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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses guidelines from the American Heart Association\/American Stroke Association on vascular contributions to cognitive impairment and dementia [Gorelick PB et al. \u003Cem\u003EStroke\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDementias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EVascular contributions to cognitive impairment and dementia in later life are common as people live longer and the burden of cognitive impairment in society becomes increasingly important [Gorelick PB et al. \u003Cem\u003EStroke\u003C\/em\u003E 2011]. Every 69 seconds, a person in the United States develops Alzheimer disease (AD). This rate is expected to double by 2050, with total direct costs of AD and dementia expected to rise to $1.1 trillion [Stefanacci RG. \u003Cem\u003EAm J Manag Care\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPhilip B. Gorelick, MD, MPH, FACP, Medical Director, Hauenstein Neuroscience Center, Saint Mary\u0027s Health Care, Grand Rapids, Michigan, USA, discussed guidelines from the American Heart Association\/American Stroke Association (AHA\/ASA) on vascular contributions to cognitive impairment and dementia [Gorelick PB et al. \u003Cem\u003EStroke\u003C\/em\u003E 2011]. The objectives of the presentation were to provide a rationale for the AHA\/ASA guidance statement, along with key recommendations and next steps.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe imperative for such a statement has been driven by high rates of stroke as the population ages; the association between risk factors and both vascular cognitive impairment (VCI) and AD; and the need for an evidence-based review to guide health care professionals in the treatment, management, and possible prevention of these vascular factors and cognitive impairment.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOlder patients who present to primary care offices often have some form of dementia, but various factors cause the diagnosis to be missed or delayed [Cooksey R, Knebel \u003Cem\u003EJ. J Clin Psychiatry\u003C\/em\u003E 2012]. Some of the key recommendations from the guidelines follow:\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ELifestyle Factors\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe following lifestyle intervention in persons who are at risk for VCI is reasonable: 1) smoking cessation (Class IIa: Level of Evidence [LOE]: A); 2) moderation of alcohol intake (Class IIb; LOE: B); 3) weight control (Class IIb; LOE: B); and 4) physical activity (Class IIb; LOE: B). The use of antioxidants and B vitamins in persons who are at risk for VCI are not useful, based on current evidence (Class III; LOE: A), and are not recommended.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPhysiological Risk Factors\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ETreatment of hypertension (Class I; LOE: A) is recommended for those who are at risk for VCI. Treatment of hyperglycemia (Class IIb; LOE: C) and hypercholesterolemia (Class IIb; LOE: B) may be reasonable. It is uncertain if treatment of inflammation will reduce the risk of VCI in persons who are at risk for VCI (Class IIb; LOE: C).\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EBlood Pressure Lowering and Cognition\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EIn stroke patients, lowering blood pressure is effective for reducing the risk of poststroke dementia (Class I; LOE: B). Reasonable evidence indicates that in middle-aged and young elderly patients, lowering blood pressure can be useful for prevention of late-life dementia (Class IIa; LOE: B). The usefulness of lowering blood pressure in individuals aged older than 80 years is not well established (Class IIb; LOE: B).\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EOther recommendations pertain to a Mediterranean-type dietary pattern, vitamin supplementation, physical activity, and the use of antiaggregant therapy for VCI (all Class IIb; LOE: B) but are not widely agreed upon. The National Institutes of Health State-of-the-Science Conference Statement: Preventing AD and Cognitive Decline concluded that there is no association of even moderate evidence that a modifiable risk factor reduces the risk of developing AD; that most studies show no association, inconclusive evidence, or evidence of generally low quality; and that evidence is inadequate to conclude that any therapeutic intervention delays the onset of AD. The statement also cited inconsistent and varied methodological assessments that prevent clear and concise answers to questions and the need to bridge these gaps [Daviglus ML et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EIn summary, Dr. Gorelick said that VCI may occur when there is clinical or subclinical vascular brain injury that could lead to VCI via strategically placed small and large brain strokes and white matter lesions. Cardiovascular risks, such as hypertension and other factors, are linked not only to VCI risk but also to AD risk. Lowering blood pressure is recommended in those who are at risk for VCI prevention.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/1\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznj51\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}