pearl: statins and fibrates both affect amyloid protein and reduce cognitive decline in hyperlipidemic patients until the decline less that patients without hyperlipidemia in the first place
pearl: treating atherosclerosis slows progression of dementia

notes from medscape

Treating Vascular Risk Factors Slows Cognitive Decline in Alzheimer's Disease
Pauline Anderson
http://www.medscape.com/viewarticle/708364?src=mpnews&spon=12&uac=89474MT

observational study
patients who had all their vascular risk factors (VRFs) treated
had slowest rate of cognitive decline
CVR's to treat: HTN, dyslipidemia, diabetes, tobacco smoking, and atherosclerotic disease

study uses PE, imaging, labs, MMSE
n = 301, mean age 71.7
definite, probably or possible Alz dz (according to National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria)
at least 2 MMSEs at least 6 months apart
mean follow-up for pts was 2.3 years

"The 21 patients who did not have any VRFs to begin with were excluded from the analysis, leaving 280 patients (93.0%) with at least 1 VRF. These participants were divided into 3 groups: no VRFs treated (25.7%), some VRFs treated (42.5%), and all VRFs treated (31.8%).

To assess cognition, the Dementia Rating Scale was performed at baseline, and MMSE scores were recorded at each visit. At the start of the study, the mean MMSE score of patients was 21.6. During the study period, the mean annual decline on MMSE was 1.6 points. The decline was slowest for patients with all VRFs treated."

**Patients whose dyslipidemia was treated with either a statin or a fibrate had a slower decline than those without dyslipidemia.

atherosclerosis
patients with untreated disease declined faster than patients with no disease
not clear how tx slowed decline: decr microinfarcts or other?

no significant effect for treating HTN, diabetes, or tobacco-smoking
n = not enough?

24 died during study
mortality risk was not sig different among groups

2003 dementia affected 27.7 million people worldwide
prevalence is expected to double within 20 yrs

Neurology. 2009;73:674-680. Abstract:
1: Neurology. 2009 Sep 1;73(9):674-80.
Treatment of vascular risk factors is associated with slower decline in Alzheimer disease.Deschaintre Y, Richard F, Leys D, Pasquier F.
Université Lille Nord de France, INSERM UMR 744, Institut Pasteur de Lille, 1 rue Calmette, 59019 Lille Cedex, France.

BACKGROUND: There is growing evidence that vascular risk factors (VRF) contribute to cognitive decline. Whether their treatment can slow down the progression of Alzheimer disease (AD) remains unsettled. The aim of this observational study was to evaluate whether the treatment of VRF is associated with a slower cognitive decline in patients who have AD without cerebrovascular disease (CVD). METHODS: We recruited 301 consecutive patients who had AD without CVD (mean age 71.7 years; 69.4% women; first Mini-Mental State Examination [MMSE] mean score 21.6; mean follow-up 2.3 years), who had attended a memory clinic between 1997 and 2003. VRF sought were high blood pressure, dyslipidemia, diabetes mellitus, tobacco smoking, and atherosclerotic disease. Only 21 patients (7.0%) had no VRF. Others were classified as having no VRF treated (n = 72; 25.7%), some VRF treated (n = 119; 42.5%), or all VRF treated (n = 89; 31.8%). We compared MMSE progression over time among these 3 groups using a mixed random effects regression model. RESULTS: Baseline MMSE scores were similar in the 3 groups. With adjustment for confounding factors, MMSE progression over time differed significantly between groups (p = 0.002). Patients with all their VRF treated declined less than those with none of their VRF treated. Those with some VRF treated tended to have an intermediate decline. CONCLUSIONS: In patients who have Alzheimer disease without CVD, treatment of vascular risk factors (VRF) is associated with a slower decline in Mini-Mental State Examination score. Randomized controlled trials are needed to confirm this association, but our data suggest that dementia should not prevent treatment of VRF.

PMID: 19720973 [PubMed