Dementia Risk Strongly Linked to Cardiovascular Risk Factors

Internal Medicine World ReportFebruary 2005

Dementia Risk Strongly Linked to Cardiovascular Risk Factors

Results of a new study strongly support the idea that 4 cardiovascular (CV) risk factors—hypertension, elevated lipid levels, diabetes, and smoking— in mid-life may be harmful to the brain and linked to dementia in older age. These findings were recently published in Neurology (2005;64:277-281).

The study included nearly 9000 patients from Northern California. “The real strength of our study is the large, multi-ethnic cohort of men and women, followed-up for 27 years, all with equal access to medical care,” said study coinvestigator Rachel Whitmer, PhD, of the Kaiser Permanente Division of Research, Oakland, Calif.

When identified at midlife (ie, age 40-44 years),these 4 CV risk factors were associated with a 20% to 40% increase in the risk of dementia in later life. Compared with those with no CV risk factors, those with 2 risk factors were up to 70% more likely to be diagnosed with dementia. Patients with 3 of these risk factors were more than twice as likely to be diagnosed with dementia, and those with all 4 CV risk factors had a 237% increased risk of being diagnosed with dementia.

Treating these CV risk factors early not only serves as prevention of heart disease but may reduce the risk for dementia by virtue of the cumulative effect of longer exposure to protective therapies.

Assessment of individual risk factors in midlife reveals the following increased risks for dementia in older age:

  • 46% with diabetes
  • 42% with high total cholesterol
  • 26% with ever smoking in midlife
  • 24% with hypertension

It is interesting to note that the effects of CV risk factors on prevalence of dementia were not significantly different among different racial or gender subgroups.

Although previous studies have reported an association between individual CV risk factors and dementia, whether these risk factors in midlife are prospectively associated with risk for dementia in older age had not been thoroughly investigated until now.

Postmenopausal Women Benefit from Moderate Alcohol Intake

Women older than 65 years may receive significant cognitive protection from moderate alcohol consumption. New analysis of data collected by the Women’s Health Initiative Memory Study, which was designed to assess the effects of hormone replacement therapy on dementia and cognitive function, shows that 1 or 2 drinks a day may be helping women >65 years of age keep their minds sharp. An initial analysis of the data showed that long-term use of hormone therapy contributed to onset of dementia.

In this new analysis, a connection was revealed between alcohol drinking and cognitive function among postmenopausal women. “In our study, older women who drank moderate amounts of alcohol tended to perform better on tests for cognitive function and dementia,” said lead investigator Mark Espeland, PhD, of Wake Forest University Baptist Medical Center, Winston-Salem, NC.

These new findings, collected over the 4.2-year duration of the study, were published in the American Journal of Epidemiology (2005;161:228-238), showed that women who reported consuming ³1 alcoholic drinks daily during that period scored higher on tests of cognitive function (ie, concentration, language, memory, and abstract reasoning) than women who reported drinking less or not at all during that same period of 4.2 years.

“Women who reported drinking 1 or more drinks a day had a 40% lower risk of significant declines in cognitive function over time compared with women who reported no alcohol intake,” said Dr Espeland.

“Some cognitive problems are due to strokes and blood vessels in the brain becoming blocked, and alcohol may reduce the development of blood clots and increase blood flow, thereby improving cognition,” he speculated.

Alcohol also tends to increase levels of high-density lipoprotein cholesterol, which may also reduce the risk for clogged or narrowing blood vessels in the brain.

The study included 4461 women (aged 65-79 years) who were evaluated annually with the Modified Mini-Mental State Exam. Even after adjusting for additional factors (ie, education level, family income), the same pattern of moderate alcohol intake was associated with better cognitive function and less risk of dementia.

Endoscopic Sinus Surgery Safe, Effective in Older Patients

New research suggests that minimally invasive surgery, called functional endoscopic sinus surgery (FESS), is a safe and effective therapy for the treatment of sinusitis in elderly patients who cannot be sufficiently helped by medications alone. These findings were published in Otolaryngology-Head and Neck Surgery (2004;131:946-949).

Lead investigator Stilianos Kountakis, MD, of the Medical College of Georgia, and colleagues looked at 56 patients >60 years of age who underwent FESS. Results showed that these elderly patients continued to report improvement in symptoms during the year after surgery, had few minor complications, and no major complications. Dr Kountakis said that these new findings were comparable with findings from other studies involving younger patient populations.

“We thought that the endoscopic sinus surgery would not be as effective because of the decreased efficiency of the sinuses that naturally occurs with age, but that wasn’t the case. We thought other medical problems might make surgery less safe and effective, but that wasn’t the case either,” he said.

Instead, this study demonstrated a 64% improvement rate in symptoms at 3 months, a 73% improvement rate at 6 months, and a 75% improvement rate at 12 months, based on patient reports of their symptoms as well as on physical examinations.

“This tells us that we should not neglect sinus problems in the elderly, [and] that if medicines don’t work, we have a surgical technique that is not that invasive and results in good outcomes,” Dr Kountakis said.

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