Preventing dementia: role of vascular risk factors and cerebral emboli
|
|
- Daniel French
- 5 years ago
- Views:
Transcription
1 Published Online June 10, 2009 Preventing dementia: role of vascular risk factors and cerebral emboli Nitin Purandare * Psychiatry Research Group, Room 3.319, 3rd Floor East, University Place, University of Manchester, Oxford Road, Manchester M13 9PL, UK Accepted: May 13, 2009 *Correspondence to: Nitin Purandare, Psychiatry Research Group, Room 3.319, 3rd Floor East, University Place, University of Manchester, Oxford Road, Manchester M13 9PL, UK. nitin.purandare@ manchester.ac.uk Introduction or background: Dementia, Alzheimer s disease and vascular dementia being two main causes, is major and growing health problem. Vascular risk factors are thought to be involved in the causation of both dementias. Sources of data: A review of the literature was conducted using MedLine to identify current evidence for role of vascular risk factors as potential targets in preventing dementia. Cross-references were hand searched. Areas of agreement: The evidence from prospective epidemiological studies suggests that optimizing the control of vascular risk factors such as hypertension, high cholesterol, diabetes, smoking and heart disease may prevent dementia. However, this has been proven in randomized placebo-controlled trials (RCT) for only hypertension. Areas of controversy: Dementia is a secondary outcome in most RCTs and it is not known if there is a therapeutic time window between mid- and late-life when interventions are most effective. Also, we do not know precise mechanisms by which interventions for vascular risk factors offer brain protection. Growing points: Our research suggests that asymptomatic cerebral emboli, which are preventable, may be involved in the causation of dementia. Areas timely for developing research: There is a need for RCT targeting multiple vascular risk factors in patients at high risk of dementia such as those with mild cognitive impairment. Keywords: dementia/alzheimer s disease/vascular dementia/vascular risk factors/hypertension/emboli British Medical Bulletin 2009; 91: DOI: /bmb/ldp020 & The Author Published by Oxford University Press. All rights reserved. For permissions, please journals.permissions@oxfordjournals.org
2 N. Purandare Introduction Dementia affects over 24 million people in the world currently and the number with dementia is expected to increase to over 81 million by In the UK, there are about people suffering from dementia with the annual cost to the economy of 17 billion. 2 Dementia is a chronic progressive condition with no cure and the currently available cognitive enhancers for Alzheimer s disease (AD) offer only a modest symptomatic improvement with some concerns about their cost-effectiveness. 3 The consultation document on the National Dementia Strategy 4 recognizes the important of research on prevention strategies. If the onset of dementia could be delayed by about 5 years then its prevalence could almost be halved. 5 AD and vascular dementia (VaD) account for about 80% of all dementias with evidence of considerable overlap between the two and mixed dementia is common. 6 The Nun study showed the additive effect of cerebrovascular and neurodegenerative pathologies in producing clinical dementia. A fewer neuropathological lesions of AD were required for the clinical manifestation of dementia in those who had infarcts in basal ganglia, thalamus or deep white matter. 7 Until recently, the autopsy diagnosis of dementia subtypes was considered definitive. However, this assumption was based on the research that devised staging for one type of neuropathology [for example, senile plaques (SP) and neurofibrillary tangles (NFT)] while ignoring the other co-existent pathologies (for example, vascular disease). Gold et al. 8 in their autopsy study proposed a new system of classification which allocates the diagnosis of pure AD, pure VaD or mixed dementia depending on the severity of neurodegenerative and cerebrovascular pathology. Braak staging of NFT higher than stage II and score of greater than two on a semi-quantitative scale measuring the total burden of cortical microinfarcts and thalamic and basal ganglia lacunes are taken as cut off for dementia due to AD and VaD, respectively. Mixed dementia is diagnosed when both criteria are satisfied. This review focuses on the potential role of vascular risk factors, specifically evidence from clinical studies, in the prevention of AD and VaD. Vascular risk factors Hypertension, hypercholesterolemia, elevated homocysteine, diabetes, heart disease, smoking and carotid artery disease are known risk factors for dementia, AD and VaD. 50 British Medical Bulletin 2009;91
3 Preventing dementia: vascular risk factors and cerebral emboli Hypertension A number of cross-sectional and epidemiological studies have shown than hypertension in mid-life is a risk factor for dementia in old age. For example, Honolulu Asia aging study (HAAS) followed 3731 Japanese American men for over 14 years with autopsy data on 650 participants. 9 High systolic blood pressure (BP 160 mm Hg) was associated with increased risk of dementia (hazard ratio, HR ¼ 4.8). Hypertension was also associated with lower total brain weight, increased SP count and hippocampal atrophy. A coexistence of SP and lacunar infarcts further increased the risk of incident dementia. Interestingly, the BP drops around the time of or soon after the onset of clinical dementia and the current research is trying to find out whether this is a risk factor or risk marker for dementia. The Kungsholmen project 10 followed 947 people aged 75 years every 3 years for 6 years. BP decreased significantly over 3 years prior to and following diagnosis of dementia. In people with baseline systolic BP,160 mm Hg, a drop of 15 mm Hg over the first follow-up was associated with an increased risk of dementia at the second follow-up (relative risk, RR ¼ 3.1). However, this finding was challenged by another prospective study of 2356 older people 65 years over 8 years. The study concluded that the association between BP and dementia depended on age at which BP was measured and not the time relative to the onset of dementia. In years of age group, high systolic BP and borderline-high diastolic BP was associated with an increased risk of dementia while in those 75 years there was a trend towards high systolic BP being associated with low risk of developing dementia. 11 There have been a number of randomized controlled trials (RCT) of antihypertensive medications with cognition and or dementia as one of the outcomes. Some of the earlier trials that used diuretics or beta-blockers were negative. 12,13 SCOPE trial 14 included a much older (70 89 years) patient group and excluded those with stroke or myocardial infarction in previous 6 months. Candesartan [angiotensin II type 1 (AT1) receptor blocker] was not found to have any positive effect on progression of cognitive impairment over 3.7 years. However, antihypertensive medications were used in 84% of the controls. The RCTs involving angiotensin-converting enzyme (ACE) inhibitors (HOPE 15 and PROGRESS 16 ) have been mixed but encouraging. PROGRESS trial, which included both normotensive and hypertensive patients with previous history of cerebrovascular disease, found a significant reduction in stroke-related dementia in patients treated with perindopril (ACE inhibitor) as the main antihypertensive. The Syst-Eur trial included 2410 older people with isolated systolic British Medical Bulletin 2009;91 51
