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Vascular factors have been found to play a role in both vascular and so-called neurodegenerative forms of cognitive impairment such as Alzheimer's disease.
Hypertension, diabetes, smoking, and obesity in midlife are associated with an increased rate of progression of vascular brain injury, global and hippocampal atrophy, and decline in executive function a decade later, a new study has found.
"Walking train wrecks"
The analysis of 1352 people without dementia from the Framingham Offspring Study with an average age of 54 found that hypertension and increasing systolic blood pressure in midlife was associated with accelerated white matter hyperintensity volume (WMHV), and worsening executive function.
Midlife diabetes and smoking were associated with a more rapid increase in temporal horn volume, a surrogate marker of accelerated hippocampal.
Midlife smoking also predicted a more marked decrease in total brain volume and increased risk of extensive change in WMHV.
Obesity in midlife was associated with an increased risk of being in the top quartile of change in executive function and increasing waist-to-hip ratio was associated with marked decline in total brain volume (TBV). Longitudinal changes in brain structure were significantly correlated with decline in memory and executive function.
The study results should be a “wake-up call’ not to take midlife hypertension lightly, said lead author Dr Charles DeCarli (University of California, Davis). “We should be very, very clear about the insidious impact of hypertension and be more wary about just saying, ‘your blood pressure is 140 over 90; that's no big deal, we'll just watch it,’ “ he said. “That's a common mistake.”
Cardiovascular factors are additive. Identifying these factors such as hypertension, diabetes, or obesity in middle-aged people could be useful in screening those who may be at risk for dementia and encouraging them to make crucial lifestyle changes.
Debette S, Seshadri S, Beiser A, Au R, Himali JJ, Palumbo C, Wolf PA, DeCarli C, Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology 2011; 77:461-468.