[Alzheimer's disease: cardiovascular risk factors must be assessed]

Area of Science:

• Neurodegenerative diseases
• Cardiovascular health
• Public health

Context:

• Dementia, including Alzheimer's disease (AD) and vascular cognitive impairment (VCI), is a major public health concern in the elderly.
• The exact cause of AD remains unknown, with ongoing debate regarding the initiating factor.
• While amyloid deposition has been a focus, emerging evidence highlights cardiovascular risk factors and arterial wall alterations leading to chronic brain hypoperfusion as potential primary triggers.

Purpose:

• To explore the controversial roles of amyloid deposition versus cardiovascular factors in the pathophysiology of Alzheimer's disease.
• To emphasize the critical importance of assessing cardiovascular risk factors in the context of cognitive decline.

Summary:

• The traditional theory of amyloid-induced neurotoxicity in AD is being challenged by growing data.
• Evidence suggests that cardiovascular risk factors and associated chronic brain hypoperfusion may be the primary drivers of AD and VCI.
• Epidemiological, physiopathological, neuroimaging, and neuropathological studies support the link between vascular health and cognitive impairment.

Impact:

• Highlights the significance of managing modifiable cardiovascular risk factors for preventing cognitive decline, morbidity, and mortality.
• Suggests distinct primary and secondary prevention strategies for cognitive decline based on cardiovascular risk assessment.
• Opens new avenues for research into AD pathophysiology and the development of targeted pharmacological interventions for prevention and treatment.