4 N. Purandare Other vascular risk factors hypertension (systolic BP of and diastolic BP of,95 mm Hg). The intervention group (n ¼ 1238) received nitrendipine (calcium channel blocker) and if required, enalapril and hydrocholrothiazide. 17 Over 2 year follow-up, the intervention group has 50% reduced risk of incident dementia compared with the group receiving placebo. The controls were given antihypertensive medications at the end of the trial and both groups followed for further 2 years. The long-term treatment with nitrendipine reduced incident dementia by 55% (from 7.4 to 3.3 cases per 1000 person years). Treatment of 1000 patients for 5 years could prevent 20 (95% CI: 7, 33) cases of dementia. 18 The hypertension in the Very Elderly trail (HYVET) 19 included patients with hypertension (systolic BP of and diastolic BP of,110 mm Hg, respectively) aged 80 years or older who were followed for 2 years. There was no significant reduction in incident dementia between active (indapamide with or without perindopril) and placebo arms. However, when the data were combined in a meta-analysis with other placebo-controlled trails the combined risk ratio favoured active treatment with antihypertensive HR of 0.87 (95% CI: 0.76, 1.00). A number of case control and epidemiological studies have reported hypercholesterolemia as a risk factor for dementia, including AD. For example, a prospective study from Finland with 21 years follow-up found raised cholesterol in mid-life (6.5 mmol/l) to more than double the risk of dementia, including AD, independently of other risk factors such as hypertension and ApoE4. 20 A meta-analysis of seven observational studies indicated risk reduction in cognitive impairment to be significant for only statins (OR ¼ 0.43) and not other lipid lowering agents. 21 The beneficial effect may be restricted to older people below age of 80 years 22 and to those statins that inhibit alpha and beta secretase. 23 However, not all epidemiological studies show an association between statin use and subsequent dementia 24 and the results of intervention trials, where cognition and dementia are secondary outcomes, have been disappointing. 25,26 Elevated total homocysteine (thcy) is associated with increased risk of heart disease, stroke, silent brain infarcts and dementia In older people, higher concentrations of thcy are associated with poor performance on neuropsychological tests with the odds of cognitive decline 2.8-fold (P, 0.05) higher in subjects with thcy levels above 15 mmol/l compared with those with levels below 10 mmol/l. 30 A large epidemiological study in Framingham, USA, involving 1092 older 52 British Medical Bulletin 2009;91
5 Preventing dementia: vascular risk factors and cerebral emboli residents in the community (mean age 76 years, median follow-up 8 years) reported that the risk of AD nearly doubled (relative risk, RR 1.8; confidence intervals, CI ) with one standard deviation increase in thcy levels at baseline. 31 Although elevated thcy has been shown to be associated with cognitive impairment in AD, the effect of reducing homocysteine levels on cognition and global functioning has not been adequately investigated. In a small prospective study involving 33 patients, Nilsson et al. 32 reported an improvement in cognitive function after 2 months of cobalamine (B12) and folate treatment in individuals with mild-to-moderate dementia who had elevated thcy. Patients with severe dementia and those who had normal thcy did not however show clinical improvement. Diabetes is thought to be a risk factor for AD and VaD, especially VaD Coronary heart disease is associated with increased amounts of cerebral amyloid deposits and increased risk of dementia, including AD. 37,38 In addition, atrial fibrillation (even in absence of clinical stroke) was found to have significant positive association with both AD and VaD, and interestingly the association was stronger for AD with cerebrovascular disease than VaD. 39 Smoking, a risk factor for stroke, is considered one of the prime targets in prevention of vascular cognitive impairment. 40 The HAAS found smoking during middle age to be associated with later risk of cognitive impairment and the risk increased from those who had stopped smoking to continuous smokers when compared with those who had never smoked. 41 Current smoking was shown to double the incidence of dementia in the Rotterdam study 42 but the effect of smoking on the risk of developing AD needs further exploration. Some studies find smoking to increase the risk of AD 43,44 while others find no association 45,46 or protective effect 47,48. The observed protective effect may be due to reduced survival among smokers or the positive effect of nicotine on neuronal survival. So far, there are no randomized control trials that show that treatment of diabetes, heart disease or cessation of smoking prevents incident cases of dementia, AD or VaD. The relevance of vascular risk factors to the causation of dementia receives further support from the literature that shows reduced leisuretime physical activity to be risk factor for dementia and AD. 49 Physical activity or exercise may have protective effect on multiple cardiovascular risk factors. Lautenschlager et al. 50 randomized 170 middle-age to older people with subjective memory complaints but no dementia to receive education and usual care or 24 week home-based physical activity programme. The intervention group showed greater improvement in cognition at 6 months, with evidence of continued positive effect at 18 months. British Medical Bulletin 2009;91 53
6 N. Purandare Potential role of asymptomatic cerebral emboli Above evidence suggests that a number of vascular risk factors may contribute to the clinical syndrome of dementia in AD and VaD. However, underlying pathophysiological mechanisms need further exploration, especially if there are any common pathways by which different risk factors eventually lead to cerebral damage. Stroke or transient ischaemic attacks (TIA) may be one such common pathway but not necessarily the only pathway. Over last 10 years, we (departments of old age psychiatry and vascular surgery at the University of Manchester) have been investigating the hypothesis that asymptomatic spontaneous cerebral emboli (SCE) may cause progressive brain damage and dementia. Such microemboli have been shown to be frequent in patients with severe carotid artery disease, valvular heart disease and stroke. 51,52 In these and those undergoing heart bypass surgery, cerebral emboli predict future risk of cerebrovascular accidents and poor neurocognitive outcomes. 53,54 We conducted a case control study that included 85 patients with AD (NINCDS/ADRDA criteria) 55 and 85 patients with VaD (NINDS/AIREN criteria) 56 with their respective age and sex-matched controls. In just 1 h of transcranial Doppler monitoring, SCE were detected in middle cerebral arteries in 32 (40%) AD and 31 (37%) VaD patients compared with 12 (15%) and 12 (14%) of their respective controls. The odds ratio for the presence of SCE was 2.70 ( ) for AD and 5.36 ( ) for VaD, adjusted for cardiovascular risk factors. 