Associations of Air Pollution and Genetic Risk With Incident Dementia: A Prospective Cohort Study
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Evidence on the association between air pollution and dementia is accumulating but still inconclusive, and the potential effect modification by genetics is unclear. We investigated the joint effects of air pollution exposure and genetic risk on incident dementia in a prospective cohort study, the UK Biobank study. Land use regression models were used to estimate exposure to ambient particulate matter (PM) in 3 fraction sizes (PM with diameter < 2.5 μm (PM2.5), coarse particles (PM with diameter 2.5-10 μm (PMc)), and PM with diameter < 10 μm (PM10)), PM2.5 absorbance, nitrogen dioxide levels, and nitrogen oxide levels at each individual's baseline residence. A polygenic risk score was calculated as a quantitative measure of genetic dementia risk. Incident cases of dementia were ascertained through linkage to health administrative data sets. Among the 227,840 participants included in the analysis, 3,774 incident dementia cases (including 1,238 cases of Alzheimer disease and 563 cases of vascular dementia) were identified. After adjustment for a variety of covariates, including genetic factors, positive associations were found between exposure to air pollution-particularly PM10, PM2.5 absorbance, and nitrogen dioxide-and incident all-cause dementia and Alzheimer disease but not vascular dementia. No significant interaction between air pollution and genetics was found, either on the multiplicative scale or on the additive scale. Exposure to air pollution was associated with a higher risk of developing dementia regardless of genetic risk.Keywords:
Vascular dementia
Particulate Pollution
Alzheimer's disease and vascular dementia are two most common causes of dementia in late life. The combination of Alzheimer's type dementia and vascular dementia is the third most common form of dementia, especially in the elderly. Most clinical forms of dementia are characterized by the presence of 'overlap' symptoms of both neurodegenerative and vascular pathology, which makes it expedient to consider mixed dementia as a separate entity characterized by clinical presentations, course and the rate of progression of cognitive decline. Despite the lack of clinical guidelines for management of patients with mixed dementia, it seems appropriate to use strategies that have shown their effectiveness in various types of cognitive impairment.Болезнь Альцгеймера и сосудистая деменция рассматриваются как две наиболее распространенные формы деменции в позднем возрасте. Сочетание нейроморфологических изменений альцгеймеровского типа и сосудистой патологии определяют третью по распространенности форму деменции, особенно у пациентов старческого возраста. Большинство ее клинических форм характеризуются наличием симптомов 'перекрытия' нейродегенеративных и сосудистых проявлений, что обусловливает целесообразность выделения смешанной деменции в самостоятельную форму. Она отличается по клиническим проявлениям, течению заболевания и темпам прогрессирования когнитивного дефекта. В связи с отсутствием определенных клинических рекомендаций по ведению больных со смешанной деменцией представляется целесообразным использование стратегий, показавших свою эффективность при других формах когнитивных расстройств.
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To determine the prevalence of dementia in a population of hospitalized or institutionalized elderly patients, and that of associated diseases according to dementia type.Retrospective analysis of a database of diagnostic codes.All patients admitted to 1 of the 4 geriatric units participating in the study at the Charles Foix Hospital between 1980 and 1989.All diagnoses mentioned in the discharge summary that could cause or contribute to hospitalization were recorded for each patient. A final list of 54 different diagnoses could be recorded for each patient. Dementia was subdivided into 3 subtypes: Alzheimer dementia (DAT), vascular dementia (VD), and other types of dementia (unclassifiable dementia).The study involved 3447 patients aged 81.0 +/- 8.3 years, of whom 27.7% were men. Dementia was the most frequent disease in this population (34.3%); Alzheimer disease was responsible for 15%, vascular dementia for 9.5%, and other types for 9.8%. The average number of associated diseases was 3.23 +/- 2.10 in the Alzheimer dementia group, 4.73 +/- 2.38 in the vascular dementia group, and 3.96 +/- 2.26 in the nondemented group. Parkinson disease was present in 15.5% of patients with unclassifiable dementia, compared with 7.6% in the nondemented group (P < 0.001). There were significantly more diseases commonly seen in bedridden patients in the group of patients with both other types of dementia and Parkinson disease than in the group of other types of dementia patients without Parkinson disease (P < 0.01).Dementia was the most common disease observed in our elderly institutionalized population. Alzheimer patients had significantly fewer associated diseases than nondemented patients, whereas the reverse was found in the vascular dementia group. The co-existence of Parkinson disease and dementia in our population was associated with the poorest health status, as these patients were more likely to present simultaneously such conditions as pressure sores, incontinence, dehydration, or iatrogenesis.
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Stroke and dementia are frequent and often associated in the same patient. Their association can be encountered either in the diagnostic workup of patients attending a memory clinic, or during the follow-up of stroke patients The term ‘vascular dementia’ (VaD) is used to describe a dementia syndrome likely to be the direct consequence of stroke lesions, while the term post-stroke dementia (PSD) is a more general term that includes all types of dementia occurring after a stroke, irrespective of the presumed cause. Therefore, VaD accounts for only a part of PSD, while it may sometimes occur without any clinical history of stroke and be the consequence of so-called ‘silent’ lesions of the brain of vascular origin. VaD is the second most common cause of dementia after Alzheimer’s disease (AD): it accounts for 10–50% of all cases of dementia, depending on regional variations and criteria used. Both ischaemic and haemorrhagic strokes lead to a high risk of cognitive impairment and dementia. About one in ten patients is demented before having a first-ever stroke, one in ten develops new-onset dementia after a first-ever stroke, and more than one in three develops dementia after a recurrent stroke. A vascular origin of cognitive impairment is frequent, and often preventable: therefore, patients could benefit from early detection and therapy. An accurate diagnosis of vascular cognitive impairment or VaD is necessary. Dementia is probably the tip of the iceberg, accounting for a small part of the cognitive consequences of stroke, as most of these consequences are represented by cognitive impairment without dementia, and are due to the coexistence of vascular and degenerative lesions of the brain.
