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Cited by 411Dementia and Cognitive Impairment ResearchCardiovascular Health and Risk FactorsHealth Promotion and Cardiovascular Prevention

Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association

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Gorelick, Philip B., Furie, Karen L., Iadecola, Costantino, Smith, Eric E., Waddy, Salina P., Lloyd-Jones, Donald M., Bae, Hee-Joon, Bauman, Mary Ann +11 more·2017·Stroke
DOI 10.1161/str.0000000000000148PMC PMC5654545
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Abstract

Cognitive function is an important component of aging and predicts quality of life, functional independence, and risk of institutionalization. Advances in our understanding of the role of cardiovascular risks have shown them to be closely associated with cognitive impairment and dementia. Because many cardiovascular risks are modifiable, it may be possible to maintain brain health and to prevent dementia in later life. The purpose of this American Heart Association (AHA)/American Stroke Association presidential advisory is to provide an initial definition of optimal brain health in adults and guidance on how to maintain brain health. We identify metrics to define optimal brain health in adults based on inclusion of factors that could be measured, monitored, and modified. From these practical considerations, we identified 7 metrics to define optimal brain health in adults that originated from AHA’s Life’s Simple 7: 4 ideal health behaviors (nonsmoking, physical activity at goal levels, healthy diet consistent with current guideline levels, and body mass index <25 kg/m 2 ) and 3 ideal health factors (untreated blood pressure <120/<80 mm Hg, untreated total cholesterol <200 mg/dL, and fasting blood glucose <100 mg/dL). In addition, in relation to maintenance of cognitive health, we recommend following previously published guidance from the AHA/American Stroke Association, Institute of Medicine, and Alzheimer’s Association that incorporates control of cardiovascular risks and suggest social engagement and other related strategies. We define optimal brain health but recognize that the truly ideal circumstance may be uncommon because there is a continuum of brain health as demonstrated by AHA’s Life’s Simple 7. Therefore, there is opportunity to improve brain health through primordial prevention and other interventions. Furthermore, although cardiovascular risks align well with brain health, we acknowledge that other factors differing from those related to cardiovascular health may drive cognitive health. Defining optimal brain health in adults and its maintenance is consistent with the AHA’s Strategic Impact Goal to improve cardiovascular health of all Americans by 20% and to reduce deaths resulting from cardiovascular disease and stroke by 20% by the year 2020. This work in defining optimal brain health in adults serves to provide the AHA/American Stroke Association with a foundation for a new strategic direction going forward in cardiovascular health promotion and disease prevention.

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Crossref · 10.1161/str.0000000000000148

Cites

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Claims the paper makes

0 of 145 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Randomized clinical trials of vascular risk factor modification for preventing cognitive decline have not produced consistent results.

    “However, the randomized clinical trials (RCTs) investigating the effect of vascular risk factor modification on the prevention of cognitive decline have not shown consistent results (Table 2).”
    Quote in the paperSubstantial claim
  • Findingnone given

    A benefit of interventions to enhance social or cognitive lifestyle has not yet been convincingly demonstrated.

    “A potential benefit of interventions to enhance social or cognitive lifestyle has thus far not convincingly been demonstrated.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Cerebrovascular autoregulation keeps cerebral blood flow relatively stable despite changes in arterial pressure, protecting the brain from damaging perfusion fluctuations.

    “Cerebrovascular autoregulation maintains cerebral blood flow relatively independently of changes in arterial pressure to protect the brain from damaging fluctuations in cerebral perfusion,28”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Cipolla MJ The Cerebral Circulation San Rafael, CA Morgan & Claypool Life Sciences 2009 1 59 21452434

      Not checked in the free run.

  • Premisecitation

    The neurovascular unit is responsible for the blood-brain barrier, which controls molecular exchange between blood and brain.

    “In addition to regulating cerebral perfusion, the NVU is responsible for the blood-brain barrier, which finely controls the molecular exchange between blood and brain and vice versa through an intricate system of transporters located on the endothelial cell membrane.30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Zhao Z Nelson AR Betsholtz C Zlokovic BV Establishment and dysfunction of the blood-brain barrier Cell 2015 163 1064 1078 10.1016/j.cell.2015.10.067 26590417 PMC4655822 source

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  • Premisereasoning

    Many brain disorders appear later in life but are life-course illnesses.

    “Many brain disorders manifest later in life but, in fact, are life-course illnesses.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 36
  • Classified as probably not a substantial claim. 30

  • May combine two claims.

    Findingreasoning

    None of the trials showed that dementia was prevented; even positive trials showed only modest cognitive improvements of unclear significance for daily functioning and quality of life.

    “In addition, none of the trials showed that dementia was prevented; even the positive trials showed only modest improvements in cognitive performance on neuropsychological tests of unclear significance for daily functioning and quality of life.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Obesity, dyslipidemia, and high blood pressure are major contributors to vascular brain health.

    “Obesity,71–73 dyslipidemia,74–77 and high BP78,79 are also major contributors to vascular brain health.”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [71] Whitmer RA Gunderson EP Barrett-Connor E Quesenberry CP Jr Yaffe K Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study BMJ 2005 330 1360 10.1136/bmj.38446.466238.E0 15863436 PMC558283 source

      Not checked in the free run.

