Cognitive Decline and Dementia Trajectories by Dizziness Status in Older Adults.

When someone says, “I can't hear myself think,” it usually means that background noise is making it difficult to concentrate. But another meaning of this expression has emerged from recent research examining the relationship between hearing and cognition in aging. Several studies have demonstrated the association between aspects of auditory abilities and cognitive function in older adults (Laryngoscope Investig Otolaryngol. 2017;2[2]:69). It has long been understood that the perception of complex everyday sounds, such as music and speech, involves much more than auditory detection and discrimination. However, the relationship between hearing and cognition has only recently become the focus of intensive scientific inquiry (Ear Hear. 2016; 37 Suppl 1:5S).hearing loss, ethnicity, race, health careFigure: Kaplan–Meier failure curve showing the cumulative incidence of dementia according to observed hearing loss status (unadjusted for covariates) (N = 1,881). (Republished with permission from J Am Geriatr Soc. 2017;65:1691).One striking finding of this work is that the rate of age-related cognitive decline is significantly greater in older adults with a hearing loss than among their normal-hearing peers, even when controlling for other known risks (Laryngoscope Investig Otolaryngol. 2017). While the presence and magnitude of this effect vary across studies, overall results demonstrate that the negative impact of hearing loss extends well beyond quality of life issues. Understanding the nature of the relationship between hearing loss and cognition can potentially lead to the design of effective interventions to benefit an individual's well-being and reduce the disease burden on society. Several general mechanisms have been proposed to account for a relationship between hearing and cognition (JAMA Intern Med. 2013;173[4]:293). First, the basis could arise from a common cause, such as the general neural degeneration associated with aging that affects both hearing and cognitive function. Second, cascading consequences of the chronic sensory deprivation due to hearing loss may prevent the appropriate stimulation of higher central auditory processing structures, leading to a subsequent decline in cognitive status. The increased listening effort used to compensate for sensory deprivation may itself affect cognitive processing, resulting in suboptimal allocation of limited cognitive resources and reduced performance on other tasks. Finally, hearing loss may indirectly affect cognitive status through a concomitant reduction in the extent of social interaction and an increase in clinical depression. ETHNICITY AND RACE FACTORS A recent study by Golub and colleagues highlighted an important but less-explored aspect of the relationship between hearing loss and cognition in aging–the influence of ethnicity and race (J Am Geriatr Soc. 2017;65[8]:1691). The researchers examined the prevalence of incident dementia and hearing loss in a large longitudinal sample of aging adults from an ethnically diverse neighborhood of New York City. Among 1,881 baseline participants (40% Hispanic, 31% black, and 29% white), 377 developed incident dementia during the average of 7.4 (+/- 4.6) years of follow-up visits. Overall, there was a 1.69 greater risk of incident dementia among participants with hearing loss than normal-hearing participants, even when controlling for other potential contributors such as cardiovascular risk and stroke. When the sample was stratified by ethnicity and race, however, hearing impairment increased the risk of incident dementia only for black participants (2.62, P <.01). The risk of dementia among Hispanics and whites with hearing loss was also greater than that for those with normal hearing (1.43 and 1.61, respectively), though this trend was not statistically significant. Differences among the three groups persisted even when factors such as education and income were considered in statistical modeling. Golub, et al., observed that the specific reasons for the greater risk of dementia in older black adults with hearing loss are not known. The findings are generally consistent with previous research that demonstrated how ethnicity and race can be significant predictors of cognitive status in older adults (J Int Neuropsychol Soc. 2016;22[1]:66). In our previous work, tests of spectral-temporal processing in which listeners were asked to discriminate changes in the phase of a spectral-ripple and compare brief (0.5 sec) spectro-temporal frequency patterns showed reduced performance among black participants compared with white participants (PLoS One. 2015;10[8]:e0134330). Performance on these tests was significantly correlated with global cognition assessed using a battery of 12 neuropsychological tests, more specifically with scores on working memory tests. The authors suggested that differences in the response strategies used by white and black participants in tasks with a high degree of uncertainty may have contributed to the performance differences between the groups. Another study, however, found that black adults demonstrate a greater resilience to age-related hearing loss (J Gerontol A Biol Sci Med Sci. 2011; 66[5]:582). Therefore, the relationship between hearing and cognition in black adults is more complex than a simple group-wise association. Interpretation of the findings of Golub, et al., on racial and ethnic differences requires further caution for several reasons. First, the criterion used to determine the presence of hearing loss in the study was quite lax. The determination was based on the examiner's observations of a participant's hearing status, including whether the examiner needed to speak loudly or if the participant wore a hearing aid. As the authors acknowledged, this assessment approach may potentially confound the effects of hearing loss and dementia because the ability to repeat and follow the experimenter's instruction—part of the basis for hearing loss determination—also involves cognitive processing of linguistic information. In addition, the performance of participants with hearing loss on cognitive tests may in part reflect their inability to hear instructions well. HEARING AIDS AND COGNITIVE DECLINE The reliability of hearing assessment becomes a critical question as an increasing number of studies use examiner observations and patient reports to evaluate the relationship between hearing and cognition. For example, a study by Amieva and colleagues reported that older adults with self-reported hearing loss and who used hearing aids had the same rate of cognitive decline as their normal-hearing peers, while those who had hearing loss but did not use a hearing aid showed a significantly steeper rate of cognitive decline (J Am Geriatr Soc. 2015;63[10]:2099). This finding, based on the analysis of 3,414 participants in a 25-year longitudinal study, is encouraging because it suggests that the negative impact of hearing loss on cognition may be a modifiable risk factor that can be effectively addressed through hearing aid use. On the other hand, the determination of hearing loss in that study was made based on a single question (“Do you have hearing trouble?”) that was asked only once at the baseline assessment. Participants who were either unaware of their hearing loss or felt uncomfortable admitting it, would not be correctly categorized. Similarly, hearing aid use was also assessed only at baseline, thus reflecting neither the frequency nor consistency of hearing aid use over time. Notably, the study findings revealed that the steeper rate of cognitive decline among participants with hearing loss was no longer different from normal-hearing participants after controlling for psychosocial variables. Amieva, the lead author of the study, later observed that “it is highly unlikely that hearing aids have a direct effect on cognition,” and hypothesized that depression and social isolation associated with hearing loss may mediate the relationship (J Am Geriatr Soc. 2015). IMPACT OF HEARING LOSS Indeed, hearing loss affects many aspects of a person's life. In a recent study, Vas and colleagues examined the complaints of those affected by hearing loss and their communication partners (Trends Hear. 2017). Their analysis documented that in addition to complaints directly related to auditory function such as listening and communication, both hearing-impaired individuals and their communication partners presented with a large range of complaints related to social interactions and individual well-being. Given that social engagement and self-appraisal are known factors in the cognitive decline of older adults, it is likely that these may also play a mediating role between hearing and cognition in older adults. Although there is yet a full understanding of the relationship between hearing and cognition, our current knowledge of the mediating factors can already inform the development of a wide range of effective interventions. Among these, hearing instruments as well as cognitively-focused and healthy lifestyle interventions may serve as effective tools to improve the social circumstances and overall well-being of people with hearing loss and those of their families. Journal Club Highlight Observed Hearing Loss and Incident Dementia in a Multiethnic Cohort Golub, JS, et al. J Am Geriatr Soc. 2017; 65:1691.Valeriy Shafiro, PhDStanley Sheft, PhD

This study examined the relationship between sleep disorders and the risk of dementia in patients with newly diagnosed type 2 diabetes. This study used the Korean Health Screening Cohort data and included 39 135 subjects aged ≥40 years with new-onset type 2 diabetes between 2004 and 2007, with follow-up throughout 2013. Sleep disorders were measured by F51(sleep disorders not due to a substance or known physiological condition) or G47(sleep disorders) under International Classification of Diseases, Tenth Revision (ICD-10) codes as a primary diagnosis, and the adjusted hazard ratio (AHR) and 95% CI of all-cause dementia, Alzheimer disease, vascular dementia, and other dementia were estimated using multivariable Cox proportional hazards regression models. In the patients with type 2 diabetes with an age range between 42 and 84 years (M = 57.8, SD = 9.5), this study identified 2059 events of dementia during an average follow-up time of 5.7 years. In patients with type 2 diabetes, subjects with sleep disorders were associated with an increased risk of all-cause dementia (AHR, 1.46; 95% CI, 1.19-1.80), Alzheimer disease (AHR, 1.39; 95% CI, 1.02-1.88), and other dementia (AHR, 1.69; 95% CI, 1.23-2.31) compared to those without sleep disorders. Men (AHR, 1.93; 95% CI, 1.42-2.62) and older adults (AHR, 1.70; 95% CI, 1.35-2.15) with sleep disorders were associated with an increased risk of dementia than their counterparts without sleep disorders among patients with type 2 diabetes. These findings suggest that sleep disorders are significantly associated with an increased risk of dementia in patients with new-onset type 2 diabetes.

BackgroundWidowhood and associated spousal bereavement is a life event that may lead to stress, loneliness, and depression. Previous research found associations between widowhood and an elevated risk of dementia. However, no direct relationship has been evidenced between widowhood and beta‐amyloid (Aβ) pathology, which is a hallmark of Alzheimer’s disease. Additionally, little is known about whether particular demographic or background factors might contribute to potential influences of widowhood on Aβ levels in older adults. Our objective was to evaluate the relationship between widowhood and Aβ positivity status in older adults, and to determine whether subgroups based on age, gender, educational attainment, or APOE ε4 status are driving effects.MethodCognitively normal (CN) subjects (n = 182) who were either widowed (including widows and widowers) or married from the Alzheimer’s Disease Neuroimaging Initiative were included in this study that underwent [18F]Florbetapir PET imaging on the baseline study visit. Multivariable logistic regression interrogated associations between widowhood status and Aβ positivity classification based on a global standardised uptake value ratio threshold of 1.11. This analysis included age, gender, APOE ε4 allele possession, education, and MMSE score as covariates. Regressions were also run in subgroups of CN subjects based on gender (male vs. female), APOE ε4 allele possession (carriers vs. non‐carriers), age (youngest, middle, oldest tertiles), and education (at least an undergraduate degree vs. no undergraduate degree).ResultIn CN subjects, there was overall no significant association between widowhood status and Aβ positivity (p = 0.114). When examining subgroups, widowhood was significantly associated with an increased risk of Aβ positivity in CN individuals with an undergraduate degree or higher (p = 0.025) or in the oldest age tertile (ages ranging from 76.3 to 89) (p = 0.024).ConclusionFindings from this cross‐sectional study indicated that a positive relationship between widowhood and in vivo Aβ neuropathology measured by PET exists specifically in those that are highly educated or undergoing advanced ageing. Whereas cognitive reserve is often hypothesised to mediate links between social isolation, depression and dementia risk, these results suggest that there may also be a direct effect on Alzheimer’s disease neuropathology.

BackgroundAs the only optically accessible part of the central nervous system, the retina represents an intriguing opportunity for the detection of biomarkers for Alzheimer’s disease (AD). This study evaluated the performance of the Retinal Deep PhenotypingTM platform, a digital biomarker platform comprising a hyperspectral retinal camera and image analysis algorithms, for the detection of likely positron‐emission tomography (PET) amyloid status (negative or positive) in older adults. A set of phenotypic features that correlates with the cerebral amyloid status as determined by amyloid PET scan were identified and used to train a classifying algorithm.MethodHyperspectral retinal images acquired with a Mydriatic Hyperspectral Retinal Camera from 194 participants (age ≥ 50 years), including cognitively normal and cognitively impaired (mild cognitive impairment and dementia) across 5 imaging sites were processed in order to train the model. Of these 194 participants, 73 individuals (38%) were amyloid‐positive, as confirmed by unanimous readings of PET scans by a panel of 3 expert reviewers. The pre‐processed hyperspectral images were segmented into various anatomical sites, and a texture‐based approach was used to extract several thousands of spatial‐spectral features. The most relevant features for the classification task were selected using a minimum redundancy maximum relevance (MRMR) algorithm and used to train a linear support vector machine (SVM) classifier. A nested, cross‐validation technique was used to evaluate the performance of the classifier.ResultThe resulting model based on the 17 most significant features showed high performance to discriminate between amyloid positive and negative subjects with an area under the receiver operating curve (AUCROC) of 0.87 (95% CI: 0.83 – 0.92).ConclusionThe Retinal Deep PhenotypingTM platform shows promise for detecting the likely cerebral amyloid PET status in adults 50 years and older from a simple, non‐invasive retinal scan and could provide an accessible means to identify individuals with abnormal cerebral amyloid in a clinical or drug development context. This phenotyping platform provides a flexible approach that could also be used for the detection of multiple biomarkers involved in cognitive decline from the same hyperspectral images of the retina.

The global rise in dementia, including early-onset cases, imposes a growing burden on patients and caregivers. While midlife obesity is a recognized risk factor, the role of body weight fluctuation in dementia and cognitive decline remains uncertain. This systematic review and meta-analysis examined the association between weight variability and the risk of dementia, including Alzheimer's disease, vascular dementia, and cognitive decline. We systematically searched PubMed, Scopus, Web of Science, and PsycINFO, supplemented by manual searches, up to July 2024. Pooled hazard ratios (HRs) were estimated through pairwise meta-analysis, with subgroup analyses conducted to explore heterogeneity. Additionally, the quality of the included studies and the certainty of the evidence were assessed using the "Risk of Bias in Non-randomized Studies of Interventions" (ROBINS-I) tool and the GRADE Tool, respectively. