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

In the paper

“Obesity,71–73 dyslipidemia,74–77 and high BP78,79 are also major contributors to vascular brain health.”

What the sources say

• Partly supported

  This citation is attached to obesity, not dyslipidemia or high blood pressure. The Results (Table 2; page unavailable) associate midlife obesity with greater later dementia risk, but the Discussion (Mechanisms of effects; page unavailable) presents a cardiovascular pathway as plausible rather than established. The paper therefore supports obesity's relevance to brain health, but not the stronger claim that it is a major contributor specifically to vascular brain health. (LLM, conf=0.83)

  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 sourceExperimental — accuracy not yet measured
• Not checked yetcites [72] Barrett-Connor E An introduction to obesity and dementia Curr Alzheimer Res 2007 4 97 101 17430230 source
• Partly supported

  The Results (page unavailable) associate midlife obesity with higher dementia risk and say the relationship was similar for vascular dementia. But the study reports an association, not that obesity is a major causal contributor to vascular brain health; it also finds lower dementia risk with late-life obesity. This citation is attached to obesity, not to dyslipidemia or high blood pressure. (LLM, conf=0.86)

  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 sourceExperimental — accuracy not yet measured
• Not checked yetcites [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
• Not checked yetcites [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
• Partly supported

  The Results (Risk of Incident VaD; page unavailable) associate higher LDL-C and non–HDL-C levels with greater vascular dementia risk. But the paper’s Conclusions describe the lipid–vascular dementia relation as weak, and the Comment says dyslipidemia has not been convincingly demonstrated as a factor in brain ischemia or vascular dementia. It therefore supports a possible association, not the stronger claim that dyslipidemia is a major contributor to vascular brain health. This citation is attached to dyslipidemia, not obesity or high blood pressure. (LLM, conf=0.87)

  cites [76] Reitz C Tang MX Luchsinger J Mayeux R Relation of plasma lipids to Alzheimer disease and vascular dementia Arch Neurol 2004 61 705 714 10.1001/archneur.61.5.705 15148148 PMC2696387 sourceExperimental — accuracy not yet measured
• Not checked yetcites [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
• Not checked yetcites [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
• Not checked yetcites [79] Birns J Kalra L Cognitive function and hypertension J Hum Hypertens 2009 23 86 96 10.1038/jhh.2008.80 18650838 source

In the paper

“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”

What the sources say

• Partly supported

  The Discussion reports that midlife adiposity was associated with greater risk of dementia in old age. But the study did not measure central obesity or assess the risk from late-life obesity; its Strengths and weaknesses section explicitly says a central-obesity measure was not collected. The paper also describes a prospective study finding increased—not protective—dementia risk with obesity in elderly women (Introduction; What is already known on this topic). (LLM, conf=0.88)

  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 sourceExperimental — accuracy not yet measured
• Not checked yetcites [72] Barrett-Connor E An introduction to obesity and dementia Curr Alzheimer Res 2007 4 97 101 17430230 source
• Partly supported

  The Results report that late-life obesity measured by BMI was associated with lower dementia risk. The Discussion cites findings linking midlife abdominal diameter and late-life waist circumference to dementia, but the latter applied to ages 65–76, not all older adults. This study found no significant association between late-life waist-to-hip ratio and dementia, so it does not support the unqualified claim about late-life central obesity. (LLM, conf=0.87)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“whereas cerebral endothelial cells regulate microvascular flow by releasing vasoactive agents such as nitric oxide and prostanoids.29”

What the sources say

• Not checked yetcites [29] Andresen J Shafi NI Bryan RM Jr Endothelial influences on cerebro-vascular tone J Appl Physiol (1985) 2006 100 318 327 16357085 source

In the paper

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

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

What the sources say

• Not checked yetcites [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
• Not checked yetcites [39] Farkas E Luiten PG Cerebral microvascular pathology in aging and Alzheimer’s disease Prog Neurobiol 2001 64 575 611 11311463 source

In the paper

“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.”

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“Most existing definitions of brain health emphasize an absence of overt vascular or neurodegenerative injury such as from stroke and AD.”

In the paper

“Neurovascular coupling ensures that focal increases in brain activity are associated with corresponding increases in blood flow to the activated areas.27”

What the sources say

• Not checked yetcites [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

In the paper

“Therefore, the NVU is critical for maintaining the homeostasis of the cerebral microenvironment, which is essential for brain health (Figure 2).”

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [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
• Not checked yetcites [19] Dichgans M Leys D Vascular cognitive impairment Circ Res 2017 120 573 591 10.1161/CIRCRESAHA.116.308426 28154105 source

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

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

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [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
• Not checked yetcites [105] Singh-Manoux A Fayosse A Sabia S Canonico M Bobak M Elbaz A Kivimaki M Dugravot A Atrial fibrillation as a risk factor for cognitive decline and dementia [published online ahead of print April 29, 2017] Eur Heart J 10.1093/eurheartj/ehx208 https://www.academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehx208 Accessed August 14, 2017 PMC5837240 28460139 source
• Not checked yetcites [106] Thacker EL McKnight B Psaty BM Longstreth WT Jr Sitlani CM Dublin S Arnold AM Fitzpatrick AL Gottesman RF Heckbert SR Atrial fibrillation and cognitive decline: a longitudinal cohort study Neurology 2013 81 119 125 10.1212/WNL.0b013e31829a33d1 23739229 PMC3770176 source