    • cites [72] Barrett-Connor E An introduction to obesity and dementia Curr Alzheimer Res 2007 4 97 101 17430230 source

      Not checked in the free run.

    • cites [73] Fitzpatrick AL Kuller LH Lopez OL Diehr P O’Meara ES Longstreth WT Jr Luchsinger JA Midlife and late-life obesity and the risk of dementia: Cardiovascular Health Study Arch Neurol 2009 66 336 342 10.1001/archneurol.2008.582 19273752 PMC3513375 source

      Not checked in the free run.

    • cites [74] Solomon A Kåreholt I Ngandu T Wolozin B Macdonald SW Winblad B Nissinen A Tuomilehto J Soininen H Kivipelto M Serum total cholesterol, statins and cognition in non-demented elderly Neurobiol Aging 2009 30 1006 1009 10.1016/j.neurobiolaging.2007.09.012 18022292 source

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    • cites [75] Solomon A Kivipelto M Wolozin B Zhou J Whitmer RA Midlife serum cholesterol and increased risk of Alzheimer’s and vascular dementia three decades later Dement Geriatr Cogn Disord 2009 28 75 80 10.1159/000231980 19648749 PMC2814023 source

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    • cites [77] Mielke MM Zandi PP Sjögren M Gustafson D Ostling S Steen B Skoog I High total cholesterol levels in late life associated with a reduced risk of dementia Neurology 2005 64 1689 1695 10.1212/01.WNL.0000161870.78572.A5 15911792 source

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    • cites [78] Launer LJ Ross GW Petrovitch H Masaki K Foley D White LR Havlik RJ Midlife blood pressure and dementia: the Honolulu-Asia Aging Study Neurobiol Aging 2000 21 49 55 10794848 source

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    • cites [79] Birns J Kalra L Cognitive function and hypertension J Hum Hypertens 2009 23 86 96 10.1038/jhh.2008.80 18650838 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Because hypertension, obesity, smoking, and diabetes contribute to cognitive impairment and dementia and can be modified, using AHA's Life's Simple 7 to lower cardiovascular risk, stroke, and heart attack should also help maintain brain health.

    “Because hypertension, obesity, smoking, and diabetes mellitus contribute to cognitive impairment and dementia23,24 and there are interventions that successfully prevent or modify these risk factors, a strategy using AHA’s Life’s Simple 7 to decrease cardiovascular risk, stroke, and heart attack should also contribute to maintenance of brain health.25”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [23] Middleton LE Yaffe K Promising strategies for the prevention of dementia Arch Neurol 2009 66 1210 1215 10.1001/archneurol.2009.201 19822776 PMC2762111 source

      Not checked in the free run.

    • cites [24] Unverzagt FW McClure LA Wadley VG Jenny NS Go RC Cushman M Kissela BM Kelley BJ Kennedy R Moy CS Howard V Howard G Vascular risk factors and cognitive impairment in a stroke-free cohort Neurology 2011 77 1729 1736 10.1212/WNL.0b013e318236ef23 22067959 PMC3208949 source

      Not checked in the free run.

    • cites [25] Thacker EL Gillett SR Wadley VG Unverzagt FW Judd SE McClure LA Howard VJ Cushman M The American Heart Association Life’s Simple 7 and incident cognitive impairment: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study J Am Heart Assoc 2014 3 e000635 10.1161/JAHA.113.000635 24919926 PMC4309046 source

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  • May combine two claims.

    Premisenone given

    Research has convincingly shown that cardiovascular risk factors are major contributors to late-life cognitive health and to risk of stroke and Alzheimer disease.

    “Research has convincingly demonstrated that cardiovascular risk factors are major contributors to late-life cognitive health and risk of stroke and AD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    More recently, molecular interrogation of brain parenchyma through cerebrospinal fluid studies and PET imaging of amyloid and tau burden, and brain network connectivity patterns through functional and diffusion-weighted MRI, have been added as markers of subtle brain injury.

    “More recently, molecular interrogation of brain parenchyma through cerebrospinal fluid studies and positron emission tomography imaging of amyloid and tau burden and of brain network connectivity patterns through functional and diffusion-weighted MRI has been added as a marker of subtle brain injury.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    A broader definition of brain health is needed, one that does not rely only on absence of anatomic and physiological disease and that allows measurement, monitoring, and modification in individuals and populations.

    “There is a need for a broader perspective of the definition of brain health that does not depend on the mere absence of anatomic and physiological disease and encompasses the potential measurement, monitoring, and modification in individuals and in the population.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Brain health is inextricably related to cardiovascular and cerebrovascular health, and interventions that promote cardiovascular health would be expected to promote brain health and vice versa.

    “Therefore, the health of the brain is inextricably related to cardiovascular and cerebrovascular health, and interventions aimed at promoting cardiovascular health would be expected to promote brain health and vice versa.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cerebral endothelial cells regulate microvascular flow by releasing vasoactive agents such as nitric oxide and prostanoids.

    “whereas cerebral endothelial cells regulate microvascular flow by releasing vasoactive agents such as nitric oxide and prostanoids.29”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Andresen J Shafi NI Bryan RM Jr Endothelial influences on cerebro-vascular tone J Appl Physiol (1985) 2006 100 318 327 16357085 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Because many cardiovascular risks can be modified, maintaining brain health and preventing dementia later in life may be possible.

