Alzheimer’s Disease, Cerebrovascular Disease and Dementia: Pathology, Risk Factors and Prevention; A Comprehensive Approach

Alzheimer’s disease (AD) and cerebrovascular disease (CVD) frequently co-exist. CVD may precede and act additionally and synergistically with AD in aging-related cognitive impairment and dementia (ARCID) resulting in “mixed dementia”. The incidence of ARCID may be decreased by the prevention and treatment of cardiovascular disease. ARCID is increased by adverse psycho-social factors and the incidence may be reduced by appropriate psycho-social interventions. A number of men and women with the neurodegenerative and cerebrovascular changes of AD and CVD have normal cognition at the time of death attributable to “high cognitive reserve” or “cognitive resilience”; the underlying mechanisms merit urgent investigation. ADmodifying treatments are still in the early stages of development and the best hope for reducing agingrelated cognitive impairment and dementia in the immediate future lies in a broad approach including the promotion of physical and mental exercise and the active treatment of vascular risk factors from early and mid-life onwards, combined with better education and correction of adverse psycho-social factors.