Review:Risk Factors for Dementia

The article reviewed here is ‘Risk factors for Dementia’ by Jen-Hua Chen and colleagues and freely available here. The authors begin with an introduction to dementia and the prevalence of the main types. They then outline the methodology for the paper identifying the databases used and the search period. However there is no mention of the search terms that were used and the search strategy beyond this including exclusion criteria for considered papers. The authors do not state the number of papers identified. They begin with a look at genetics including the strong associations with the APOE4, presenilin-1 and presenilin-2 genes. Presumably due to the submission date they have missed out on the recent findings from the Genome Wide Association studies last year showing three new candidate genes. In the next section they identify the strong association with age as well as looking at some of the controversy over an association with parental age at birth. Gender differences in prevalence are then examined and figures are cited showing that these vary between countries. The authors then discuss some of the evidence showing a strong protective effect for physical activity against dementia and cognitive decline in dementia. The controversies over smoking are discussed and the need for further studies (there was a study from last year which I thought provided convincing evidence against smoking as a protective factor in dementia for instance).

They then discuss the role of drugs as risk factors and include some evidence of benzodiazepine use as a risk factor while also mentioning some conflicting evidence for statins before moving onto antihypertensive medication which is quite topical given a paper published in the BMJ last month. They then discuss some further conflicting data on a potential protective role of HRT and NSAIDS. I think that the antihypertensive medication that is getting a lot of attention at the moment. The protective role of education is discussed briefly but there is probably an interesting story behind this association that is yet to be told. The authors identify the controversies in the evidence for alcohol use as protective factor and they suggest that focusing on wine rather than considering all types of alcohol together would address some of the conflicting findings. The authors identify a differential relationship between BMI and risk of dementia according to age stratifications. The section on comorbidity is brief and after considering some associations they speculate that inflammatory pathways might represent a common theme on the basis of two meta-analyses. They then consider environmental factors lumping together exposure to metals and diet. Again there has been more recent evidence of a protective role of the Mediteranean diet which might have just missed the submission date. Factors such as social relationships are not considered.

This is a brief review in which the authors group risk factors into a number of useful categories and this would be a starting point for a more definitive treatment of the subject.


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