    “Because many cardiovascular risks are modifiable, it may be possible to maintain brain health and to prevent dementia in later life.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Subclinical or silent stroke is at least five times as common as symptomatic stroke and is linked to cognitive, mood, and personality disturbances.

    “Subclinical or silent stroke occurs at least 5 times as commonly as symptomatic stroke and may not be silent because subclinical events are associated with impairment of cognition and disturbances of mood and personality.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Hachinski V World Stroke Organization Stroke and potentially preventable dementias proclamation: updated World Stroke Day proclamation [published correction appears in Stroke. 2016;47:d18] Stroke 2015 46 3039 3040 10.1161/STROKEAHA.115.011237 26504189 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Aging has profound effects on the structure and function of the cerebrovascular system, which may combine with vascular risk factors to further compromise brain health.

    “Aging has profound effects on the structure and function of the cerebrovascular system,34,39 which may act in concert with vascular risk factors to further compromise brain health.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] Faraci FM Protecting against vascular disease in brain Am J Physiol Heart Circ Physiol 2011 300 H1566 H1582 10.1152/ajpheart.01310.2010 21335467 PMC3094081 source

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    • cites [39] Farkas E Luiten PG Cerebral microvascular pathology in aging and Alzheimer’s disease Prog Neurobiol 2001 64 575 611 11311463 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Some definitions also emphasize absence of subclinical injury on brain imaging or cognitive scores above age- and education-dependent normative thresholds.

    “Some definitions additionally emphasize the absence of subclinical injury on brain imaging such as white matter hyperintensities, silent infarcts, microbleeds on brain magnetic resonance imaging (MRI), or cognitive function assessment values above the age- and education-dependent normative thresholds.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Normal brain function depends heavily on adequate delivery of oxygen and glucose by cerebral blood flow, which in turn depends on cardiovascular and cerebrovascular health.

    “With minimal or no energy reserves and the exquisite sensitivity of neurons and glia to chemical changes in the internal milieu, normal brain function is highly dependent on adequate delivery of energy substrates, mainly oxygen and glucose. These are delivered by cerebral blood flow, which, in turn, depends on cardiovascular and cerebrovascular health.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Attwell D Laughlin SB An energy budget for signaling in the grey matter of the brain J Cereb Blood Flow Metab 2001 21 1133 1145 10.1097/00004647-200110000-00001 11598490 source

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  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Most existing definitions of brain health emphasize the absence of overt vascular or neurodegenerative injury such as stroke and Alzheimer disease.

    “Most existing definitions of brain health emphasize an absence of overt vascular or neurodegenerative injury such as from stroke and AD.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Neurovascular coupling matches focal increases in brain activity with increased blood flow to the activated areas.

    “Neurovascular coupling ensures that focal increases in brain activity are associated with corresponding increases in blood flow to the activated areas.27”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Iadecola C Neurovascular regulation in the normal brain and in Alzheimer’s disease Nat Rev Neurosci 2004 5 347 360 10.1038/nrn1387 15100718 source

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  • May combine two claims.

    Interpretationreasoning

    The neurovascular unit is critical for maintaining homeostasis of the cerebral microenvironment, which is essential for brain health.

    “Therefore, the NVU is critical for maintaining the homeostasis of the cerebral microenvironment, which is essential for brain health (Figure 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Macroscopic infarcts occur in about one third to one half of elderly people, and a vascular component is present in up to 80% of major cognitively impairing disorders including Alzheimer disease.

    “Furthermore, macroscopic infarcts occur in about one third to one half of elderly individuals, and of all major cognitively impairing disorders, including AD, there is a vascular component in up to 80%.4,18,19”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [4] Gorelick PB Scuteri A Black SE Decarli C Greenberg SM Iadecola C Launer LJ Laurent S Lopez OL Nyenhuis D Petersen RC Schneider JA Tzourio C Arnett DK Bennett DA Chui HC Higashida RT Lindquist R Nilsson PM Roman GC Sellke FW Seshadri S on behalf of the American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Hea source

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    • cites [18] Centers for Disease Control and Prevention Diabetes public health resource https://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm Accessed May 23, 2017

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    • cites [19] Dichgans M Leys D Vascular cognitive impairment Circ Res 2017 120 573 591 10.1161/CIRCRESAHA.116.308426 28154105 source

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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Factors other than those tied to cardiovascular health may also influence cognitive health.

    “Furthermore, although cardiovascular risks align well with brain health, we acknowledge that other factors differing from those related to cardiovascular health may drive cognitive health.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The neurovascular unit participates in immune surveillance of the brain and produces growth factors that support brain cells and blood vessels.

    “The NVU is also involved in the immune surveillance of the brain and in producing growth factors that support the survival of brain cells and blood vessels.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Faraco G Iadecola C Hypertension: a harbinger of stroke and dementia Hypertension 2013 62 810 817 10.1161/HYPERTENSIONAHA.113.01063 23980072 PMC3847558 source

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  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    To best prevent late-life disease, interventions targeting modifiable risk and protective factors may need to begin in young adulthood, possibly as early as childhood.