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Objective To explore whether P300 can be the method for early diagnosis of vascular dementia.Methods 123 cases of multi infarct dementia(dementia group) were examined and compared with non dementia groups and healthy control groups according to 3 different age ranges respectively.Results There were significant differences between the dementia groups and the non dementia groups(P0.05) and between the non dementia and the healthy groups(P0.05).The latent period of P300 in patients over 60 years old of the dementia groups was longer than that in non dementia groups and the healthy controls.The latent period of P300 was prolonged by 1.5 S for every increase in one year of age.Conclusions The results suggest that the change in P300 can occur ealier than that in the intellective score of Haseyakawa Dementia Scales(HDS),P300 can be one of the methods for diagnosis of vascular dementia and favor early diagnosis and early treatment.Early treatment of vascular dementia with Ginaton is effective.
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One hundred and one patients with dementia, treated at Psychiatric department of GH Bjelovar were studied regarding the sort and frequency of complications, the evidence of other psychiatric or physical illnesses and psychopharmacological therapy. Of all the patients diagnosed with dementia, 21.78% were diagnosed with primary dementia, 70.3% with secondary dementia and 7.92% with combined (both primary and secondary) dementia. The number of patients diagnosed with vascular and primary dementia and the number of the registered complications vs. the so called other psychiatric diagnoses accompanying dementia reflects the difficulties in diagnosing Alzheimer's disease and the complications of dementia. The results of therapy are thoroughly discussed.
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In the UK, an estimated 954 000 people have dementia. Vascular dementia (VaD) is the second most common type of dementia and affects around 257 607 people ( Prince et al, 2014:16 —Table 4). This article, the third in a series, explains about the pathophysiology and clinical features of VaD, how it can be prevented, how it is diagnosed and the medication used to treat VaD.
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Vascular dementias, VD, are dementias due to cerebrovascular lesions. Subgroups of VD include multi-infarct dementia, single infarct (or strategic infarct) dementia, subcortical ischemic vascular dementia, hemorrhagic dementia, hypoperfusion dementia. VD are also related to post-stroke dementia, mixed Alzheimer's disease and vascular dementia and vascular cognitive impairment. These various entities allow to characterize more homogenous subgroups within the heterogeneous group of vascular dementias. However, ambiguities in their definitions, associated with frequent overlaps as well as lack of consensual definition for mixed dementia limit both their theoretical value and use in clinical practice. The diagnosis of cerebrovascular diseases should be dissociated from that of dementia, which could be associated with other pathologies.
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Dementia is world’s fifth leading cause of mortality. It is an term for several diseases affecting memory, other cognitive abilities and behavior. There are mainly three types of dementia are seen commonly allover the world, there are Vascular dementia, Alzheimer disease and Mixed dementia. Vascular dementia cover 40% in the whole dementia, Alzheimer's disease occupy nearly 60% of dementia but Mixed dementia is more prevalent it is due to other types of dementia are less prevalent. dementia is influenced by several factors like hypertension,age, obesity etc… but main risk factor is hypertension and it is also differ based on age as mid life hypertension seen in people of middle age 40-65years and late life hypertension see in people of 75years or above. In this article we come over about dementia, types of dementia with etiology, pathophysiology and diagnosis of each type and influence of hypertension on dementia with recent evidences…
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Alzheimers disease associated with cerebrovascular disease is now considered as the most frequent type of dementia. The aim was to study some clinical characteristics of mixed dementia (Alzheimer-type dementia associated with cerebral atherosclerosis) comparatively with «pure» Alzheimers disease (AD) and vascular dementia (VaD). A sample made up all patients diagnosed as mild/moderate dementia admitted for the first time to the psychogeriatric unit of one of Moscow psychiatric hospital. A total 283patients (81m and 202f) aged 48-93years were evaluated. The main group made up 94patients with a diagnosis of mixed dementia (33,2%). Two control groups included 75patients with VaD (26,5 %) and 114 patients with AD (40,3 %) without clinical and MRI signs of cerebral atherosclerosis. Mean duration of dementia didnt differ in all cases of dementia. Mixed dementia is more frequent in females (m/f 1:3,9); late onset is more common for mixed dementia (90,4%); there is a high risk of delirium-like confusional states in patients with mixed dementia closed to its frequency in vascular dementia; prevalence of vascular risk factors in mixed dementia is closed to its frequency in VaD. Strokes and TIA occurred before dementia as well as in the course of dementia in cases of mixed dementia (35,1%). A high frequency of focal vascular changes in mixed dementia didnt differ from MRI picture in cases of VaD. Due to complex genesis of disorders mixed dementia needs a multimodal therapeutical intervention.
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