Vascular risk factors, cognitve decline, and dementia

Figures & data

Table 1 Blood pressure (BP) and cognitive decline or dementia. Longitudinal studies

References	na	Age at baseline (years)	Follow up (years)	Outcomes
Elias 1993	1702	55–88	12–14	Positive correlation between BP and cognitive decline
Launer 1995	3735	50	20–28	Positive correlation between BP and cognitive decline
Yoshikate 1995	828	74	7	Positive correlation between BP and vascular dementia
Skoog 1996	382	70	9–15	Positive correlation between BP and dementia (Alzheimer’s and vascular types)
Starr 1997	603	>69	4	Positive correlation between BP and cognitive decline
Kilander 1998a	999	50	20	Positive correlation between BP and cognitive decline
Swan 1998a,b	717	45	25–30	Positive correlation between BP and cognitive decline
Tzourio 1999	1373	59–71	4	Positive correlation between BP and cognitive decline RR = 2.8 (95% CI = 1.6–5.0)
Launer 2000	3703	50	25	Positive correlation between BP and dementia (Alzheimer’s and vascular types) RR = 4.8 (95% CI = 2.0–11.0)
Knopman 2001	10963	47–70	6	Positive correlation between BP and cognitive decline
Kivipelto 2001	1449	53	21	Positive correlation between BP and AD OR = 2.1 (95% CI = 1.0–4.3)
Qiu 2003	1270	81	4.7	Positive correlation between pulse pressure and AD OR = 2.1 (95% CI = 1.0–4.3)
Reinprecht 2003	186	68	13	Positive correlation between BP and cognitive decline
Piguet 2003	377	≥75	6	Positive correlation between BP and cognitive decline
Whitmer 2005	8845	40–44	30	Positive correlation between BP and dementia OR = 2.1 (95% CI = 1.0–4.3)
Okumiya 1997	155	78	3	J curve between BP and cognitive decline
Glynn et al 1999	2068	65–102	6	J curve between BP and cognitive decline
Bohannon 2002	4136	65–105	3	J curve between BP and cognitive decline
Guo et al 1997	1736	75–101	3	Negative correlation between BP and cognitive decline
Zhu et al 1998	924	>75	3	Negative correlation between BP and cognitive decline
Verghese et al 2003	488	79	6.7	Negative correlation between BP and AD
Morris et al 2001	634	>65	13	No correlation between BP and AD
Freitag et al 2006	2505	57	5.1	No corrrelation between pulse pressure and AD

a n = numbers of subjects at inclusion.

Abbreviations: AD, Alzheimer’s disease; OR, odds ratio; BP, blood pressure; RR, relative risk.

Table 2 Effect of antihypertensive drugs on cognitive decline or dementia in randomised, placebo - controlled studies

Studies	na	ΔSBP/DBP (active - placebo)	Drugs	Follow up	Outcomes
MRC	2584	−15.8/5 mmHg	BB or Diu	54 months	Non−significant effect on cognitive function
SHEP	4736	−12/4 mmHg	BB ± Diu	4.5 years	Reduction of dementia 16% (non significant)
SYST-EUR	2418	−8.3/3.8 mmHg	CCB ± ACEI ± Diu	2 years	Reduction of dementia 50% (0 to 76%)
SYST-EUR 2 (open follow up)	2902	–7/3.2 mmHg	CCB ± ACEI ± Diu ± others	4 years	Reduction of dementia 55% (24%–73%)
PROGRESS	6105	−9/4 mmHg	ACEI ± Diu	4 years	Reduction of cognitive decline 19% (4%–32%) Reduction of dementia with recurrent stroke: 34% (3%–55%)
HOPE	9297	−3.8/2.8 mmHg	ACEI	4.5 years	Reduction of cognitive decline related to stroke 41% (6%–63%)
SCOPE	4964	−3.2/1.6 mmHg	ARB ± Diu	3.7 years	Reduction of dementia 7% (non significant)

a n = numbers of subjects at inclusion.