    “Although this advisory statement is focused on adults, to best prevent late-life disease, interventions focused on modifiable risk and protective factors may ideally need to be applied in young adulthood, possibly as far back as childhood.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Higher socioeconomic conditions provide more opportunities for cognitive enrichment through more complex occupational exposure.

    “Higher socioeconomic conditions also provide more opportunities for cognitive enrichment through more complex occupational exposure.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Much less is known about how cardiovascular risk factor exposure affects brain health in midlife or earlier in life, despite these factors being well-established risks for cognitive decline, Alzheimer disease, and other dementias.

    “Despite being well-established key risk factors of cognitive decline, AD, and other dementias, much less is known about how cardiovascular risk factor exposure affects brain health in midlife or earlier in the life course.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Atrial fibrillation is causally linked to stroke and subclinical stroke, is increased by certain cardiovascular risks, is associated with cognitive impairment, and is modifiable or preventable.

    “Atrial fibrillation is an important risk in that it is causally linked to stroke and subclinical stroke, is increased by certain cardiovascular risks, is associated with cognitive impairment, and is modifiable or preventable.104–106”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [104] de Bruijn RF Heeringa J Wolters FJ Franco OH Stricker BH Hofman A Koudstaal PJ Ikram MA Association between atrial fibrillation and dementia in the general population JAMA Neurol 2015 72 1288 1294 10.1001/jamaneurol.2015.2161 26389654 source

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  • May combine two claims.

    Premisecitation

    Adherence to a Mediterranean or DASH diet is associated with reduced cognitive decline, possibly through homocysteine reduction and antioxidant and anti-inflammatory pathways.

    “Finally, adherence to a Mediterranean or DASH (Dietary Approach to Stop Hypertension) diet80 has been associated with reduced cognitive decline, potentially and controversially a result of homocysteine reduction, and through antioxidant and anti-inflammatory pathways.81–83”
    Quote in the paperNot a substantial claim0 of 4 sources checked
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      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Midlife and late-life central obesity increase the risk of cognitive impairment, but high late-life obesity as measured by BMI may be protective.

    “Studies suggest that midlife and late-life central obesity increases the risk of cognitive impairment but that high late-life obesity (as assessed by BMI) may be protective.71–73”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [71] Whitmer RA Gunderson EP Barrett-Connor E Quesenberry CP Jr Yaffe K Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study BMJ 2005 330 1360 10.1136/bmj.38446.466238.E0 15863436 PMC558283 source

      Not checked in the free run.

    • cites [72] Barrett-Connor E An introduction to obesity and dementia Curr Alzheimer Res 2007 4 97 101 17430230 source

      Not checked in the free run.

    • cites [73] Fitzpatrick AL Kuller LH Lopez OL Diehr P O’Meara ES Longstreth WT Jr Luchsinger JA Midlife and late-life obesity and the risk of dementia: Cardiovascular Health Study Arch Neurol 2009 66 336 342 10.1001/archneurol.2008.582 19273752 PMC3513375 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Population-based studies have found that midlife hypertension or high systolic blood pressure is associated with cognitive dysfunction and decline and with dementia.

    “Several population-based studies have found that midlife hypertension or high systolic BP is associated with cognitive dysfunction and decline85–88 and dementia.65,79”
    Quote in the paperSubstantial claim0 of 6 sources checked
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      Not checked in the free run.

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      Not checked in the free run.

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      Not checked in the free run.

    • cites [79] Birns J Kalra L Cognitive function and hypertension J Hum Hypertens 2009 23 86 96 10.1038/jhh.2008.80 18650838 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Various sleep characteristics-short or long sleep duration, excessive daytime sleepiness, and more night awakenings-may be associated with poorer cognition or cognitive decline.

    “In addition, a number of studies have suggested that various aspects of sleep (eg, short or long sleep duration, excessive daytime sleepiness, greater number of night awakenings) may be associated with poorer cognition or cognitive decline.107–111”
    Quote in the paperNot a substantial claim0 of 5 sources checked
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    • cites [108] Wu L Sun D Tan Y A systematic review and dose-response meta-analysis of sleep duration and the occurrence of cognitive disorders [published online ahead of print June 6, 2017] Sleep Breath 10.1007/s11325-017-1527-0 https://www.link.springer.com/article/10.1007%2Fs11325-017-1527-0 Accessed August 14, 2017 28589251 source

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    • cites [109] Devore EE Grodstein F Schernhammer ES Sleep duration in relation to cognitive function among older adults: a systematic review of observational studies Neuroepidemiology 2016 46 57 78 10.1159/000442418 26735553 source

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    • cites [110] Keage HA Banks S Yang KL Morgan K Brayne C Matthews FE What sleep characteristics predict cognitive decline in the elderly? Sleep Med 2012 13 886 892 10.1016/j.sleep.2012.02.003 22560827 source

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    • cites [111] Blackwell T Yaffe K Laffan A Ancoli-Israel S Redline S Ensrud KE Song Y Stone KL Osteoporotic Fractures in Men (MrOS) Study Group Associations of objectively and subjectively measured sleep quality with subsequent cognitive decline in older community-dwelling men: the MrOS sleep study Sleep 2014 37 655 663 10.5665/sleep.3562.AB 24899757 PMC4044750 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The statement was independently reviewed by the AHA Science Advisory and Coordinating Committee.

