background Dementia affects over 24 million people in the world currently and the number with dementia is expected to increase to over 81 million by 2040. The prevalence of dementia would be reduced by 50% if risk reduction strategies were successful in delaying the onset of dementia by five years.
aim The talk will review the epidemiological and randomised controlled trial (rct) evidence for following strategies that are particularly amenable to therapeutic intervention: control of risk factors for cerebrovascular disease, antiinflammatory drugs, anti-oxidants, and increasing neuronal reserve.
methods A selective review of the literature was conducted using MedLine to identify current evidence for role of vascular risk factors as potential targets in preventing dementia. Crossreferences were hand searched.
results The epidemiological evidence suggests that it is possible to delay, if not prevent, the onset of dementia, both Alzheimer's disease and vascular dementia. There is limited rct evidence to support anti-hypertensives but not for other strategies.
conclusion The talk will discuss the likely reasons for the observed 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 mild cognitive impairment (mci). They include limitations of methodologies, therapeutic time window and unsuspected mechanisms of action of individual drugs. It will discuss the additive effect of multiple risk factors and present preliminary findings on asymptomatic cerebral emboli as a novel and potentially amenable risk factor in prevention of dementia.