Characterization of risk factors for vascular dementia: the Honolulu-Asia Aging Study.

Department of Veterans Affairs, Honolulu, HI 96850, USA.
Neurology (Impact Factor: 8.3). 08/1999; 53(2):337-43. DOI: 10.1212/WNL.53.2.337
Source: PubMed

ABSTRACT The Honolulu Heart Program (HHP) is a prospective study of heart disease and stroke that has accumulated risk factor data on a cohort of 8,006 Japanese American men since the study began in 1965. A recent examination of the cohort identified all patients with vascular dementia (VaD) using the criteria of the California Alzheimer's Disease Diagnostic and Treatment Center.
To characterize patients with VaD by stroke subtype and to investigate risk factors for VaD in a cohort of Japanese American men, aged 71 to 93, living in Hawaii and participating in the HHP.
Sixty-eight men with VaD were compared with 3,335 men without dementia or stroke (NSND). Men with VaD were also compared with 106 men with stroke who were not demented (SND). Candidate risk factors were measured prospectively.
Of the 68 men with VaD there were 34 (50%) whose VaD was attributed to small vessel infarcts, 16 (23%) whose VaD was related to large vessel infarcts, and 11 (16%) with both large and small vessel infarcts. The remainder could not be classified. In a multivariate logistic regression model for VaD compared with NSND containing variables found to be associated with VaD in a univariate analysis, age (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.13 to 1.27), coronary heart disease (OR 2.50, 95% CI 1.35 to 4.62), and 1-hour postprandial glucose (OR 1.41, 95% CI 1.06 to 1.88) remained significantly predictive of VaD, whereas preference for a Western diet (OR 0.54, 95% CI 0.30 to 0.98) as opposed to an Oriental or mixed diet and use of supplementary vitamin E (OR 0.32, 95% CI 0.12 to 0.82) were protective. A similar model for the comparison of men with VaD and SND revealed age (OR 1.24, 95% CI 1.14 to 1.35) was predictive of VaD, whereas preference for a Western diet (OR 0.43, 95% CI 0.22 to 0.86) was protective.
The most common stroke subtype associated with VaD was lacunar stroke. Age and traditional vascular risk factors are important contributors to the development of VaD in late life. The antioxidant vitamin E and presently unknown factors related to a Western diet as opposed to an Oriental diet may be protective against developing VaD.

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    • "In all studies but one (Nilsson et al., 2007), the OR was significantly in favour of the hypothesis, with a higher risk of VaD in those patients who had a history of hypertension. In one of these studies, the association between hypertension and VaD is only significant when the authors removed the effect of coronary heart disease from the analysis model, suggesting that the effect was masked by coronary disease (Ross et al., 1999). However, one group reported that in subjects 80 years and older, higher systolic blood pressure was associated with good cognitive function whereas lower systolic blood pressure was associated with cognitive decline and dementia (Nilsson et al., 2007). "
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    ABSTRACT: Objective The aim of the study was to conduct a meta-analysis of epidemiological and case control studies to determine whether arterial hypertension is specifically associated with an increased risk of vascular dementia (VaD).DesignLongitudinal and cross-sectional prospective studies using operationalised criteria to define VaD and hypertension, with a normal control comparison group were systematically reviewed. Cochrane Library, Embase, Medline, and PsycInfo data sources were searched along with reference lists of included articles and reviews. Original, prevalence or incidence studies were included if operationalised criteria for hypertension and VaD as well as number of cases with and without hypertension in VaD and non-demented groups were provided. Intervention studies and post-stroke and CADASIL studies were excluded.ResultsEleven studies recruiting either volunteers or clinical patients, or which were population-based, examined a total of 768 people with VaD and 9857 control cases. A meta-analysis of the six longitudinal studies showed that hypertension was significantly associated with increased risk of incident VaD (odds ratio, OR: 1.59, CI: 1.29–1.95, p < 0.0001). A similar association between hypertension and the risk of prevalent VaD was found in the five cross-sectional studies (OR: 4.84, CI: 3.52–6.67, p < 0.00001).Conclusions Hypertension significantly increases the risk of vascular dementia. The current meta-analysis highlights the potential importance of rigorous treatment of hypertension as a key measure to help prevent the development of VaD. Copyright © 2010 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 07/2011; 26(7):661 - 669. DOI:10.1002/gps.2572 · 3.09 Impact Factor
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    • "High cerebrovascular disease burden in VaD was associated with the worst survival rate [15]. VaD and AD have been linked to a number of cardiovascular factors [16] [17] [18] [19] [20], but the effect of vascular risk factors on the progression of already-established dementia has been less studied. Vascular risk factors measured clinically and biochemically did not significantly increase the rate of deterioration during 18 months in AD patients with a low burden of cerebrovascular risk factors; however, cerebrovascular events predicted cognitive decline in AD [21]. "
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    ABSTRACT: Introduction. This study evaluates the progression of dementia and identifies prognostic risk factors for dementia. Methods. A group of 80 Brazilian community residents with dementia (34 with Alzheimer's disease and 46 with vascular dementia) was assessed over the course of 2 years. Data were analyzed with Cox regression survival analysis. Results. The data showed that education predicted cognitive decline (HR = 1.2; P < .05) when analyzed without controlling for vascular risk factors. After the inclusion of vascular risk factors, education (HR = 1.32; P < .05) and hypertension were predictive for cognitive decline (HR = 38; P < .05), and Alzheimer's disease diagnosis was borderline predictive (P = .055). Conclusion. Vascular risk factors interacted with the diagnosis of vascular dementia. Education was a strong predictor of decline.
    03/2010; 2010. DOI:10.4061/2010/673581
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    • "This study suggested that an elevated intake of lipids and saturated fat increased the risk for dementia with a cerebrovascular component (Kalmijn et al., 1997b) (Table 2). One of the most interesting findings of a recent study on VaD risk factors conducted on the cohort of the Honolulu- Asia Aging Study (HAAS), in 3385 older Japanese subjects, was the protective effect of a Western diet against the development of VaD (Ross et al., 1999) (Table 2). As reported above, oriental populations from Asian countries are known to be more prone to stroke (Kagan, 1996) and VaD (Jorm, 1991; White et al., 1996 "
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    ABSTRACT: There is a recent increase in the level of interest in the possible role of dietary fatty acids in age-related cognitive decline, and cognitive impairment of both degenerative (Alzheimer's disease, AD) or vascular origin. At present, several studies suggested that an increase of saturated fatty acids (SFA) could have negative effects on cognitive functions. Furthermore, a clear reduction of risk of cognitive decline has been found in a population sample with a high intake of polyunsaturated fatty acids (PUFA) and monounsaturated fatty acids (MUFA). These findings were confirmed by studies in which high intakes of n-6 PUFA, n-3 PUFA, MUFA, and weekly fish consumption, providing large amount of n-3 PUFA, appear to be protective against the risk of AD. In our elderly population from Southern Italy, elevated unsaturated fatty acids intake (MUFA and PUFA), high levels of antioxidant compounds, and very low SFA intake could act synergistically in improving cognitive performance. Epidemiological studies on the association between diet and cognitive decline suggested a possible role of fatty acids intake in maintaining adequate cognitive functioning and possibly in preventing or delaying the onset of dementia, both of degenerative or vascular origin. Appropriate dietary measures or supplementation with specific micro- and macronutrients might open new ways for the prevention and management of cognitive decline and dementia.
    Experimental Gerontology 05/2005; 40(4):257-70. DOI:10.1016/j.exger.2005.01.001 · 3.53 Impact Factor