Dementia: new vistas and opportunities

Over the past four decades, Alzheimer disease has become near synonymous with dementia and the amyloid/tau hypothesis as its dominant explanation. However, this monorail approach to etiology has failed to yield a single disease-modifying drug. Part of the explanation stems from the fact that most de...

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Published in:Neurological sciences 2019-04, Vol.40 (4), p.763-767
Main Author: Hachinski, Vladimir
Format: Article
Language:English
Subjects:
Alzheimer's disease
Amyloid
Blood pressure
Cerebrovascular diseases
Cerebrovascular Disorders - enzymology
Cerebrovascular Disorders - prevention & control
Cognitive ability
Dementia
Dementia - epidemiology
Dementia - prevention & control
Dementia disorders
Etiology
Fibrillation
Geriatrics
Humans
Medicine
Medicine & Public Health
Neurodegenerative diseases
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Original Article
Psychiatry
Risk factors
Stroke
Tau protein
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description Over the past four decades, Alzheimer disease has become near synonymous with dementia and the amyloid/tau hypothesis as its dominant explanation. However, this monorail approach to etiology has failed to yield a single disease-modifying drug. Part of the explanation stems from the fact that most dementias in the elderly result from interactive Alzheimer and cerebrovascular pathologies. Stroke and dementia share the same risk factors and their control is associated with a decrease in stroke and some dementias. Additionally, intensive control of risk factors and enhancement of protective factors improve cognition. Moreover, anticoagulation of atrial fibrillation patients decreases their chance of developing dementia by 48%. Preliminary data suggest that treating blood pressure to a target of 120 mmHg systolic compared to a target of 140 mmHg decreases the chances of mild cognitive impairment by 19%. The Berlin Manifesto establishes the scientific bases of “preventing dementia by preventing stroke.” Enlarging our vista of dementia to include cerebrovascular disease offers the opportunity of preventing not only stroke, but some dementias, beginning now.
doi_str_mv 10.1007/s10072-019-3714-1
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subjects Alzheimer's disease
Amyloid
Blood pressure
Cerebrovascular diseases
Cerebrovascular Disorders - enzymology
Cerebrovascular Disorders - prevention & control
Cognitive ability
Dementia
Dementia - epidemiology
Dementia - prevention & control
Dementia disorders
Etiology
Fibrillation
Geriatrics
Humans
Medicine
Medicine & Public Health
Neurodegenerative diseases
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Original Article
Psychiatry
Risk factors
Stroke
Tau protein
title Dementia: new vistas and opportunities
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