57 In controls, the presence of SCE was associated with cardiovascular risk factors (a history of stoke or TIA, a history myocardial infarction or angina, higher diastolic BP, presence of severe carotid artery stenosis) and current treatment with antiplatelet medications. Carotid stenosis and other vascular risk factors did not explain the increased frequencies of SCE in patients with dementia in our study. The potential role of coagulation cascade, including platelet disorders, in increasing the risk of microemboli formation needs further investigation as some studies have shown abnormalities in coagulation pathways and platelet activation in AD patients. 58,59 We investigated the clinical relevance of SCE by conducting a longitudinal follow-up of patients with dementia over 6 months. 60 A total of 132 patients had validated SCE assessment and at least one of the outcome measure data initially and at 6 months. Patients with dementia who were SCE positive (n ¼ 47, 36%) at initial assessment showed a more rapid decline in cognitive functioning and activities of daily living over 6 months compared with SCE negative patients. These results were unaltered after adjusting for ApoE4 status and the use of cholinesterase inhibitors and or antiplatelet drugs. 54 British Medical Bulletin 2009;91
7 Preventing dementia: vascular risk factors and cerebral emboli SCE and potential mechanisms of brain damage in dementia The mechanism by which cerebral microemboli cause brain damage is not known but is presumably by microischaemic changes. We did not find SCE to be associated with either infarcts or severity of white matter hyperintensities (WMH). However, one of the mechanisms of cerebral embolization (venous to arterial circulation shunt suggestive of patent foramen ovale in the heart) was associated with increased severity of deep and peri-ventricular WMH in patients with AD alone. 61 Another source of SCE (unstable carotid plaques) was recently shown to be associated with increased frequency of WMH lesions in patients undergoing magnetic resonance imaging of the brain prior to carotid endarterectomy. 62 However, it is likely that SCE do not lead to a structural evidence of cerebrovascular disease that is large enough to be detected by the currently available neuroimaging techniques. Alternatively, the initial vascular insult resulting from embolization of microvessels may trigger another mechanism of brain damage, such as inflammation, but leaves no evidence of the original vascular insult. In AD, cerebral microvessels have been shown to release significantly higher amounts of inflammatory mediators such as interleukin (IL)1b, IL-6 and tumour necrosis factor alpha. 63 It is also proposed that the microglia in the diseased or aged brain are primed, and switch their phenotype to produce neurotoxic molecules when they respond to systemic inflammatory signals. 64 Systemic infections are suggested as potential triggers for microglial activation. However, microglia is sensitive to other disturbances of brain homeostasis 65 that may include SCE induced ischaemia in cerebral microcirculation. Directions for future research The current literature on the control of vascular risk factors in prevention of dementia has certain limitations. Most RCTs target hypertension with a few targeting cholesterol. None of the RCTs attempt to optimize control of multiple vascular risk factors. Cognition and dementia is a secondary outcome with limited statistical power to detect significance of any true difference between intervention and placebo groups due to low frequencies of incident dementia in the selected population. There are not any prevention trials (except for atorvastatin) targeting specifically people at most risk of developing dementia. The term mild cognitive impairment (MCI) is commonly used to describe a group of patients who have some cognitive deficits but not severe enough to affect daily functioning and warrant a diagnosis of dementia. 66 However, tests used to assess cognition and daily British Medical Bulletin 2009;91 55
8 N. Purandare Conclusion functions and diagnostic criteria for MCI vary. The trials targeting older people with MCI with incident dementia as the primary outcome are likely to need at least participants and multiple centres. It is essential to operationalized criteria for MCI to allow comparison between studies 67 and develop surrogate markers to help reduce the size of the study. There may be a therapeutic time window between mid- and late-life during which vascular risk factors increase the risk of dementia. This may explain the dissonance between the epidemiological research that identifies potential risk factor and the RCT that fails to show positive effect of the intervention in older people with MCI. Systolic BP drops around the onset of dementia and lowering BP in patients with MCI, some of whom may have already developed neurodegenerative changes, may not have beneficial effects. In addition, lower the better doctrine applied to BP and cholesterol in cardiovascular and stroke prevention trails may not hold true for cognition in people with MCI. Lastly, we need RCTs that optimize the control of multiple risk factors as co-morbidity is common in older people. Over the next few decades, dementia is going to be a major health problem worldwide. AD and VaD are two main causes with mixed dementia being common. Epidemiological evidence has highlighted a number of vascular risk factors in mid-life to be associated with dementia in late-life. RCT evidence that treatment of vascular risk factor prevents dementia exists for hypertension but not for others. RCT studies are limited in their methodology with dementia often being a secondary outcome and studies not specifically focusing on those at high risk of dementia, for example those with MCI. Future research needs to explore novel mechanisms of vascular brain damage. Asymptomatic SCE may be one such mechanism worth further exploration as interventions that inhibit emboli formation are already available. We are currently conducting a pilot study investigating two such therapies (clopidogrel and atorvastatin) in patients with dementia. Funding The studies on cerebral emboli in dementia were funded by the Wellcome Trust and the Alzheimer s Society, UK. 56 British Medical Bulletin 2009;91
9 Preventing dementia: vascular risk factors and cerebral emboli References 1 Ferri CP, Prince M, Brayne C et al. (2005) Global prevalence of dementia: a Delphi consensus study. Lancet, 366, Knapp M, Prince M, Albanese E et al. (2007) Dementia UK: A Report into the Prevalence and Cost of Dementia Prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King s College London, for the Alzheimer s Society. London, UK: Alzheimer s Society. 3 National Institute of Clinical Excellence (2007) Donepezil, Galantamine, Rivastigmine (Review) and Memantine for the Treatment of Alzheimer s Disease (amended) NICE Technology Appraisal Guidance 111 (amended). London: NICE. 4 Department of Health (2008) Transforming the Quality of Dementia Care. Consultation on a National Dementia Strategy, released 19th June Leeds, UK: Department of Health. 