    “The statement was independently reviewed by the AHA Science Advisory and Coordinating Committee.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Blood pressure lowering substantially reduces stroke risk in people with elevated blood pressure, but in clinical trials it has not been conclusively shown to preserve cognitive function.

    “Thus, while BP lowering has been shown to substantially reduce the risk of stroke, in individuals with elevation of BP, BP lowering in a clinical trial setting has not been shown conclusively to preserve cognitive function.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    There is some suggestion of clinical benefit from blood pressure control or multidomain interventions that combine vascular risk modification with lifestyle and behavioral interventions.

    “There is some suggestion for clinical benefit from BP control or multidomain interventions, including vascular risk modification combined with lifestyle and behavioral interventions156”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [156] Ngandu T Lehtisalo J Solomon A Levälahti E Ahtiluoto S Antikainen R Bäckman L Hänninen T Jula A Laatikainen T Lindström J Mangialasche F Paajanen T Pajala S Peltonen M Rauramaa R Stigsdotter-Neely A Strandberg T Tuomilehto J Soininen H Kivipelto M A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial Lancet 2015 385 2255 2263 10.1016/S0140-6736(15)60461-5 25771249 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Head injury can be partly influenced by behavior.

    “head injury, which can in part be influenced by behavior”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Modifiable cardiovascular risks are prevalent worldwide, may occur across the age continuum, and are associated with adverse consequences later in life.

    “Modifiable cardiovascular risks are prevalent worldwide, may occur across the age continuum, and are associated with adverse consequences later in life.128,176”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [128] Gottesman RF Schneider AL Zhou Y Coresh J Green E Gupta N Knopman DS Mintz A Rahmim A Sharrett AR Wagenknecht LE Wong DF Mosley TH Association between midlife vascular risk factors and estimated brain amyloid deposition JAMA 2017 317 1443 1450 10.1001/jama.2017.3090 28399252 PMC5921896 source

      Not checked in the free run.

    • cites [176] GBD 2015 Tobacco Collaborators Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015 Lancet 2017 389 1885 1906 28390697 PMC5439023 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Low cardiac output leads to hypoperfusion dementia.

    “low cardiac output, leading to hypoperfusion dementia”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Although randomized trial evidence to prevent cognitive decline and dementia is incomplete and evolving, observational epidemiological evidence for modifiable risk factors is substantial and was judged substantially in favor of modifying key cardiovascular risks.

    “Although the RCT evidence to prevent cognitive decline and dementia is still incomplete and evolving, the observational epidemiological evidence for modifiable risk factors is substantial.”
    • Also stated in: § Discussion · plain
      “Although the RCT evidence to prevent cognitive decline and dementia is incomplete but evolving, the observational epidemiological evidence for modifiable risk factors was judged to be substantially in favor of modifying key cardiovascular risks.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 2011 AHA/ASA scientific statement did not recommend changes to current management of cardiovascular risk factors to prevent dementia.

    “The statement did not recommend changes to the current management of cardiovascular risk factors to prevent dementia”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Gorelick PB Scuteri A Black SE Decarli C Greenberg SM Iadecola C Launer LJ Laurent S Lopez OL Nyenhuis D Petersen RC Schneider JA Tzourio C Arnett DK Bennett DA Chui HC Higashida RT Lindquist R Nilsson PM Roman GC Sellke FW Seshadri S on behalf of the American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Hea source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Addressing cardiovascular and stroke risk is a large part of maintaining optimal brain health, but it is not the only part.

    “Addressing cardiovascular and stroke risk is a large part of maintaining optimal brain health, but not the only part.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Outcomes such as cognitive function, stroke, and dementia are strongly influenced by metrics that act as antecedents for optimal brain health and serve as ongoing indicators of brain health.

    “The latter outcomes are strongly influenced by metrics that act as antecedents for optimal brain health and serve as ongoing indicators for brain health and the potential for maintenance of optimal brain health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The only Class I recommendation in the 2011 statement was that hypertension treatment is recommended in people at risk for vascular cognitive impairment.

    “The only Class I recommendation was, “In people at risk for vascular cognitive impairment, treatment of hypertension is recommended.”4”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Gorelick PB Scuteri A Black SE Decarli C Greenberg SM Iadecola C Launer LJ Laurent S Lopez OL Nyenhuis D Petersen RC Schneider JA Tzourio C Arnett DK Bennett DA Chui HC Higashida RT Lindquist R Nilsson PM Roman GC Sellke FW Seshadri S on behalf of the American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Hea source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Age and genetic factors are substantial determinants of brain health but are not modifiable and thus not well suited as metrics.

    “For instance, although age and genetic factors are among the substantial determinants of brain health, they are not modifiable and thus not well suited as metrics.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Relevant literature was identified through a systematic review complemented by hand searching of reference lists and expert knowledge.

    “Relevant literature was identified through a systematic review complemented by hand searching of reference lists and expert knowledge of relevant articles focused primarily on topics relating to brain health and maintenance of brain health.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Air pollution is the environmental factor studied most, but results have been inconsistent.