Abbreviations: ACEI, angiotensin converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta blockers; CCB, calcium channel blockers; Diu, diuretics.

Table 3 Risk of incident dementia in patients with Diabetus mellitus in longitudinal studies

Dementia	na	Follow-up (years)	Ageb	Outcomes
Any dementia
Peila, 2002	3508	2.9	77	Positive correlation. RR (95% CI) = 1.5 (1.0–2.2) Adjusted RRc (95% CI) = 1.5 (1.0–2.2)
Whitmer 2005	8845	35	42	Positive correlation. RR (95% CI) = 1.5 (1.2–1.8)
Schnaider Berri 2004	10059	35	45	Positive correlation. RR (95% CI) = 2.8 (1.4–5.7)
Ott 1999	6370	2.1	69	Positive correlation. RR (95% CI) = 1.9 (1.3–2.8)
Xu 2004	1301	4.7	81	Positive correlation. RR (95% CI) = 1.5 (1.1–2.1) Adjusted RR (95% CI) = 1.5 (1.0–2.1)
Curb 1999	3774	25	53	Non significant correlation. RR (95% CI) = 1.1 (0.7–1.8)
Hassing 2002	702	6	84	Non significant correlation. Adjusted RR (95% CI) = 1.2 (0.8–1.7)
MacKnight 2002	9131	5	74	Non significant correlation. RR (95% CI) = 1.2 (0.9–1.7) Adjusted RR (95% CI) = 1.3 (0.9–1.8)
AD
Peila 2002	3508	2.9	77	Positive correlation. RR (95% CI) = 1.7 (1.0–2.8)
Yamada 2003	1774	30	43	Positive correlation. RR = 4.4
Akomolafe 2006	2210	12.7	70	Positive correlation. Adjusted RR (95% CI) = 2.98 (1.06–8.9)
Ott 1999	6370	2.1	69	Positive correlation. RR (95% CI) = 1.9 (1.2–3.1)
Luchsinger 2001	1799	4.3	76	Positive correlation. RR (95% CI) = 2.4 (1.8–3.2) Adjusted RR (95% CI) = 2.0 (1.4–2.9)
Arvanitakis 2004	847	5.5	75	Positive correlation. RR (95% CI) = 1.7 (1.1–2.5)
Xu 2004	1301	4.7	81	No significant correlation. RR (95% CI) = 1.3 (0.8–1.9) Adjusted RR (95% CI) = 1.3 (0.9–2.1)
Luchsinger 2005	1786	5.5	76	Positive correlation. RR (95% CI) = 2.4 (1.8–3.2) Adjusted RR (95% CI) = 2.0 (1.4–2.9)
Curb 1999	3774	25	53	Non significant correlation. RR (95% CI) = 1.0 (0.5–2)
Hassing 2002	702	6	84	Non significant correlation. Adjusted RR (95% CI) = 0.8 (0.5–1.5)
MacKnight 2002	9131	5	74	Non significant correlation. RR (95% CI) = 1.2 (0.8–1.8) Adjusted RR (95% CI) = 1.3 (0.8–2.0)
VaD
Peila 2002	3508	2.9	77	Positive correlation RR (95% CI) = 2.2 (1.1–4.7) Adjusted RR (95% CI) = 2.3 (1.1–5.0)
Yamada 2003	1774	30	43	Positive correlation. RR = 1.3 (p = 0.06)
Ott 1999	6370	2.1	69	Positive correlation. RR (95% CI) = 2.0 (1.7–5.6)
Luchsinger, 2001	1799	4.3	76	Positive correlation. RR (95% CI) = 4.2 (2.2–8.3) Adjusted RR (95% CI) = 3.4 (1.7–6.9)
Hassing 2002	702	6	84	Positive correlation. Adjusted RR (95% CI) = 2.5 (1.4–4.8)
MacKnight, 2002	9131	5	74	Positive correlation. RR (95% CI) = 2.2 (1.3–3.6) Adjusted RR (95% CI) = 2.0 (1.2–3.6)
Xu 2004	1301	4.7	81	Positive correlation. RR (95% CI) = 2.2 (1.1–5.0) Adjusted RR (95% CI) = 2.6 (1.2–6.1)
Curb 1999	3774	25	53	Non significant correlation. RR (95% CI) = 1.5 (0.8–2.8)

a = numbers of subjects at inclusion.

b at baseline.

c RR adjusted for vascular risk factors.