In the paper

“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”

What the sources say

• Not checked yetcites [80] Scarmeas N Stern Y Mayeux R Manly JJ Schupf N Luchsinger JA Mediterranean diet and mild cognitive impairment Arch Neurol 2009 66 216 225 10.1001/archneurol.2008.536 19204158 PMC2653223 source
• Not checked yetcites [81] Welch GN Loscalzo J Homocysteine and atherothrombosis N Engl J Med 1998 338 1042 1050 10.1056/NEJM199804093381507 9535670 source
• Not checked yetcites [82] Miller JW Green R Ramos MI Allen LH Mungas DM Jagust WJ Haan MN Homocysteine and cognitive function in the Sacramento Area Latino Study on Aging Am J Clin Nutr 2003 78 441 447 12936927 source
• Not checked yetcites [83] Elias MF Sullivan LM D’Agostino RB Elias PK Jacques PF Selhub J Seshadri S Au R Beiser A Wolf PA Homocysteine and cognitive performance in the Framingham Offspring Study: age is important Am J Epidemiol 2005 162 644 653 10.1093/aje/kwi259 16107567 source

In the paper

“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”

What the sources say

• Not checked yetcites [85] Kivipelto M Helkala EL Hänninen T Laakso MP Hallikainen M Alhainen K Soininen H Tuomilehto J Nissinen A Midlife vascular risk factors and late-life mild cognitive impairment: a population-based study Neurology 2001 56 1683 1689 11425934 source
• Not checked yetcites [86] Reitz C Tang MX Manly J Mayeux R Luchsinger JA Hypertension and the risk of mild cognitive impairment Arch Neurol 2007 64 1734 1740 10.1001/archneur.64.12.1734 18071036 PMC2672564 source
• Not checked yetcites [87] Gottesman RF Schneider AL Albert M Alonso A Bandeen-Roche K Coker L Coresh J Knopman D Power MC Rawlings A Sharrett AR Wruck LM Mosley TH Midlife hypertension and 20-year cognitive change: the Atherosclerosis Risk in Communities Neurocognitive Study JAMA Neurol 2014 71 1218 1227 10.1001/jamaneurol.2014.1646 25090106 PMC4226067 source
• Not checked yetcites [88] Knopman D Boland LL Mosley T Howard G Liao D Szklo M McGovern P Folsom AR Atherosclerosis Risk in Communities (ARIC) Study Investigators Cardiovascular risk factors and cognitive decline in middle-aged adults Neurology 2001 56 42 48 11148234 source
• Not checked yetcites [65] Kalmijn S Foley D White L Burchfiel CM Curb JD Petrovitch H Ross GW Havlik RJ Launer LJ Metabolic cardiovascular syndrome and risk of dementia in Japanese-American elderly men: the Honolulu-Asia Aging Study Arterioscler Thromb Vasc Biol 2000 20 2255 2260 11031212 source
• Not checked yetcites [79] Birns J Kalra L Cognitive function and hypertension J Hum Hypertens 2009 23 86 96 10.1038/jhh.2008.80 18650838 source

In the paper

“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”

What the sources say

• Not checked yetcites [107] Lo JC Groeger JA Cheng GH Dijk DJ Chee MW Self-reported sleep duration and cognitive performance in older adults: a systematic review and meta-analysis Sleep Med 2016 17 87 98 10.1016/j.sleep.2015.08.021 26847980 source
• Not checked yetcites [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
• Not checked yetcites [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
• Not checked yetcites [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
• Not checked yetcites [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

In the paper

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

In the paper

“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.”

In the paper

“There is some suggestion for clinical benefit from BP control or multidomain interventions, including vascular risk modification combined with lifestyle and behavioral interventions156”

What the sources say

• Not checked yetcites [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

In the paper

“head injury, which can in part be influenced by behavior”

In the paper

“Modifiable cardiovascular risks are prevalent worldwide, may occur across the age continuum, and are associated with adverse consequences later in life.128,176”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“low cardiac output, leading to hypoperfusion dementia”

In the paper

“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.”

In the paper

“The statement did not recommend changes to the current management of cardiovascular risk factors to prevent dementia”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“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.”

In the paper

“The only Class I recommendation was, “In people at risk for vascular cognitive impairment, treatment of hypertension is recommended.”4”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

“A more contemporary scientific statement found inconclusive evidence that BP control preserves cognition in the population at-large.5”

What the sources say

• Not checked yetcites [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

In the paper

“atrial fibrillation, which can be prevented or efficiently monitored and treated to prevent cardioembolism”

In the paper

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

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“For example, there is a limited but increasing body of knowledge on the importance of childhood exposures affecting cognition in later life.183”

What the sources say

• Not checked yetcites [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

In the paper

“This approach may apply to elderly populations.”

In the paper

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

In the paper

“Furthermore, intrauterine and early-life exposures may play important roles in neurocognitive development, as may stress in early life.”

In the paper

“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”

What the sources say

• Not checked yetcites [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

In the paper

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

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“Furthermore, cardiovascular mortality, including ischemic heart disease and stroke, may vary substantially on the basis of geographic variation.177”

What the sources say

• Not checked yetcites [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

In the paper

“In addition, favorable cardiovascular health may be associated with lower healthcare expenditures and resource use.182”

What the sources say

• Not checked yetcites [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