    “Air pollution is the factor that has been studied the most, but the results have not been consistent. Thus, air pollution was not included as a metric for optimal brain health in this AHA statement.120–122”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [120] Peters R Peters J Booth A Mudway I Is air pollution associated with increased risk of cognitive decline? A systematic review Age Ageing 2015 44 755 760 10.1093/ageing/afv087 26188335 source

      Not checked in the free run.

    • cites [121] Jung CR Lin YT Hwang BF Ozone, particulate matter, and newly diagnosed Alzheimer’s disease: a population-based cohort study in Taiwan J Alzheimers Dis 2015 44 573 584 10.3233/JAD-140855 25310992 source

      Not checked in the free run.

    • cites [122] Loop MS Kent ST Al-Hamdan MZ Crosson WL Estes SM Estes MG Jr Quattrochi DA Hemmings SN Wadley VG McClure LA Fine particulate matter and incident cognitive impairment in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort [published correction appears in PLoS One. 2015;10:e0125137] PLoS One 2013 8 e75001 10.1371/journal.pone.0075001 24086422 PMC3783452 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Long-term multidomain lifestyle intervention was feasible and in some cases improved cognition, but its applicability and cost-effectiveness in the general population are unclear.

    “Although the clinical trials showed that implementing a long-term multi-domain lifestyle intervention was feasible and in some cases improved cognition, the applicability and cost-effectiveness of such labor-intensive interventions (ie, often requiring a lifestyle coach, nutritionist, and supervised exercise sessions) in the general population are unclear.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Another scientific statement found insufficient evidence on how to prevent or treat silent cerebrovascular disease detected on neuroimaging, which has been associated with increased future dementia risk.

    “Another scientific statement found insufficient evidence on how to prevent or treat silent cerebrovascular disease (including silent strokes) detected on neuroimaging, which has been associated with increased risk of future dementia.143”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [143] Smith EE Saposnik G Biessels GJ Doubal FN Fornage M Gorelick PB Greenberg SM Higashida RT Kasner SE Seshadri S on behalf of the American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Functional Genomics and Translational Biology; Council on Hypertension Prevention of stroke in patients with silent cerebrovascular disease: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke 2017 48 e44 e71 10.1161/STR.0000000000000116 27980126 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Primordial prevention may be a powerful way to prevent key primary and secondary cardiovascular outcomes because once risk factors are present, optimal reduction of stroke and cardiovascular disease risk may not be possible.

    “Thus, primordial prevention may be a powerful means to prevent key primary and secondary cardiovascular outcomes because once risk factors are present, one may not be able to optimally reduce stroke and cardiovascular disease risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the CHA cohort, members with a favorable health profile in midlife had prolonged survival by about 4 years and postponed onset of all-cause and cardiovascular mortality by 7 years.

    “Overall, those CHA cohort members who had a favorable health profile in midlife had prolonged survival by ≈4 years and postponed onset of all-cause and cardiovascular mortality of 7 years.173”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [173] Allen NB Zhao L Liu L Daviglus M Liu K Fries J Shih YT Garside D Vu TH Stamler J Lloyd-Jones DM Favorable cardiovascular health, compression of morbidity, and healthcare costs: forty-year follow-up of the CHA Study (Chicago Heart Association Detection Project in Industry) Circulation 2017 135 1693 1701 10.1161/CIRCULATIONAHA.116.026252 28461414 PMC5476215 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a Chinese longevity study of the oldest old, compression of activities of daily living disability occurred, but life-span extension was associated with expansion of physical and cognitive disability because more frail elderly survived health problems.

    “In this study, there was compression of activities of daily living disability, but life-span extension was associated with expansion of disability of physical and cognitive functioning because there were more frail elderly who survived health problems.175”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [175] Zeng Y Feng Q Hesketh T Christensen K Vaupel JW Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study Lancet 2017 389 1619 1629 10.1016/S0140-6736(17)30548-2 28285816 PMC5406246 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A more contemporary scientific statement found inconclusive evidence that blood pressure control preserves cognition in the population at large.

    “A more contemporary scientific statement found inconclusive evidence that BP control preserves cognition in the population at-large.5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Iadecola C Yaffe K Biller J Bratzke LC Faraci FM Gorelick PB Gulati M Kamel H Knopman DS Launer LJ Saczynski JS Seshadri S Zeki Al Hazzouri A on behalf of the American Heart Association Council on Hypertension; Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Stroke Council Impact of hypertension on cognitive function: a scientific statement from the American Heart Association Hypertension 2016 68 e67 e94 10.1161/HYP.0000000000000053 27977393 PMC5361411 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Atrial fibrillation can be prevented, monitored, or treated to prevent cardioembolism.

    “atrial fibrillation, which can be prevented or efficiently monitored and treated to prevent cardioembolism”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Education may affect brain health by increasing the capacity to compensate for brain pathology, such as through cognitive reserve.

    “education may affect brain health by enhancing the capacity to compensate for the effects of brain pathology on brain function (eg, cognitive reserve)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    People with hypertension treated to below 120/80 mm Hg have lower stroke and cardiovascular event risk than those with higher blood pressure, but their risk is not as low as that of people who maintain untreated blood pressure below 120/80 mm Hg.