5 Jorm AF, Dear KB, Burgess NM (2005) Projections of future numbers of dementia cases in Australia with and without prevention. Aust N Z J Psychiatry, 39, Agüero-Torres H, Winblad B (2000) Alzheimer s disease and vascular dementia. Some points of confluence. Ann N Y Acad Sci, 903, Snowdon DA, Greiner LH, Mortimer JA et al. (1997) Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA, 277, Gold G, Giannakopoulos P, Herrmann FR et al. (2007) Identification of Alzheimer and vascular lesion thresholds for mixed dementia. Brain, 130, Petrovitch H, Ross GW, Steinhorn SC et al. (2005) AD lesions and infarcts in demented and non-demented Japanese-American men. Ann Neurol, 57, Qiu C, von Strauss E, Winblad B, Fratiglioni L (2004) Decline in blood pressure over time and risk of dementia: a longitudinal study from the Kungsholmen project. Stroke, 35, Li G, Rhew IC, Shofer JB et al. (2007) Age-varying association between blood pressure and risk of dementia in those aged 65 and older: a community-based prospective cohort study. J Am Geriatr Soc, 55, Applegate WB, Pressel S, Wittes J et al. (1994) Impact of the treatment of isolated systolic hypertension on behavioural variables. Results from the systolic hypertension in the elderly program. Arch Intern Med, 154, Prince MJ, Bird AS, Blizard RA et al. (1996) Is the cognitive function of older patients affected by antihypertensive treatment? Results from 54 months of the Medical Research Council s trial of hypertension in older adults. BMJ, 312, Lithell H, Hansson L, Skoog I et al. (2003) for SCOPE study group. The study on cognition and prognosis in the elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens, 21, Bosch J, Yusuf S, Pogue J et al. (2002) HOPE Investigators. Heart outcomes prevention evaluation. Use of ramipril in preventing stroke: double blind randomized trial. BMJ, 324, Tzourio C, Anderson C, Chapman N et al. (2003) PROGRESS Collaborative Group. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med, 163, Forette F, Seux ML, Staessen J et al. (1998) Prevention of dementia in randomised doubleblind placebo-controlled systolic hypertension in Europe (Syst-Eur) trial. Lancet, 352, Forette F, Seux ML, Staessen J et al. (2002) The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur study). Arch Intern Med, 162, Peters R, Beckett N, Forette F et al. (2008) Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol, 7, Kivipelto M, Helkala EL, Laakso MP et al. (2002) Apolipoprotein E epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for late-life Alzheimer disease. Arch Intern Med, 137, British Medical Bulletin 2009;91 57
10 N. Purandare 21 Etminan M, Gill S, Samii A (2003) The role of lipid-lowering drugs in cognitive function: a meta-analysis of observational studies. Pharmacotherapy, 23, Rockwood K, Kirkland S, Hogan DB et al. (2002) Use of lipid-lowering agents, indication bias, and the risk of dementia in community-dwelling elderly people. Arch Neurol, 59, Sjogren M, Gustafsson K, Syversen S et al. (2003) Treatment with simvastatin in patients with Alzheimer s disease lowers both alpha- and beta-cleaved amyloid precursor protein. Dement Geriatr Cogn Disord, 16, Zandi PP, Sparks DL, Khachaturian AS et al. (2005) Do statins reduce risk of incident dementia and Alzheimer disease? The Cache County Study. Arch Gen Psychiatry, 62, Collins R, Armitage J, Parish S et al. (2004) Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in people with cerebrovascular disease or other high-risk conditions. Lancet, 363, Shepherd J, Blauw GJ, Murphy MB et al. (2002) Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet, 360, Homocysteine Studies Collaboration (2002) Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA, 288, Vermeer SE, van Dijk EJ, Koudstaal PJ et al. (2002) Homocysteine, silent brain infarcts, and white matter lesions: The Rotterdam Scan Study. Ann Neurol, 51, McIlroy SP, Dynan B, Lawson JT et al. (2002) Moderately elevated plasma homocysteine, methylenetetrahydrofolate reductase genotype, and risk for stroke, vascular dementia, and Alzheimer s disease in Northern Ireland. Stroke, 33, Dufouil C, Alperovitch A, Ducros V et al. (2003) Homocysteine, white matter hyperintensities, and cognition in healthy elderly people. Ann Neurol, 53, Seshadri S, Beiser A, Selhub J et al. (2002) Plasma homocysteine as a risk factor for dementia and Alzheimer s disease. N Engl J Med, 346, Nilsson K, Gustafson L, Hultberg B (2001) Improvement of cognitive functions after cobalamin/folate supplementation in elderly patients with dementia and elevated plasma homocysteine. Int J Geriatr Psychiatry, 16, Leibson CL, Rocca WA, Hanson VA et al. (1997) The risk of dementia among persons with diabetes mellitus: a population-based cohort study. Ann N Y Acad Sci, 826, Ott A, Stolk RP, Hofman A et al. (1996) Association of diabetes mellitus and dementia: the Rotterdam study. Diabetologia, 39, Boston PF, Dennis MS, Jagger C (1999) Factors associated with vascular dementia in an elderly community population. Int J Geriatr Psychiatry, 14, Curb JD, Rodriguez BL, Abbott RD et al. (1999) Longitudinal association of vascular and Alzheimer s dementias, diabetes, and glucose tolerance. Neurology, 52, Sparks DL, Hunsaker JC 3rd, Scheff SW et al. (1990) Cortical senile plagues in coronary artery disease, aging and Alzheimer s disease. Neurobiol Aging, 11, Soneira CF, Scott TM (1996) Severe cardiovascular disease and Alzheimer s disease: senile plaque formation in cortical areas. Clin Anat, 9, Ott A, Breteler MM, de Bruyne MC et al. (1997) Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke, 28, Gorelick PB, Erkinjuntti T, Hofman A et al. (1999) Prevention of vascular dementia. Alzheimer Dis Assoc Disord, 13 (Suppl 3), S Galanis DJ, Petrovitch H, Launer LJ et al. (1997) Smoking history in middle age and subsequent cognitive performance in elderly Japanese-American men. The Honolulu-Asia Aging Study. Am J Epidemiol, 145, Ott A, Slooter AJ, Hofman A et al. (1998) Smoking and risk of dementia and Alzheimer s disease in a population-based cohort study: the Rotterdam Study. Lancet, 351, Merchant C, Tang MX, Albert S et al. (1999) The influence of smoking on the risk of Alzheimer s disease. Neurology, 52, Doll R, Peto R, Boreham J et al. (2002) Smoking and dementia in male British doctors: prospective study. BMJ, 302, British Medical Bulletin 2009;91
11 Preventing dementia: vascular risk factors and cerebral emboli 45 Tyas SL, Pederson LL, Koval JJ (2000) Is smoking associated with the risk of developing Alzheimer s disease? Results from three Canadian data sets. Ann Epidemiol, 10, Debanne SM, Rowland DY, Riedel TM et al. (2000) Association of Alzheimer s disease and smoking: the case for sibling controls. J Am Geriatr Soc, 48, Lee PN (1994) Smoking and Alzheimer s disease: a review of the epidemiological evidence. Neuroepidemiol, 13, Fratiglioni L, Wang HX, (2000) Smoking and Parkinson s and Alzheimer s disease: review of the epidemiological studies. Behav Brain Res, 113, Rovio S, Kåreholt I, Helkala EL et al. (2005) Leisure-time physical activity at midlife and the risk of dementia and Alzheimer s disease. Lancet Neurol, 4, Lautenschlager NT, Cox KL, Flicker L et al. (2008) Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA, 300, Hutchinson S, Riding G, Coull S, McCollum CN (2002) Are spontaneous cerebral microemboli consistent in carotid disease? Stroke, 33, Deklunder G, Roussel M, Lecroart JL, Prat A, Gautier C (1998) Microemboli in cerebral circulation and alteration of cognitive abilities in patients with mechanical prosthetic heart valves. Stroke, 29, Fearn SJ, Pole R, Wesnes K, Faragher EB, Hooper TL, McCollum CN (2001) Cerebral injury