Primary prevention

It is unclear what proportion of dementia is due to vascular risk factors. There is some evidence from European studies that a decrease in the incidence of dementia corresponds with improved cardiovascular health.[10][47]

High-risk groups - that is, older patients with hypertension, diabetes, obesity, atrial fibrillation, past transient ischemic attack (TIA), or stroke, or who drink to excess or smoke - should be targeted for primary prevention in the following ways:

  • Optimal treatment of hypertension and diabetes

  • Reduction in BMI through dietary changes and graduated low-impact physical activity/exercise

  • Antiplatelet therapy for patients with history of TIA, stroke, or coronary disease

  • Encouraging patients to stop smoking and decrease alcohol consumption

  • Control of hyperlipidemia

  • Rhythm control strategies (particularly ablation) and anticoagulation treatment for patients with atrial fibrillation[48]

  • Treatment of high-grade carotid stenosis with antiplatelet agents or carotid endarterectomy

One cohort study concluded that potentially modifiable midlife vascular risk factors are associated with increased risk of dementia in later life, and that further studies are needed to assess the effects of risk factor control.[49] In another study, higher cardiovascular risk burden was associated with some aspects of cognitive decline and structural brain changes.[50]

A 2020 cohort study showed that 10-year risk of all-cause dementia increases with diabetes, low education, and smoking, along with certain genes (apolipoprotein E and genome-wide association studies risk alleles), and, importantly, that healthy cardiovascular lifestyle attenuates genetic susceptibility for dementia.[51]​ More recent studies have confirmed this interplay between cardiometabolic diseases, genetics and dementia risk. This ongoing research will enable high-risk individuals to be identified earlier in life, so that intervention can be targeted to prevent dementia later on.[52][53]

Multimorbidity (2 or more chronic diseases) is associated with an increased risk of dementia, particularly if onset is in midlife as opposed to later life, which makes prevention of multimorbidity in people with a first chronic disease increasingly important.[54]​​

There is some evidence to suggest that regular physical activity is associated with a lower incidence of vascular dementia. Although the association is relatively weak, this is still important from a population health perspective.​[55][56]​​[57]​ Daily step count correlates with reduced incidence of dementia up to 9800 steps per day, beyond which the benefits are reversed, and performing the steps at higher intensity is also associated with reduced dementia risk.[58]

There is some historical controversy about lipid-lowering therapy and whether it may be a risk factor for cognitive decline but overall benefits, in terms of cardiovascular disease prevention, certainly appear to outweigh any risk. Long-term study outcomes are still pending.[59]​ High HDL levels in initially-healthy over ages 75 years has been shown to be associated with higher risk of all-cause dementia.[60]

For people with hearing loss, hearing aids delay or prevent the onset and progression of dementia.[61]

One large randomized controlled trial showed that giving aspirin to people with diabetes and no previous history of cardiovascular disease did not reduce their risk of developing dementia over the 7.4 year follow-up period.[62]

Secondary prevention

Interventions to reduce the risk of further vascular damage in people diagnosed with vascular dementia include the following.

  • Hyperlipidemia should be treated with lifestyle and dietary changes, and statin therapy if appropriate.[97]

  • Tight glucose control is advocated in patients with diabetes with transient ischemic attack, with a goal hemoglobin A1c (HbA1c) of <7%.[72]​​

  • Maintaining a BMI of 18.5 to 24.9 kg/m² and moderate-intensity physical activity (if possible for the patient) should be encouraged.[72]​ 

  • Patients should be advised and encouraged to stop smoking and reduce alcohol intake if applicable.[72]​​

Use of this content is subject to our disclaimer