    “Observational epidemiological study shows that individuals with hypertension treated to a BP <120/<80 mm Hg have less risk of stroke and cardiovascular events, but that risk is not as low as those the risk for those who have maintained untreated BP <120/<80 mmHg.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [159] Liu K Colangelo LA Daviglus ML Goff DC Pletcher M Schreiner PJ Sibley CT Burke GL Post WS Michos ED Lloyd-Jones DM Can antihypertensive treatment restore the risk of cardiovascular disease to ideal levels? The Coronary Artery Risk Development in Young Adults (CARDIA) Study and the Multi-Ethnic Study of Atherosclerosis (MESA) J Am Heart Assoc 2015 4 e002275 26391135 PMC4599509 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the CHA cohort, all morbidities were reduced, compression of morbidity was observed absolutely and relatively, and cumulative and annual healthcare costs during Medicare-eligibility years were lower for those with favorable cardiovascular health profiles in midlife.

    “In addition, all morbidities were reduced, compression of morbidity was observed both absolutely and relatively, and there were lower cumulative and annual healthcare costs during the Medicare-eligibility life span in older ages for those with favorable cardiovascular health profiles in midlife.173”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [173] Allen NB Zhao L Liu L Daviglus M Liu K Fries J Shih YT Garside D Vu TH Stamler J Lloyd-Jones DM Favorable cardiovascular health, compression of morbidity, and healthcare costs: forty-year follow-up of the CHA Study (Chicago Heart Association Detection Project in Industry) Circulation 2017 135 1693 1701 10.1161/CIRCULATIONAHA.116.026252 28461414 PMC5476215 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All writing committee members were required to declare conflicts of interest.

    “All writing committee members were required to declare conflicts of interest.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Available evidence from study of AHA's Life's Simple 7 indicates that these factors help preserve cognition and can be measured, modified, and monitored.

    “Available evidence from study of AHA’s Life’s Simple 7 indicates that these factors play a role in the preservation of cognition and can be measured, modified, and monitored.25,112”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [25] Thacker EL Gillett SR Wadley VG Unverzagt FW Judd SE McClure LA Howard VJ Cushman M The American Heart Association Life’s Simple 7 and incident cognitive impairment: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study J Am Heart Assoc 2014 3 e000635 10.1161/JAHA.113.000635 24919926 PMC4309046 source

      Not checked in the free run.

    • cites [112] Reis JP Loria CM Launer LJ Sidney S Liu K Jacobs DR Jr Zhu N Lloyd-Jones DM He K Yaffe K Cardiovascular health through young adulthood and cognitive functioning in midlife Ann Neurol 2013 73 170 179 10.1002/ana.23836 23443990 PMC3608821 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Premisecitation

    The Alzheimer's Association concluded that evidence was sufficiently strong to support promotion of physical activity, management of vascular risk factors, healthy eating, and lifelong learning and cognitive training.

    “The writing committee concluded that the evidence was sufficiently strong to support promotion of physical activity, management of vascular risk factors, healthy eating, and lifelong learning and cognitive training.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [160] Baumgart M Snyder HM Carrillo MC Fazio S Kim H Johns H Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective Alzheimers Dement 2015 11 718 726 10.1016/j.jalz.2015.05.016 26045020 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is a limited but increasing body of knowledge on the importance of childhood exposures affecting cognition in later life.

    “For example, there is a limited but increasing body of knowledge on the importance of childhood exposures affecting cognition in later life.183”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [183] Livingston G Sommerlad A Orgeta V Costafreda SG Huntley J Ames D Ballard C Banerjee S Burns A Cohen-Mansfield J Cooper C Fox N Gitlin LN Howard R Kales HC Larson EB Ritchie K Rockwood K Sampson EL Samus Q Schneider LS Selbæk G Teri L Mukadam N Dementia prevention, intervention and care [published online ahead of print on July 19, 2017] Lancet 2017 http://dx.doi.org/10.1016/S0140-6736(17)31363-6 Accessed August 14, 2017 28735855 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    This approach may apply to elderly populations.

    “This approach may apply to elderly populations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Brain health is an important component of successful aging, and cardiovascular risks seem to play a key role in it.

    “Brain health is an important component of successful aging and one in which cardiovascular risks seem to play a key role.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Intrauterine and early-life exposures may play important roles in neurocognitive development, as may stress in early life.

    “Furthermore, intrauterine and early-life exposures may play important roles in neurocognitive development, as may stress in early life.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Prevention of cognitive impairment and dementia may be viewed as a lifelong process predicated on antecedent factors, with cardiovascular risks playing an important role.

    “Prevention of cognitive impairment and dementia may be viewed as a lifelong process predicated on a number of antecedent factors, with cardiovascular risks playing an important role.112”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [112] Reis JP Loria CM Launer LJ Sidney S Liu K Jacobs DR Jr Zhu N Lloyd-Jones DM He K Yaffe K Cardiovascular health through young adulthood and cognitive functioning in midlife Ann Neurol 2013 73 170 179 10.1002/ana.23836 23443990 PMC3608821 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    AHA's Life's Simple 7 is an ideal starting point for defining optimal brain health because it is easy to measure, monitor, and modify.

    “and is an ideal starting point for defining optimal brain health because it is easy to measure, monitor, and modify.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The South American Tsimane of Bolivia have few coronary artery disease risk factors and the lowest reported levels of coronary artery disease of any population, suggesting the value of primordial prevention.

