Vascular factors in dementia and apathy

The number of individuals suffering from dementia is expected to rise significantly in the future. Because so far no curative treatment exists, prevention remains paramount. A large body of evidence points to the direction of an important role of vascular risk factors in the aetiology of dementia and it has been hypothesized that these factors could represent an important target for dementia prevention in older individuals. This thesis presents the findings from the Prevention of Dementia by Intensive Vascular Care study, a large cluster-randomised controlled trial that was executed in primary care to assess whether nurse-led intensive vascular care compared to usual care can prevent dementia and all-cause disability in community-dwelling older adults. Although the intervention did not reduce the incidence of all-cause dementia, subgroup analyses suggested beneficial effects in individuals who were adherent to the intervention, especially those with untreated baseline hypertension. Vascular factors have also been assumed to contribute to the aetiology of apathy symptoms in old age. The second aim of this thesis was to assess whether symptoms of apathy and depression are differentially associated with future cardiovascular disease and stroke in community-dwelling older individuals and to assess potential mechanisms underlying these relationships. Symptoms of apathy, but not of depression, were associated with an increased cardiovascular disease risk. Smoking, diabetes mellitus, and physical inactivity appeared to partly mediate this association. Specifically apathy symptoms were associated with concurrent low-grade inflammation. These findings suggest that apathy symptoms may be both a risk factor and marker for future cardiovascular disease