Changing perspectives regarding late-life dementia

Majid Fotuhi, Vladimir Hachinski, Peter J. Whitehouse

Research output: Contribution to journalReview article

Abstract

Individuals over 80 years of age represent the most rapidly growing segment of the population, and late-life dementia has become a major public health concern worldwide. Development of effective preventive and treatment strategies for late-life dementia relies on a deep understanding of all the processes involved. In the centuries since the Greek philosopher Pythagoras described the inevitable loss of higher cognitive functions with advanced age, various theories regarding the potential culprits have dominated the field, ranging from demonic possession, through 'hardening of blood vessels', to Alzheimer disease (AD). Recent studies suggest that atrophy in the cortex and hippocampusnow considered to be the best determinant of cognitive decline with agingresults from a combination of AD pathology, inflammation, Lewy bodies, and vascular lesions. A specific constellation of genetic and environmental factors (including apolipoprotein E genotype, obesity, diabetes, hypertension, head trauma, systemic illnesses, and obstructive sleep apnea) contributes to late-life brain atrophy and dementia in each individual. Only a small percentage of people beyond the age of 80 years have 'pure AD' or 'pure vascular dementia'. These concepts, formulated as the dynamic polygon hypothesis, have major implications for clinical trials, as any given drug might not be ideal for all elderly people with dementia.

Original languageEnglish (US)
Pages (from-to)649-658
Number of pages10
JournalNature Reviews Neurology
Volume5
Issue number12
DOIs
StatePublished - Dec 1 2009

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience

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