    “Recently, it has been shown that a forager-horticulturalist population, the South American Tsimane of Bolivia, who have few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population,178 suggesting the value of primordial prevention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [178] Kaplan H Thompson RC Trumble BC Wann LS Allam AH Beheim B Frohlich B Sutherland ML Sutherland JD Stieglitz J Rodriguez DE Michalik DE Rowan CJ Lombardi GP Bedi R Garcia AR Min JK Narula J Finch CE Gurven M Thomas GS Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study Lancet 2017 389 1730 1739 10.1016/S0140-6736(17)30752-3 28320601 PMC6028773 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cardiovascular mortality, including ischemic heart disease and stroke, may vary substantially by geographic location.

    “Furthermore, cardiovascular mortality, including ischemic heart disease and stroke, may vary substantially on the basis of geographic variation.177”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [177] Roth GA Dwyer-Lindgren L Bertozzi-Villa A Stubbs RW Morozoff C Naghavi M Mokdad AH Murray CJL Trends and patterns of geographic variation in cardiovascular mortality among US counties, 1980–2014 JAMA 2017 317 1976 1992 28510678 PMC5598768 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Favorable cardiovascular health may be associated with lower healthcare expenditures and resource use.

    “In addition, favorable cardiovascular health may be associated with lower healthcare expenditures and resource use.182”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [182] Osondu CU Aneni EC Valero-Elizondo J Salami JA Rouseff M Das S Guzman H Younus A Ogunmoroti O Feldman T Agatston AS Veledar E Katzen B Calitz C Sanchez E Lloyd-Jones DM Nasir K Favorable cardiovascular health is associated with lower health care expenditures and resource utilization in a large US employee population: the Baptist Health South Florida Employee Study [published online ahead of print March 13, 2017] Mayo Clin Proc 2017 92 512 524 10.1016/j.mayocp.2016.12.026 https://www.linkinghub.elsevier.com/retrieve/pii/S0025-6196(17)30088-5 Accessed August 14, 2017 28365099 source

      Not checked in the free run.

63 of 63

Cites

Flagged first, then by citations

6 of the 203 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Preventing Dementia and Cognitive Impairment. Leshner AI, Landis S, Stroud C, Downey A, eds. In: Preventing Cognitive Decline and Dementia: A Way Forward. Washington, DC: National Academies Press; 2017:1–130. http://www.nap.edu/24782. Accessed June 23, 2017.
  2. Welsh KA, Breitner JC, Magruder-Habib KM. Detection of dementia in the elderly using telephone screening of cognitive status. Neuropsychiatry Neuropsychol Behav Neurol. 1993;6:103–110.
  3. Glymour M. Identifying Social Determinants of Old Age Cognitive Function [thesis]. Cambridge, MA: Harvard University; 2004.
  4. 10.1097/01.hjh.0000059028.82022.89 · DOI
  5. Bosch J; HOPE Investigators. The effect of blood pressure and cholesterol lowering on cognition. Circulation. 2016;134:e703–e704.

Cited by

Sorted by citations

Related

Authors
Gorelick, P. B., Furie, K. L., Iadecola, C., Smith, E. E., Waddy, S. P., Lloyd-Jones, D. M., Bae, H.-J., Bauman, M. A., Dichgans, M., Duncan, P. W., Girgus, M., Howard, V. J., Lazar, R. M., Seshadri, S., Testai, F. D., van Gaal, S., Yaffe, K., Wasiak, H., & Zerna, C.
Affiliations
Also a member of Maintenance of Brain Health writing group section. Also a member of Optimal Brain Health writing group section. Lead of Maintenance of Brain Health writing group section. Lead of Public Health Impact of Cognitive Impairment, Dementia, Stroke, and Cardiovascular and Stroke Risks writing group section. Senior reviewer.
ORCID
Venue
Stroke
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-10
Volume
48
Issue
10
Pages
e284-e303
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
DOI
10.1161/str.0000000000000148
PMC
PMC5654545
OpenAlex
W2750828728
Semantic Scholar
bdfb5e28fe77abe8675cdd7d96e851d59f91dae8
Cited by
411
References
203
Citations by year
2026: 33 · 2025: 56 · 2024: 39 · 2023: 61 · 2022: 48 · 2021: 54 · 2020: 44 · 2019: 42 · 2018: 32 · 2017: 2
FWCI
4.98
Type
journal article
Language
en
Open access
Locations
  • Stroke (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Seoul National University Open Repository (Seoul National University) (submittedVersion)
Funders
  • American Heart Association
  • Office of Science
  • National Institute on Aging (P30AG010129)
  • National Institute of Neurological Disorders and Stroke (R01NS034179, R01NS095692, R37NS089323, R01NS100447, R21NS096972, R01NS037853, R01NS095441, R01NS017950)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
cognitive health, dementia prevention, cardiovascular risk factors, Life's Essential 8, Life's Simple 7, blood pressure, cholesterol, fasting blood glucose, physical activity, diet, smoking, body mass index, social engagement, primordial prevention, cognitive impairment, aging
MeSH terms
Adult, American Heart Association, Brain, Cognition Disorders, Health Promotion, Humans, United States, Health Behavior, Stroke, Advisory Committees

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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