during cardiopulmonary bypass: emboli impair memory. J Thorac Cardiovasc Surg, 121, Stygall J, Newman SP, Fitzgerald G et al. (2003) Cognitive change 5 years after coronary artery bypass surgery. Health Psychol, 22, McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer s Disease. Neurology, 34, Roman GC, Tatemichi TK, Erkinjuntti T et al. (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, Purandare N, Burns A, Daly KJ et al. (2006) Cerebral emboli as a potential cause of Alzheimer s disease and vascular dementia: case-control study. BMJ, 332, Gupta A, Pansari K (2003) The association between blood coagulation markers, atherothrombosis and dementia. Int J Clin Pract, 57, Borroni B, Akkawi N, Martini G et al. (2002) Microvascular damage and platelet abnormalities in early Alzheimer s disease. J Neurol Sci, , Purandare N, Voshaar RC, Morris J et al. (2007) Asymptomatic spontaneous cerebral emboli predict cognitive and functional decline in dementia. Biol Psychiatry, 62, Purandare N, Oude Voshaar RC, McCollum C et al. (2008) Paradoxical embolisation and cerebral white matter lesions in dementia. Br J Radiol, 81, Altaf N, Daniels L, Morgan PS et al. (2006) Cerebral white matter hyperintense lesions are associated with unstable carotid plaques. Eur J Vasc Endovasc Surg, 31, Grammas P, Ovase R (2001) Inflammatory factors are elevated in brain microvessels in Alzheimer s disease. Neurobiol Aging, 22, Perry VH, Cunningham C, Holmes C (2007) Systematic infections and inflammation affect chronic neurodegeneration. Nat Rev Immunol, 7, Kreutzberg GW (1996) Microglia: a sensor for pathological events in the CNS. Trends Neurosci, 19, Petersen RC (2004) Mild cognitive impairment as a diagnostic entity. J Intern Med, 256, Matthews FE, Stephan BC, Bond J et al. (2007) Operationalization of mild cognitive impairment: a graphical approach. PLoS Med, 4, British Medical Bulletin 2009;91 59
김광일 서울대학교의과대학내과학교실 분당서울대학교병원내과
치매예방을위한만성질환관리전략 김광일 서울대학교의과대학내과학교실 분당서울대학교병원내과 A sharp rise in the death rate from Alzheimer s disease Ivan Casserly & Eric Topol, Lancet 2004 Potential for primary prevention of Alzheimer s disease Alzheimer
More informationChapter 1. Introduction
The older people get, the bigger the chance of losing cognitive abilities and ultimately to develop dementia. Increasing age is the largest known risk factor of dementia, with a prevalence of 1% in people
More informationRisk Factors for Ischemic Stroke: Electrocardiographic Findings
Original Articles 232 Risk Factors for Ischemic Stroke: Electrocardiographic Findings Elley H.H. Chiu 1,2, Teng-Yeow Tan 1,3, Ku-Chou Chang 1,3, and Chia-Wei Liou 1,3 Abstract- Background: Standard 12-lead
More informationSeptember 26 28, 2013 Westin Tampa Harbour Island. Co-sponsored by
September 26 28, 2013 Westin Tampa Harbour Island Co-sponsored by From Brains at Risk to Cognitive Dysfunction: The Role of Vascular Pathology Ralph Sacco, MD, MS, FAHA, FAAN Miller School of Medicine
More informationResearch Article Hypertension and Dementia in the Elderly: The Leisure World Cohort Study
International Hypertension Volume 2012, Article ID 205350, 5 pages doi:10.1155/2012/205350 Research Article Hypertension and Dementia in the Elderly: The Leisure World Cohort Study Annlia Paganini-Hill
More informationBlood pressure and dementia a comprehensive review
Therapeutic Advances in Neurological Disorders Review Blood pressure and dementia a comprehensive review Sean P. Kennelly, Brian A. Lawlor and Rose Anne Kenny Ther Adv Neurol Disord (2009) 2(4) 241 260
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/42751 holds various files of this Leiden University dissertation Author: Foster-Dingley, J.C. Title: Blood pressure in old age : exploring the relation
More information03/30/2016 DISCLOSURES TO OPERATE OR NOT THAT IS THE QUESTION CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE
CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE Elizabeth L. Detschelt, M.D. Allegheny Health Network Vascular and Endovascular Symposium April 2, 2016 DISCLOSURES I have no
More informationORIGINAL INVESTIGATION
Effects of Blood Pressure Lowering With Perindopril and Indapamide Therapy on Dementia and Cognitive Decline in Patients With Cerebrovascular Disease The PROGRESS Collaborative Group* ORIGINAL INVESTIGATION
More informationIncidence of Dementia over Three Decades in the Framingham Heart Study
The new england journal of medicine Original Article Incidence of Dementia over Three Decades in the Framingham Heart Study Claudia L. Satizabal, Ph.D., Alexa S. Beiser, Ph.D., Vincent Chouraki, M.D.,
More informationThe Primary Care Guide To Understanding The Role Of Diabetes As A Risk Factor For Cognitive Loss Or Dementia In Adults
The Primary Care Guide To Understanding The Role Of Diabetes As A Risk Factor For Cognitive Loss Or Dementia In Adults. Introduction Glucose intolerance is common in older individuals and this metabolic
More informationIncident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial [HYVET] R. Peters
Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial [HYVET] R. Peters ClinicalTrials.gov: NCT00122811 Backgound The prevalence of dementia rises with increasing
More informationKey Words: Hypertension, Blood pressure, Cognitive impairment, Age 대한신경과학회지 22 권 1 호
Seul-Ki Jeong, M.D., Hae-Sung Nam, M.D., Min-Ho Shin, M.D., Sun-Seok Kweon, M.D., Myong-Ho Son, M.D., Eui-Ju Son, M.D., Jae-Min Kim, M.D., Ki-Hyun Cho, M.D. Background: It has been reported that the association
More informationMidlife vascular risk factors and Alzheimer s disease in later life: longitudinal, population based study
Midlife vascular risk factors and Alzheimer s disease in later life: longitudinal, population based study Miia Kivipelto, Eeva-Liisa Helkala, Mikko P Laakso, Tuomo Hänninen, Merja Hallikainen, Kari Alhainen,
More informationEPIDEMIOLOGY AND RISK FACTORS OF DEMENTIA
v2 EPIDEMIOLOGY AND RISK FACTORS OF DEMENTIA See end of article for authors affiliations Correspondence to: W M van der Flier, Department of Neurology and Alzheimer Center, Vrije Universiteit Medical Center,
More informationGeriatric Grand Rounds
Geriatric Grand Rounds Tuesday, January 29, 2008 12:00 noon Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital Cardiovascular Risks Factors and Dementia Christian Bocti,, MD, FRCP(C) Clinical Associate
More informationSUPPLEMENTARY APPENDIX
Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 23 million people and more than 100,000 cases of dementia SUPPLEMENTARY APPENDIX Supplementary Methods Newcastle
More informationHow would you manage Ms. Gold
How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56
More informationCarotid Artery Stenosis
Evidence-Based Approach to Carotid Artery Stenosis Seong-Wook Park, MD Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea Carotid Artery Stenosis Carotid
More informationRisk Factors for Vascular Dementia: A Hospital-Based Study in Taiwan
22 Risk Factors for Vascular Dementia: A Hospital-Based Study in Taiwan Jun-Cheng Lin 1,2, Wen-Chuin Hsu 1, Hai-Pei Hsu 1,2, Hon-Chung Fung 1, and Sien-Tsong Chen 1 Abstract- Background: In Taiwan, next
More informationAPPENDIX B: LIST OF THE SELECTED SECONDARY STUDIES
APPENDIX B: LIST OF THE SELECTED SECONDARY STUDIES Main systematic reviews secondary studies on the general effectiveness of statins in secondary cardiovascular prevention (search date: 2003-2006) NICE.
More informationSlide notes: References:
1 2 3 Cut-off values for the definition of hypertension are systolic blood pressure (SBP) 135 and/or diastolic blood pressure (DBP) 85 mmhg for home blood pressure monitoring (HBPM) and daytime ambulatory
More informationSilent Brain Infarcts and the Risk of Dementia and Cognitive Decline
The new england journal of medicine original article Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline Sarah E. Vermeer, M.D., Ph.D., Niels D. Prins, M.D., Tom den Heijer, M.D., Albert
More information5/2/2016. Outpatient Stroke Management Sheila Smith MD May 5, 2016
Outpatient Stroke Management Sheila Smith MD May 5, 2016 1 Management of Outpatient Stroke Objectives Review blood pressure management post stroke Review antithrombotic therapy Review statin therapy Discuss
More informationThe Epidemiology of Stroke and Vascular Risk Factors in Cognitive Aging
The Epidemiology of Stroke and Vascular Risk Factors in Cognitive Aging REBECCA F. GOTTESMAN, MD PHD ASSOCIATE PROFESSOR OF NEUROLOGY AND EPIDEMIOLOGY JOHNS HOPKINS UNIVERSITY OCTOBER 20, 2014 Outline
More informationThe problem of uncontrolled hypertension
(2002) 16, S3 S8 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh The problem of uncontrolled hypertension Department of Public Health and Clinical Medicine, Norrlands
More informationT. Suithichaiyakul Cardiomed Chula
T. Suithichaiyakul Cardiomed Chula The cardiovascular (CV) continuum: role of risk factors Endothelial Dysfunction Atherosclerosis and left ventricular hypertrophy Myocardial infarction & stroke Endothelial
More informationDementia and antihypertensive treatment Willem H. Birkenhäger a, Françoise Forette b and Jan A. Staessen c
Dementia and antihypertensive treatment Willem H. Birkenhäger a, Françoise Forette b and Jan A. Staessen c Purpose of review We present an updated overview on the long-term effects of hypertension on the
More informationCite this article as: BMJ, doi: /bmj ae (published 28 April 2006)
Cite this article as: BMJ, doi:10.1136/bmj.38814.696493.ae (published 28 April 2006) Cerebral emboli as a potential cause of Alzheimer s disease and vascular dementia: case-control study Nitin Purandare,
More informationORIGINAL CONTRIBUTION. Obesity and Vascular Risk Factors at Midlife and the Risk of Dementia and Alzheimer Disease
ORIGINAL CONTRIBUTION Obesity and Vascular Risk Factors at Midlife and the Risk of Dementia and Alzheimer Disease Miia Kivipelto, MD, PhD; Tiia Ngandu, BM; Laura Fratiglioni, MD, PhD; Matti Viitanen, MD,
More informationMild Cognitive Impairment (MCI)
October 19, 2018 Mild Cognitive Impairment (MCI) Yonas E. Geda, MD, MSc Professor of Neurology and Psychiatry Consultant, Departments of Psychiatry & Psychology, and Neurology Mayo Clinic College of Medicine
More informationStatins and Cognition A Focus on Mechanisms
Statins and Cognition A Focus on Mechanisms Note: Deleted copyrighted graphs/tables are described In red text and source references are provided Disclosures: SPARCL Steering Committee and past consultant
More informationIN ADDITION TO THE WELL-DOCUmented
ORIGINAL CONTRIBUTION Enhanced Risk for Alzheimer Disease in Persons With Type 2 Diabetes and APOE 4 The Cardiovascular Health Study Cognition Study Fumiko Irie, MD, PhD, MPH; Annette L. Fitzpatrick, PhD;
More informationStarting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective
Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective Cathy Sila MD George M Humphrey II Professor and Vice Chair of Neurology Director, Comprehensive Stroke Center
More informationCerebral involvement in hypertensive cardiovascular disease
European Heart Journal Supplements (2003) 5 (Supplement F), F19 F25 Cerebral involvement in hypertensive cardiovascular disease Hypertension Unit, Hospital Clinic (IDIBAPS), University of Barcelona, Barcelona,
More informationUNIVERSITY OF WESTERN ONTARIO
UNIVERSITY OF WESTERN ONTARIO Vladimir Hachinski, CM, MD, FRCPC, DSc Department of Clinical Neurological Sciences University of Western Ontario London, Ontario, Canada Vladimir.hachinski@lhsc.on.ca ALZHEIMER
More informationORIGINAL INVESTIGATION. Body Mass Index, Other Cardiovascular Risk Factors, and Hospitalization for Dementia
ORIGINAL INVESTIGATION Body Mass Index, Other Cardiovascular Risk Factors, and Hospitalization for Dementia Annika Rosengren, MD, PhD; Ingmar Skoog, MD, PhD; Deborah Gustafson, PhD; Lars Wilhelmsen, MD,
More informationAntithrombotic therapy in patients with transient ischemic attack / stroke (acute phase <48h)
Antithrombotic therapy in patients with transient ischemic attack / stroke (acute phase
More informationVascular dementia (VaD) is preceded by several years of
Cognitive Functioning in Preclinical Vascular Dementia A 6-Year Follow-Up Erika Jonsson Laukka, MSc; Sari Jones, MSc; Laura Fratiglioni, MD, PhD; Lars Bäckman, PhD Background and Purpose Recent studies
More informationEmboli detection to evaluate risk of stroke
Emboli detection to evaluate risk of stroke Background: Improved methods are required to identify patients with asymptomatic carotid stenosis at high risk for stroke. Whether surgery is beneficial for
More informationAndrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION
2 Hyperlipidemia Andrew Cohen, MD and Neil S. Skolnik, MD CONTENTS INTRODUCTION RISK CATEGORIES AND TARGET LDL-CHOLESTEROL TREATMENT OF LDL-CHOLESTEROL SPECIAL CONSIDERATIONS OLDER AND YOUNGER ADULTS ADDITIONAL
More informationOverview of the outcome trials in older patients with isolated systolic hypertension
Journal of Human Hypertension (1999) 13, 859 863 1999 Stockton Press. All rights reserved 0950-9240/99 $15.00 http://www.stockton-press.co.uk/jhh Overview of the outcome trials in older patients with isolated
More informationLong-term follow-up studies suggest that elevated blood
Decline in Blood Pressure Over Time and Risk of Dementia A Longitudinal Study From the Kungsholmen Project Chengxuan Qiu, MD, PhD; Eva von Strauss, PhD; Bengt Winblad, MD, PhD; Laura Fratiglioni, MD, PhD
More informationMORTALITY AND MORBIDITY RISK FROM CAROTID ARTERY ATHEROSCLEROSIS. 73 year old NS right-handed male applicant for $1 Million Life Insurance
MORTALITY AND MORBIDITY RISK FROM CAROTID ARTERY ATHEROSCLEROSIS October 17, 2012 AAIM Triennial Conference, San Diego Robert Lund, MD What Is The Risk? 73 year old NS right-handed male applicant for $1
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE QUALITY AND OUTCOMES FRAMEWORK (QOF) INDICATOR DEVELOPMENT PROGRAMME Briefing paper QOF indicator area: Peripheral arterial disease Potential output:
More informationProjections of future numbers of dementia cases in Australia with and without prevention
Projections of future numbers of dementia cases in Australia with and without prevention Anthony F. Jorm, Keith B.G. Dear, Nicole M. Burgess Objective: To produce projections of the number of dementia
More informationStatins after 80 years old. Pros/Cons symposium. 13 th EUGMS Congress Nice Sept 2017
Statins after 80 years old Pros/Cons symposium 13 th EUGMS Congress Nice 20-22 Sept 2017 Athanasios Benetos Conflict of interest: None The Statinissean War Two fearless fighters Athanasios the Athenian
More informationBrain Health and Risk Factors for Dementia
Welcome To Brain Health and Risk Factors for Dementia Presented by Kamal Masaki, MD Professor and Chair Department of Geriatric Medicine John A. Burns School of Medicine, UH Manoa April 4, 2018 10:00 11:00
More informationBlood Pressure Targets: Where are We Now?
Blood Pressure Targets: Where are We Now? Diana Cao, PharmD, BCPS-AQ Cardiology Assistant Professor Department of Clinical & Administrative Sciences California Northstate University College of Pharmacy
More informationLLL Session - Nutrition support in diabetes and dyslipidemia. Dyslipidemia: targeting the management of cardiovascular risk factors. M.
