sulkava, Raimo

doi:10.1016/j.neurobiolaging.2008.02.020

Cited by 67 publications

(54 citation statements)

References 50 publications

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“…Nine studies reported an estimate of the effect of a history of stroke on the risk of dementia. [13][14][15][16][17][18][19][20][21] Seven studies reported the effect of incident stroke on dementia risk in cohorts that were initially both stroke-and dementia-free. 13,15,16,[22][23][24][25] Rochester study investigators 26 estimated standardized morbidity ratios for dementia by comparing dementia incidence rates in a population with incident stroke with those found in the general Rochester population and so this study is included despite no direct control comparison.…”

Section: Resultsmentioning

confidence: 99%

“…17 A slight inverse relationship between prevalent stroke and dementia incidence was discovered in the Vantaa study, whose participants were Ն85 years of age at baseline. 13 Likewise, Leibetrau et al 16 found no association between history of stroke and incident dementia in a population-based cohort of 85 year olds. This might be explained by survivor effects in very old cohorts; a survival analysis of incident stroke in the Vantaa study 13 revealed a significant association with dementia (hazard ratioϭ3.3, CIϭ1.9 to 5.6) after adjusting for APOE genotype and other cardiovascular risk factors, and Leibetrau et al found a strong cross-sectional relationship between stroke and dementia (ORϭ4.3: CIϭ2.7 to 6.9).…”

Section: Demographic Factorsmentioning

confidence: 96%

“…13 Likewise, Leibetrau et al 16 found no association between history of stroke and incident dementia in a population-based cohort of 85 year olds. This might be explained by survivor effects in very old cohorts; a survival analysis of incident stroke in the Vantaa study 13 revealed a significant association with dementia (hazard ratioϭ3.3, CIϭ1.9 to 5.6) after adjusting for APOE genotype and other cardiovascular risk factors, and Leibetrau et al found a strong cross-sectional relationship between stroke and dementia (ORϭ4.3: CIϭ2.7 to 6.9). The effect of incident stroke on dementia incidence in older cohorts is similar to that in younger cohorts, so the lack of effect of history of stroke in older cohorts might also reflect a longer delay between stroke and baseline assessment.…”

Section: Demographic Factorsmentioning

confidence: 96%

“…Univariate results from cohort studies of the effect of a history of stroke on the risk of incident dementia vary from no effect 13,16 to a 4-fold increase 17 in risk, although most report an effect consistent with a doubling of the risk of incident dementia in those with stroke compared with those without. 14,15,18,20,21 …”

Section: Effect Of a History Of Strokementioning

confidence: 99%

“…Estimates of the effect of incident stroke were also variable, 13,15,16,[22][23][24][25] but the effect of an incident stroke on incident dementia is higher than the effect of a history of stroke, suggesting that the excess risk of stroke is greatest close to stroke occurrence.…”

Section: Time Since Strokementioning

confidence: 99%

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Epidemiological Studies of the Effect of Stroke on Incident Dementia

Savva

Stephan

2010

Stroke

255

151

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Background and Purpose-Stroke is implicated in the incidence of dementia, and the risk of poststroke dementia is well characterized, but the excess risk of dementia in those with stroke compared with those without stroke is not well known. Methods-We conducted a systematic review of the excess risk of incident dementia conferred by stroke. Studies of the risk of incident dementia in the population with stroke compared with the population without stroke were identified and compared. Results-Sixteen studies were identified with all but one conducted in a community setting. A history of stroke doubles the risk of incident dementia in the older population. This increase is not explained by demographic or cardiovascular risk factors or by prestroke cognitive decline. The excess risk of incident dementia diminishes with time after stroke and may be higher in those without an APOE ⑀4 allele. There is no excess risk of incident dementia in those aged Ͼ85 years with a history of stroke compared to those aged Ͼ85 years without stroke. Conclusions-The effect of stroke on dementia incidence in the population is not explained by common risk factors. At this time of population aging and increased stroke survival, more research is needed to determine to what extent efforts to reduce the incidence of stroke will affect the incidence of dementia. (Stroke. 2010;41:e41-e46.)

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Section: Resultsmentioning

confidence: 99%

Section: Demographic Factorsmentioning

confidence: 96%

Section: Demographic Factorsmentioning

confidence: 96%

Section: Effect Of a History Of Strokementioning

confidence: 99%

Section: Time Since Strokementioning

confidence: 99%

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Epidemiological Studies of the Effect of Stroke on Incident Dementia

Savva

Stephan

2010

Stroke

255

151

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Dementia and Systemic Disorders

Molano

Kelley

2013

Neurological Disorders Due to Systemic Disease

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Population‐based analysis of pathological correlates of dementia in the oldest old

Tanskanen

Mäkelä

Notkola³

et al. 2017

Ann Clin Transl Neurol

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ObjectiveThe aim of this study was to analyze brain pathologies which cause dementia in the oldest old population.MethodsAll 601 persons aged ≥85 years living in the city of Vantaa (Finland), on April 1st, 1991 formed the study population of the Vantaa85 + study, 300 of whom were autopsied during follow‐up (79.5% females, mean age‐at‐death 92 ± 3.7 years). Alzheimer's disease (AD) pathology (tau and beta‐amyloid [Aβ]), cerebral amyloid angiopathy (CAA) and Lewy‐related pathologies were analyzed. Brain infarcts were categorized by size (<2 mm, 2–15 mm, >15 mm) and by location. Brain hemorrhages were classified as microscopic (<2 mm) and macroscopic.Results195/300 (65%) were demented. 194/195 (99%) of the demented had at least one neuropathology. Three independent contributors to dementia were identified: AD‐type tau‐pathology (Braak stage V‐VI), neocortical Lewy‐related pathology, and cortical anterior 2–15 mm infarcts. These were found in 34%, 21%, and 21% of the demented, respectively, with the multivariate odds ratios (OR) for dementia 5.5, 4.5, and 3.4. Factor analysis investigating the relationships between different pathologies identified three separate factors: (1) AD‐spectrum, which included neurofibrillary tau, Aβ plaque, and neocortical Lewy‐related pathologies and CAA (2) >2 mm cortical and subcortical infarcts, and (3) <2 mm cortical microinfarcts and microhemorrhages. Multipathology was common and increased the risk of dementia significantly.InterpretationThese results indicate that AD‐type neurodegenerative processes play the most prominent role in twilight cognitive decline. The high prevalence of both neurodegenerative and vascular pathologies indicates that multiple preventive and therapeutic approaches are needed to protect the brains of the oldest old.

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Vascular risk factors and dementia in the general population aged >85 years

Cited by 67 publications

References 50 publications

Epidemiological Studies of the Effect of Stroke on Incident Dementia

Epidemiological Studies of the Effect of Stroke on Incident Dementia

Dementia and Systemic Disorders

Population‐based analysis of pathological correlates of dementia in the oldest old

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