Occurrence and Progression of Dementia in a Community Population Aged 75 Years and Older

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Abstract
IF DEMENTIA with a vascular component comprises nearly half of all cases of dementia in persons aged 85 years and older,1 a substantial portion of cases of dementia may be prevented in this age group. Among many vascular factors or diseases that may be related to dementia,2 hypertension has been suggested3 as the most important vascular risk factor. In fact, hypertension may not only increase the risk of vascular dementia (VaD) by causing ischemic stroke and other cerebrovascular events or lesions,4-10 it may also be involved in the pathogenesis of Alzheimer disease (AD).11 This hypothesis is supported by a recent study12 showing that brain infarction increases the clinical expression of AD and a report13 indicating that cerebral infarction in AD is associated with severe amyloid angiopathy and hypertension. Despite these findings, no data are available regarding the possible effects of antihypertensive medication use in decreasing the risk of dementia in the general population,14 although several clinical trials15,16 have examined the effects of these drugs on cognition.

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