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Could you eventually develop vascular dementia? Here is a concise review of the most important warning signs and controllable risk factors for the disease.

Anything that increases your risk of heart disease and stroke – such as high blood pressure, high cholesterol, diabetes, and smoking – also increases your risk of eventually developing vascular dementia. But the risk factors for vascular dementia are not limited to the risk factors for cardiovascular disease.

Some people have a genetic predisposition to vascular dementia, but there's something to do about it

A gene called ApoE4 is clearly associated with an increased risk for both vascular dementia and Alzheimer's disease. (There are other variations of the ApoE gene that are associated with a very low risk of developing dementia.) However, intermittent fasting may offset some of the brain-damaging effects of this gene, and one clinical study found that it only takes a couple of years of dietary restraint to greatly reduce the risk of developing dementia.

Uncontrolled diabetes greatly increases risk of vascular dementia

Having diabetes is nearly as potent a predictor of future vascular dementia as having the ApoE4 gene. However, keeping diabetes under control reduces your future risk of dementia. Keeping your HbA1C under 7.0 percent is associated with no additional risk of vascular dementia. Having HbA1C over 10.0 percent is a potent risk factor for the disease. However, dietary restraint offsets both genetic factors and diabetes. For most people with diabetes, it really is important to eat less.

Any elevation in blood pressure is a risk factor for vascular dementia

Getting a diagnosis of high blood pressure, in one study, was associated with a 39 percent higher risk of vascular dementia. But getting a diagnosis of "pre-hypertension," a reading of 120 to 139 over 80 to 89 mm Hg, was associated with a 31 percent higher risk of vascular dementia. If your doctor knows you have vascular dementia in your family, you will probably be prescribed aggressive measures to keep high blood pressure in check.

High blood pressure and poor diabetes control seem to be more detrimental for Blacks than Whites

At least in the United States. It is not clear whether Blacks simply get worse medical care than Whites, or whether there are genetic patterns that account for the difference in the increased risk of vascular dementia. When people of sub-Saharan African ancestry develop vascular dementia, they tend to experience relatively rapid decline in memory and more Alzheimer's-like symptoms. For these reasons, preventative measures are probably especially important for Black people.

LDL cholesterol is a risk factor for vascular dementia

The higher your LDL cholesterol, the greater your risk for vascular dementia. However, raising your "good" HDL cholesterol levels and lowering your triglycerides won't lower your risk of vascular dementia. (Lower triglycerides sometimes indicate better blood sugar control, and that would be a good thing for preventing vascular dementias.) Statin medications seem both to protect against Alzheimer's and vascular dementia and to improve brain function in earlier stages of the disease, although there isn't conclusive proof that any particular statin or any particular dosage of statin is best for your brain.

Smoking is associated with increased risk of vascular dementia in some people, but not others

Is anyone surprised that smoking would be linked to poor brain health? Current smokers have about a 34 percent greater risk of developing some kind of dementia for every pack of 20 cigarettes they smoke on an "average" day. However, former smokers have no additional risk of the disease. And complicating the relationship between smoking and dementia a little more, Chinese researchers have found that:

  • Increased risk for dementias of all kinds linked to smoking usually shows up between ages 65 and 75, not before and not after.
  • Only people who carry the ApoE4 gene have increased risk for dementia if they smoke.
That doesn't mean that you can get genetic testing, confirm that you don't have ApoE4, and then smoke all you want without any detrimental effects on your health. But it's the combination of this gene and smoking that increases the risk for vascular dementia and Alzheimer's disease.

Heavy drinking is associated with increased risk of vascular dementia

The HUNT study in Norway found that heavy drinkers (usually defined as more than one drink a day for women and more than two drinks a day for men) had up to nearly double the risk of developing vascular dementia than the general public. Not drinking any alcohol at all did not lower the risk of dementia. Heavy drinkers, however, had elevated risk of dementia up to 27 years after they quit.

High-fat diet increases risk of vascular dementia

The (SAD) Standard American Diet is about 40 percent fat. This diet is not associated with increased risk of developing vascular dementia. However a really-high-fat diet with 60 percent fat or more is linked to increased risk. But taking the analysis one more step, a really-really-high-fat diet, such as a carefully controlled ketosis diet, usually under professional supervision, which carefully limits carbohydrates and protein, is not known to induce vascular dementia with prolonged use.

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  • Photo courtesy of SteadyHealth

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