Vascular risk factors, brain changes and cognitive functioning in mid and late life

Abstract

People with dementia have problems with cognitive functions, including their memory. The risk of dementia is greater in people with vascular risk factors such as hypertension or diabetes mellitus. Underlying brain damage can often be visualized with a brain scan. In this thesis, we researched in people without dementia if vascular risk factors are associated with brain changes and if these changes are associated with cognitive functions that may precede dementia. Furthermore, we researched if these risk factors were associated with progression of cognitive decline in patients with dementia. We describe that vascular risk factors are associated with subfields of the hippocampus, an important brain structure for memory, but we did not find that specific subfields were vulnerable. We also researched the presence of small cavities in the hippocampus and found that these were not associated with vascular risk factors or cognitive functioning. Their presence is most likely due to normal anatomical variation of the hippocampus.

In this thesis we also describe that if people with a history of vascular disease experience cognitive problems, this may be associated with small infarctions of the brain, but not with other brain changes such as shrinkage of brain tissue. These people performed less on cognitive tests at first, but after an average of eight years we did not find this difference in performance anymore. We also describe that vascular risk factors have no or limited influence on progression of cognitive decline in patients with dementia.