ESPEN Congress Leipzig 2013 LLL Session - Nutrition support in diabetes and dyslipidemia Dyslipidemia: targeting the management of cardiovascular risk factors M. Leon Sanz (ES) Dyslipidemia: Targeting
More informationShould beta blockers remain first-line drugs for hypertension?
1 de 6 03/11/2008 13:23 Should beta blockers remain first-line drugs for hypertension? Maros Elsik, Cardiologist, Department of Epidemiology and Preventive Medicine, Monash University and The Alfred Hospital,
More informationNext patient please Dementia Clare Hawley 2018
Next patient please Dementia Clare Hawley 2018 I have no conflict of interest to declare Dr Clare Hawley Associate Specialist Cardiology Chesterfield Royal Hospital GPwSI Refractory Angina Hon Clinical
More informationFerrari R, Fox K, Bertrand M, Mourad J.J, Akkerhuis KM, Van Vark L, Boersma E.
Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular mortality in hypertension: a meta-analysis of randomized controlled trials Ferrari R, Fox K, Bertrand
More informationPeripheral Arterial Occlusive Disease- The Challenge in patients with diabetes
Peripheral Arterial Occlusive Disease- The Challenge in patients with diabetes Ashok Handa Reader in Surgery and Consultant Surgeon Nuffield Department of Surgery University of Oxford Introduction Vascular
More informationBGS Spring Risk Factors and Preventative Strategies for Dementia
Risk Factors and Preventative Strategies for Dementia Dr Blossom Stephan Senior Lecturer (in Risk Prediction) Newcastle University Institute for Ageing and Institute of Health and Society BGS Spring Meeting
More informationPrevention, health promotion & early intervention in dementia
Prevention, health promotion & early intervention in dementia Alzheimer New Zealand Conference 2014 Steve Iliffe Professor of Primary Care & Older People University College London Rotorua, New Zealand
More informationNIH Public Access Author Manuscript Metab Brain Dis. Author manuscript; available in PMC 2011 October 24.
NIH Public Access Author Manuscript Published in final edited form as: Metab Brain Dis. 2006 September ; 21(2-3): 235 240. doi:10.1007/s11011-006-9017-2. Risk factors for incident Alzheimer s disease in
More informationMORTALITY AND MORBIDITY RISK FROM CAROTID ARTERY ATHEROSCLEROSIS. 73 year old NS right-handed male applicant for $1 Million life insurance
MORTALITY AND MORBIDITY RISK FROM CAROTID ARTERY ATHEROSCLEROSIS October 17, 2012 AAIM Triennial Conference, San Diego Robert Lund, MD What Is The Risk? 73 year old NS right-handed male applicant for $1
More informationDeclaration of conflict of interest. None to declare
Declaration of conflict of interest None to declare Risk management of coronary artery disease Arrhythmias and diabetes Hercules Mavrakis Cardiology Department Heraklion University Hospital Crete, Greece
More informationDisclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease
Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures
More informationAsymptomatic Carotid Stenosis To Do or Not To Do
Asymptomatic Carotid Stenosis To Do or Not To Do October 22, 2016 Neurosciences: Updates and Controversies Andrew C. MacDougall, MD Advocate Medical Group Advocate Lutheran General Hospital Principle
More informationORIGINAL CONTRIBUTION
ORIGINAL CONTRIBUTION Antihypertensive Medication Use and Incident Alzheimer Disease The Cache County Study Ara S. Khachaturian, PhD; Peter P. Zandi, PhD; Constantine G. Lyketsos, MD, MHS; Kathleen M.
More informationStroke secondary prevention. Gill Cluckie Stroke Nurse Consultant St. George s Hospital
Stroke secondary prevention Gill Cluckie Stroke Nurse Consultant St. George s Hospital Stroke recurrence The risk of recurrent stroke is greatest after first stroke 2 3% of survivors of a first stroke
More informationcalcium-channel blockers (CCBs) on elderly people. Heckbert and associates, 1 in a cross-sectional study of 1268 older hypertensive participants in
Calcium-channel blockers and cognitive function in elderly people: results from the Canadian Study of Health and Aging Colleen J. Maxwell,* PhD; David B. Hogan,* MD; Erika M. Ebly, PhD Abstract Background:
More informationObjective 4/22/2019. Interaction of Cardiovascular Disease and Alzheimer s Disease: Implications for Cardiopulmonary Rehabilitation.
Interaction of Cardiovascular Disease and Alzheimer s Disease: Implications for Cardiopulmonary Rehabilitation Dereck Salisbury, PhD Assistant Professor, Clinical Exercise Physiologist Director: Laboratory
More informationInteraction of Cardiovascular Disease and Alzheimer s Disease: Implications for Cardiopulmonary Rehabilitation
Interaction of Cardiovascular Disease and Alzheimer s Disease: Implications for Cardiopulmonary Rehabilitation Dereck Salisbury, PhD Assistant Professor, Clinical Exercise Physiologist Director: Laboratory
More information2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension.
2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension Writing Group: Background Hypertension worldwide causes 7.1 million premature
More informationNational Horizon Scanning Centre. Irbesartan (Aprovel) for prevention of cardiovascular complications in patients with persistent atrial fibrillation
Irbesartan (Aprovel) for prevention of cardiovascular complications in patients with persistent atrial fibrillation August 2008 This technology summary is based on information available at the time of
More informationORIGINAL INVESTIGATION
ORIGINAL INVESTIGATION Heart Failure and Risk of Dementia and Alzheimer Disease A Population-Based Cohort Study Chengxuan Qiu, MD, PhD; Bengt Winblad, MD, PhD; Alessandra Marengoni, MD; Inga Klarin, MD;
More informationIschemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010
Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories
More informationPrimary Prevention of Stroke
Primary Prevention of Stroke Dr Chris Ellis Cardiologist Green Lane CVS Service, Auckland City Hospital & Auckland Heart Group, Mercy Hospital, Auckland 67 Pages Long, 735 References 29 Sub-Headings for
More informationClinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8. Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital
Clinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8 Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital Objectives Review the Eighth Joint National Committee (JNC
More informationFour Tissue Segmentation in ADNI II
Four Tissue Segmentation in ADNI II Charles DeCarli, MD, Pauline Maillard, PhD, Evan Fletcher, PhD Department of Neurology and Center for Neuroscience, University of California at Davis Summary Table of
More informationCognitive ageing and dementia: The Whitehall II Study
Cognitive ageing and dementia: The Whitehall II Study Archana SINGH-MANOUX NIH: R01AG013196; R01AG034454; R01AG056477 MRC: K013351, MR/R024227 BHF: RG/13/2/30098 H2020: #643576 #633666 Outline Lifecourse
More informationData Alert #2... Bi o l o g y Work i n g Gro u p. Subject: HOPE: New validation for the importance of tissue ACE inhibition
Vascular Bi o l o g y Work i n g Gro u p c/o Medical Education Consultants, In c. 25 Sy l van Road South, We s t p o rt, CT 06880 Chairman: Carl J. Pepine, MD Professor and Chief Division of Cardiovascular
More informationGuidelines on cardiovascular risk assessment and management
European Heart Journal Supplements (2005) 7 (Supplement L), L5 L10 doi:10.1093/eurheartj/sui079 Guidelines on cardiovascular risk assessment and management David A. Wood 1,2 * 1 Cardiovascular Medicine
More informationThe role of statins in patients with arterial hypertension
Invited review The role of statins in patients with arterial hypertension Trygve B. Tjugen 1, Sigrun Halvorsen 1, Reidar Bjørnerheim 1, Sverre E. Kjeldsen 1, 2 1University of Oslo, Department of Cardiology,
More informationThe target blood pressure in patients with diabetes is <130 mm Hg
Controversies in hypertension, About Diabetes diabetes and and metabolic Cardiovascular syndrome Risk ESC annual congress August 29, 2011 The target blood pressure in patients with diabetes is
More informationIs there a mechanism of interaction between hypertension and dyslipidaemia?