Abbreviations: AD, Alzheimer’s disease; RR, relative risk; VaD, vascular dementia.

Table 4 Association between cholesterol level and dementiain longitudinal studies

Reference	na (baseline)	Age at baseline (years)	Follow-up (years)	Outcomes
Notkola 1998	444	40–59	30	Positive correlation between TC and AD RR (95% CI = 3.1(1.2–8.5)
Kivipelto 2002	1449	53	21	Positive correlation between TC and AD RR (95% CI) = 2.8 (1.2–6.7)
Moroney 1999	111	75	7	Positive correlation between LDL-C and AD RR (95% CI) = 3.1 (1.5–6.1)
Kalmijn 2000	8006	52.7	26	Non significant correlation between TC and any dementia RR (95% CI) = 1.10 (0.95–1.26)
Tan 2003	1026	76	8	Non significant correlation between TC and AD RR (95% CI) = 0.97 (0.90–1.05)
Reitz 2004	2820	78	4.8	Non significant between LDL-C and AD RR (95% CI) = 0.48 (0.26–0.86)
Mielke 2005	392	70	18	Negative correlation between TC and any dementia RR (95% CI) = 0.31 (0.11–0.85)

a n = numbers of subjects at inclusion.

Abbreviations: AD, Alzheimer’s disease; LDL-C, LDL-cholesterol; RR, relative risk; TC, total cholesterol.

Table 5 Association between statin use and dementia or cognitive decline

Reference	na	Age (years)	Population	Type of study	Outcomes
Jick 2000	1364	350	General population	Cross sectionnal	Association between statin and decreased risk of AD. OR (95% CI) = 0.29 (0.13–0.63)
Hajjar 2002	655	79	Elderly subjects	Cross sectionnal	Association between statin and decreased risk of dementia. OR (95% CI) = 0.23 (0.1–0.56) Association between statin and decreased risk of AD. OR (95% CI) = 0.37 (0.19–0.74)
Zamrini 2004	3397	70	Elderly subjects	Cross sectionnal	Association between statin and decreased risk of AD. OR (95% CI) = 0.61 (0.42–0.87)
Dufouil-b 2005	8574	74	General population	Cross sectionnal	Association between statin and decreased risk of AD. OR (95% CI) = 0. 56 (0.33–0.94)
Bernick 2005	334	74	Elderly subjects	Longitudinal (F up = 7 years)	Association between statin and slower cognitive decline
Masse 2005	342	73.5	AD	Longitudinal (F up = 34 months)	Association between statin use and slower cognitive decline
Zandi 2005	5092	>65	Elderly subjects	Longitudinal (F up = 3 years)	No correlation between statin use and dementia OR (95% CI) = 1.19(0.53–2.34) No correlation between statin use and AD
Rea 2005	2798	>65 years	Elderly subjects with never use of lipid-lowering agents	Longitudinal (F up = 15,030	No correlation between statin use and dementia HR (95% CI) = 1.08 (0.77–1.52)
HPS	20536	40–80	High CV risk	Randomized Controlled trial (F up = 5 years)	No correlation between statin use and cognitive function
PROSPER	5804	70–82	High CV risk	Randomized controlled trial (F up = 3.2 years)	No correlation between statin use and cognitive function

a n = numbers of subjects at inclusion.

Abbreviations: AD, Alzheimer’s disease; CV, Cardiovascular; F up, follow-up; HR, hazard ratio; OR, odds ratio; VaD, vascular dementia.

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