These “minor” ischemic changes were sufficient to tip the balance and to make the AD changes manifest clinically as dementia. Many risk factors for dementia have been identified in recent years, most of which are common, and several are associated with both AD and VaD, as well as with atherosclerosis.6,7 These include age, hypertension, diabetes mellitus, dyslipidemia, hyperhomocysteinemia, obesity, smoking, coronary artery disease, and low level of education and occupational selleck inhibitor attainment.8-11 It is important to note that many of these risk factors seem to exert Inhibitors,research,lifescience,medical their critical effects already in

midlife.12 In senescence, the changes mayhave disappeared. Most elderly are not overweight any more, have stopped smoking (if they ever did), and even their cholesterol Inhibitors,research,lifescience,medical levels are lower than they have ever been. It is important to realize that an interaction exists between these factors. For example, highly educated people are more likely to follow a healthy lifestyle, eat a healthy diet, not smoke, be involved in stimulating intellectual activities, promote their Inhibitors,research,lifescience,medical physical health

through more strict attention to hypertension and hypercholesterolemia, etc. This makes it almost impossible to separate individual components potentially contributing to or slowing intellectual decline in old age. Since many risk factors are common to AD and VaD, the distinction between Inhibitors,research,lifescience,medical these two “entities” is not so important from an interventionalist point of view, and attention to the risk factors mentioned above could

be effective in controlling various forms of cognitive impairment. Prevention of dementia is theoretically possible if the risk factors are identified and successfully treated in time. While early intervention is desirable, it should be recalled that by the time a person develops the first clinical manifestation of AD, brain pathology is already widespread.4, 13 According Inhibitors,research,lifescience,medical to accepted estimates, the preclinical stage of AD may be as long as 10 years. Most of the prospective studies that were done, or are being performed Calpain at present, in attempt to reduce the incidence of dementia thus actually refer to secondary prevention, ie, assess the appearance of symptoms rather than of the first neuropathologies changes, even if this is not usually acknowledged. The overlap between AD and VaD probably means that there will never be a single mechanism by which this terrible disease can be prevented. However, attention to risk factors is likely to reduce the incidence of dementia. The best supportive data on the importance of these risk factors that we have come from observations like the CAIDE study in Finland,12 in which the incidence of dementia was estimated over a period of 20 years. Similar data were derived from several expensive studies extending for decades.