Prevention of dementia: Role of vascular risk factors and cerebral emboli

Dementia is a major health problem worldwide and the number of people affected is expected to rise considerably, especially in developing countries like India. Vascular risk factors are involved in causation of both vascular dementia and Alzheimer’s disease (AD), account for 90% of all dementias. A selective review of the literature was conducted to summarize the current evidence from clinical studies to examine the role of vascular risk factors in prevention of dementia. Epidemiological evidence suggests that control of vascular risk factors may prevent, or at least delay, the onset of dementia. This finding is supported to some extent by randomized controlled trial evidence for treatment of hypertension but not for other risk factors. However, a number of methodological issues need addressing. There is a need for a randomized controlled trials (RCT) targeting multiple vascular risk factors in patients at increased risk of dementia; i.e., those with mild cognitive impairment. The research should also explore novel risk factors and mechanisms of vascular brain damage. For example, asymptomatic spontaneous cerebral emboli have been shown to be more frequent and associated with a more rapid progression of dementia in both AD and vascular dementia.