Dementia
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Risk factors for dementia

We don't know why some people get dementia and others don't. But we do know that certain things make some people more likely to get it. These are called risk factors. Having a risk factor does not mean that you will definitely get dementia. It means only that your risk is somewhat higher than someone who does not have that risk factor.

Age
The risk of getting dementia goes up with age, but age is not the only factor. There are millions of older people who don't have dementia.

About 1 in 20 people over the age of 65 have some form of dementia. This figure rises to about 1 in 5 people who are 80 and over.
 
 
 
 
 
Source:
Alzheimer's Society.
Facts about dementia.
Available at: http://www.alzheimers.org.uk (accessed on 27 September 2006).
 
 
 
 
 
1

Sex
Some types of dementia are more common in women, while others are more common in men.

 
 
 
 
 
Alzheimer's disease
People who have Alzheimer's disease slowly lose their memory and ability to think clearly. As the disease gets worse, they get more confused and start acting differently. Several changes happen in the brain that stop it working properly. Small lumps called amyloid plaques grow in the parts of the brain used for memory and thinking. And bundles of twisted threads called 'neurofibrillary tangles' form inside brain cells. These stop brain cells communicating with each other, and they can cause cells to die. Also, in Alzheimer's disease, the brain does not have enough chemical messengers (neurotransmitters), and holes or gaps appear where brain cells have died.
 
 
 
 
 
Alzheimer's, the most common type of dementia, is more common in women.
 
 
 
 
 
Source:
Bird TD.
Alzheimer's disease and other primary dementias.
In: Braunwald E, Hauser SL, Fauci AS, et al (editors). Harrison's principles of internal medicine. 15th edition. McGraw Hill, New York, U.S.A.; 2001.
 
 
 
 
 
2 The second most common type,
 
 
 
 
 
Lewy body dementia
People with Lewy body dementia slowly lose their memory and ability to think clearly. Most people also get symptoms of Parkinson's disease. This means they may move more slowly and become rather stiff and rigid in the way they do things. People with this type of dementia get small, round clusters of proteins inside their brain cells. These are called Lewy bodies. They stop important chemicals in the brain from working normally. Lewy body dementia can also cause small lumps in the brain called amyloid plaques. They're made of protein and bits of dead cells. The lumps grow in the parts of the brain used for memory and thinking. They may stop messages from passing between brain cells.Lewy body dementia is the second most common cause of dementia after Alzheimer's disease.
 
 
 
 
 
Lewy body dementia, affects equal numbers of men and women. But the next most common type,
 
 
 
 
 
vascular dementia
This type of dementia happens when blood vessels near your brain get damaged, so your brain doesn't get enough blood. Some of the cells in your brain die, which causes symptoms such as confusion and memory problems. Vascular dementia can happen suddenly if you have a stroke. Or it can come on gradually if you have a series of little strokes (this is called multi-infarct dementia).
 
 
 
 
 
vascular dementia, is more common in men. This is probably because more men than women have
 
 
 
 
 
high blood pressure
Your blood pressure is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure "hypertension."
 
 
 
 
 
high blood pressure, which increases the risk of having a
 
 
 
 
 
stroke
You have a stroke when the blood supply to a part of your brain is cut off. This damages your brain and can cause symptoms like weakness or numbness on one side of your body. You may also find it hard to speak if you've had a stroke.
 
 
 
 
 
stroke (a cause of vascular dementia).

For women who have gone through
 
 
 
 
 
menopause
When a woman stops having periods, it is called menopause. This usually happens around the age of 50.
 
 
 
 
 
menopause, doctors used to think that taking
 
 
 
 
 
hormone replacement therapy
Hormone replacement therapy (also called HRT) is given to women after menopause to replace the estrogen (the main female hormone) that is no longer made by their ovaries. It can be given either as estrogen alone or as a combination of estrogen and progestin (another female hormone). It is useful to treat menopausal symptoms such as hot flushes, and to prevent brittle bone disease (osteoporosis). But there are concerns that it may increase the risk of breast cancer, heart attacks and strokes.
 
 
 
 
 
hormone replacement therapy (HRT) would lower their risk of getting Alzheimer's disease and other types of dementia.
 
