The prevention of the dementia epidemic

Alzheimer's disease (AD) is considered to be the most common dementing disorder. The understanding of this disorder has greatly advanced over the past few years, and new therapeutic options have been developed. Another disorder, vascular dementia (VaD), is a syndrome with multiple etiologies operating through a variety of different mechanisms. The combination of AD and VaD is extremely common, making mixed dementia the most common type of dementia. Risk factors for VaD, which are the common vascular risk factors, are presently known to apply also to AD. Cholinergic deficits occur in both conditions. The identification of several genetic factors that can contribute to vascular damage, as well as possible auto-immune damage to vascular components, are important. It is remarkable that amyloid precursor protein (APP) mutations can cause the typical pathological changes of AD as well as amyloid deposition around blood vessels. These may lead to deficient blood perfusion to the brain, changes of the blood-brain barrier, as well as cerebral hemorrhages. Interestingly, attention to risk factors, such as hypertension, coronary artery disease, hyperlipidemia and smoking could reduce or delay the incidence of dementia, both vascular and AD.