Is there a mechanism of interaction between hypertension and dyslipidaemia? Neil R Poulter International Centre for Circulatory Health NHLI, Imperial College London Daegu, Korea April 2005 Observational
More informationNeuropsychiatric Manifestations in Vascular Cognitive Impairment Patients with and without Dementia
86 Neuropsychiatric Manifestations in Vascular Cognitive Impairment Patients with and without Dementia Pai-Yi Chiu 1,3, Chung-Hsiang Liu 2, and Chon-Haw Tsai 2 Abstract- Background: Neuropsychiatric profile
More informationSlide 1. Slide 2 Conflict of Interest Disclosure. Slide 3 Stroke Facts. The Treatment of Intracranial Stenosis. Disclosure
Slide 1 The Treatment of Intracranial Stenosis Helmi Lutsep, MD Vice Chair and Dixon Term Professor, Department of Neurology, Oregon Health & Science University Chief of Neurology, VA Portland Health Care
More informationThe future of coronary heart disease prevention
The future of coronary heart disease prevention David S Wald MA MD MRCP, Consultant Cardiologist and Senior Lecturer, Wolfson Institute of Preventive Medicine, and London Chest Hospital Barts and The London,
More informationPROGRESS: Prevention of Recurrent Stroke
STATE OF THE ART REVIEW SERIES REVIEW PAPER PROGRESS: Prevention of Recurrent Stroke Hisatomi Arima, MD, PhD; John Chalmers, MD, PhD From The George Institute for Global Health, University of Sydney and
More informationVascular Dementia. Laura Pedelty, PhD MD The University of Illinois at Chicago and Jesse Brown VA Medical Center
Vascular Dementia Laura Pedelty, PhD MD The University of Illinois at Chicago and Jesse Brown VA Medical Center none Disclosures Objectives To review the definition of Vascular Cognitive Impairment (VCI);
More informationFact Sheet Alzheimer s disease
What is Alzheimer s disease Fact Sheet Alzheimer s disease Alzheimer s disease, AD, is a progressive brain disorder that gradually destroys a person s memory and ability to learn, reason, make judgements,
More informationA Dynamic Model of Care for Late Onset Cognitive Impairment. Linda CW Lam Department of Psychiatry The Chinese University of Hong Kong
A Dynamic Model of Care for Late Onset Cognitive Impairment Linda CW Lam Department of Psychiatry The Chinese University of Hong Kong Outline The pathogenesis of Late life cognitive impairment A framework
More informationESC Geoffrey Rose Lecture on Population Sciences Cholesterol and risk: past, present and future
ESC Geoffrey Rose Lecture on Population Sciences Cholesterol and risk: past, present and future Rory Collins BHF Professor of Medicine & Epidemiology Clinical Trial Service Unit & Epidemiological Studies
More informationJohn J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam
Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention
More informationLowering blood pressure in 2003
UPDATE CLINICAL UPDATE Lowering blood pressure in 2003 John P Chalmers and Leonard F Arnolda Institute for International Health, University of Sydney, Sydney, NSW. John P Chalmers, MD, FRACP, Professor
More informationPreventing the cardiovascular complications of hypertension
European Heart Journal Supplements (2004) 6 (Supplement H), H37 H42 Preventing the cardiovascular complications of hypertension Peter Trenkwalder* Department of Internal Medicine, Starnberg Hospital, Ludwig
More informationVASCULAR COGNITIVE IMPAIRMENT/DEMENTIA SETTING THE STAGE
VASCULAR COGNITIVE IMPAIRMENT/DEMENTIA SETTING THE STAGE Larry B. Goldstein, MD, FAAN, FANA, FAHA University of Kentucky Lexington, KY Issues in the Diagnosis of Vascular Cognitive Impairment and Dementia
More informationThe Primary Care Guide To Understanding The Role Of The Metabolic Syndrome In Cognitive Decline Of Older Persons
The Primary Care Guide To Understanding The Role Of The Metabolic Syndrome In Cognitive Decline Of Older Persons 1. Defining the Metabolic Syndrome A Primary care practice often includes numerous patients
More informationAtrial Fibrillation and Heart Failure: A Cause or a Consequence
Atrial Fibrillation and Heart Failure: A Cause or a Consequence Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania November
More informationErin Cullnan Research Assistant, University of Illinois at Chicago
Dr. Moises Gaviria Distinguished Professor of Psychiatry, University of Illinois at Chicago Director of Consultation Liaison Service, Advocate Christ Medical Center Director of the Older Adult Program,
More informationStatins in the elderly : Is there a rationale?
Statins in the elderly : Is there a rationale? Pr B Boland After a communication by Dr. Manfred Gogol EAMA, Sion, June, 2006 1 RCTs with Statins Meta-Analysis, 1999 182 abstracts or research papers 29
More informationPreventing Cardiovascular Disease Stroke Primary Prevention Guidelines. John Potter Professor Ageing & Stroke Medicine University of East Anglia
Preventing Cardiovascular Disease Stroke Primary Prevention Guidelines John Potter Professor Ageing & Stroke Medicine University of East Anglia Preventing Cardiovascular Disease Stroke Primary Prevention
More informationSmall Vessel Disease and Dementia:
KDA Programme lecture October 2005 Small Vessel Disease and Dementia: Prof Raj N Kalaria FRCP University of Newcastle upon Tyne Wolfson Research Centre Newcastle General Hospital United Kingdom Email:
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Cardiovascular Risk Factors
Cardiovascular Risk Factors ROB WALKER (Dunedin, New Zealand) Lipid-lowering therapy in patients with chronic kidney disease Date written: January 2005 Final submission: August 2005 Author: Rob Walker
More informationPhysical Activity, Physical Function, and Incident Dementia in Elderly Men: The Honolulu Asia Aging Study
Journal of Gerontology: MEDICAL SCIENCES 2008, Vol. 63A, No. 5, 529 535 Copyright 2008 by The Gerontological Society of America Physical Activity, Physical Function, and Incident Dementia in Elderly Men:
More informationDr Julia Hopyan Stroke Neurologist Sunnybrook Health Sciences Centre
Dr Julia Hopyan Stroke Neurologist Sunnybrook Health Sciences Centre Objectives To learn what s new in stroke care 2010-11 1) Acute stroke management Carotid artery stenting versus surgery for symptomatic
More information