 
 
 
 
Source:
Bird TD.
Alzheimer's disease and other primary dementias.
In: Braunwald E, Hauser SL, Fauci AS, et al (editors). Harrison's principles of internal medicine. 15th edition. McGraw Hill, New York, U.S.A.; 2001.
 
 
 
 
 
2
 
 
 
 
 
Source:
Hogervorst E, Williams J, Budge M, et al.
The nature of the effect of female gonadal hormone replacement therapy on cognitive function in post-menopausal women: a meta-analysis.
Neuroscience. 2000; 101: 485-512.
 
 
 
 
 
3 But studies haven't shown this to be true. Also, there are risks linked with taking HRT. To learn more, see Hormone replacement therapy (HRT).

Family history and genes
Of all the types of dementia, we know the most about the role of family history and
 
 
 
 
 
genes
Your genes are the parts of your cells that contain instructions for how your body works. Genes are housed on chromosomes, structures that sit in the nucleus at the middle of each of your cells. You have 23 pairs of chromosomes in your normal cells, each of which has thousands of genes. You get one set of chromosomes, and all of the genes that are on them, from each of your parents.
 
 
 
 
 
genes in Alzheimer's disease.

If you have a close relative who has early-onset Alzheimer's disease, you have a greater chance of getting this condition. This is a rare type of Alzheimer's that starts before the age of 60.
 
 
 
 
 
Source:
Carr DB, Goate A, Phil D, et al.
Current concepts in the pathogenesis of Alzheimer's disease.
American Journal of Medicine. 1997; 103 (supplement): S3-S10.
 
 
 
 
 
4 About 1 in 10 people who have Alzheimer's have this type.

In general, the genes people inherit from their parents can make them more likely to get Alzheimer's disease. But the genes don't directly cause the disease. Genes tell the cells of your body how to grow and work. If you have a faulty gene, it means that cells affected by that gene won't work properly.

If you have certain genes from a group called ApoE, you're more likely to get Alzheimer's disease. But having these genes doesn't mean that you'll definitely get Alzheimer's.

You can have a blood test to see if you have one of these genes, but the test can't tell you if you'll get Alzheimer's. Most specialists in the United States advise against genetic testing unless someone in your family had early-onset Alzheimer's.
 
 
 
 
 
Source:
Alzheimer's Disease Education and Referral (ADEAR) Centre
Alzheimer's Disease Genetics

 
 
 
 
 
5

Down's syndrome
Almost all people with
 
 
 
 
 
Down syndrome
Down's syndrome affects some people from birth. It causes learning difficulties, and it also makes some physical problems more likely. It is caused by an extra chromosome. Chromosomes are found in all our cells, and contain genes, which tell cells how to grow and behave.
 
 
 
 
 
Down's syndrome develop brain changes similar to Alzheimer's disease by the time they reach middle age.
 
 
 
 
 
Source:
Prasher VP, Sajith SG, Rees SD, et al.
Significant effect of APOE epsilon 4 genotype on the risk of dementia in Alzheimer's disease and mortality in persons with Down syndrome.
International Journal of Geriatric Psychiatry. 2008; 23: 1134-1140.
 
 
 
 
 
6 However, these brain changes don't lead to symptoms for everyone. One study found that around half of people with Down's had symptoms of Alzheimer's by the time they reached their 60s.
 
 
 
 
 
Source:
Alzheimer's Society.
Learning disabilities and dementia.
2008. Available at http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=103 (accessed on 4 March 2009).
 
 
 
 
 
7

Toxins
Scientists have noticed that some people with Alzheimer's disease have aluminum or zinc in their brains when they die. But we don't know if having these substances in your body increases your chances of getting the disease.
 
 
 
 
 
Source:
Blass JP, Poirer J.
Pathophysiology of Alzheimer's disease.
In: Gauthier S. Clinical diagnosis and management of Alzheimer's disease. Martin Dunitz, London, UK; 1999.
 
 
 
 
 
8 There hasn't been enough research.

Head injury
If you've had an injury to your head, you may be at risk of getting Alzheimer's disease earlier than most people.
 
 
 
 
 
Source:
Blass JP, Poirer J.
Pathophysiology of Alzheimer's disease.
In: Gauthier S. Clinical diagnosis and management of Alzheimer's disease. Martin Dunitz, London, UK; 1999.
 
 
 
 
 
8 This doesn't mean that head injuries cause Alzheimer's. But the injury may speed up the changes in the brain.

Strokes
Having a stroke or lots of little strokes can damage brain cells and lead to vascular dementia. Risk factors for stroke include:
 
 
 
 
 
Source:
Tegos TJ, Kalodiki E, Daskalopoulou SS, et al.
Stroke: epidemiology, clinical picture, and risk factors (part I of III).
Angiology. 2000; 51: 793-808.
 
 
 
 
 
9

  •  
     
     
     
     
    high blood pressure
    Your blood pressure is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure "hypertension."
     
     
     
     
     
    High blood pressure
  •  
     
     
     
     
    high cholesterol
    If you've been told that you have high cholesterol it usually means that your total cholesterol level is 240mg/dL or higher. But doctors also look at the amount of good (HDL) and bad (LDL) cholesterol you have in your blood. Having high levels of bad cholesterol can make it more likely that you'll get certain diseases in your heart and arteries.
     
     
     
     
     
    High cholesterol
  •  
     
     
     
     
    diabetes
    Diabetes is a condition that causes too much sugar to circulate in your blood. It happens when your body stops making a hormone called insulin (type 1 diabetes) or when insulin stops working (type 2 diabetes).
     
     
     
     
     
    Diabetes
  • Smoking
  • Being
     
     
     
     
     
    obesity
    If your body stores more energy than you need for daily functioning, this can make you overweight. The excess energy is stored in your fat cells. If your weight goes above a certain level, doctors call this obesity. Obesity is considered a medical condition. The excess weight can be a strain on your bones and joints. And if you are obese, you're more likely to get other diseases. Doctors have developed a scale for telling how much excess weight you have. This measure, called the body mass index (BMI), depends on your height.
     
     
     
     
     
    obese
  • Not getting much exercise
  • Having an irregular heartbeat (such as
     
     
     
     
     
    atrial fibrillation
    Atrial fibrillation happens when your heart beats in an uneven or irregular way. Normally the beating of your heart is controlled by electrical signals. The signals make the upper parts of your heart (the atria) squeeze blood into the lower parts which then squeeze blood out into your blood vessels. If you have atrial fibrillation, the electrical signal doesn't work well, so the upper parts of the heart don't beat at the right time.
     
     
     
     
     
    atrial fibrillation).

Sources for the information on this page:
  1. Alzheimer's Society.Facts about dementia.Available at: http://www.alzheimers.org.uk (accessed on 27 September 2006).
  2. Bird TD.Alzheimer's disease and other primary dementias.In: Braunwald E, Hauser SL, Fauci AS, et al (editors). Harrison's principles of internal medicine. 15th edition. McGraw Hill, New York, U.S.A.; 2001.
  3. Hogervorst E, Williams J, Budge M, et al.The nature of the effect of female gonadal hormone replacement therapy on cognitive function in post-menopausal women: a meta-analysis.Neuroscience. 2000; 101: 485-512.
  4. Carr DB, Goate A, Phil D, et al.Current concepts in the pathogenesis of Alzheimer's disease.American Journal of Medicine. 1997; 103 (supplement): S3-S10.
  5. Alzheimer's Disease Education and Referral (ADEAR) CentreAlzheimer's Disease Genetics
  6. Prasher VP, Sajith SG, Rees SD, et al. Significant effect of APOE epsilon 4 genotype on the risk of dementia in Alzheimer's disease and mortality in persons with Down syndrome. International Journal of Geriatric Psychiatry. 2008; 23: 1134-1140.
  7. Alzheimer's Society.Learning disabilities and dementia. 2008. Available at http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=103 (accessed on 4 March 2009).
  8. Blass JP, Poirer J.Pathophysiology of Alzheimer's disease.In: Gauthier S. Clinical diagnosis and management of Alzheimer's disease. Martin Dunitz, London, UK; 1999.
  9. Tegos TJ, Kalodiki E, Daskalopoulou SS, et al.Stroke: epidemiology, clinical picture, and risk factors (part I of III).Angiology. 2000; 51: 793-808.
This information was last updated on Mar 05, 2009
BMJ Group
This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2009. All rights reserved.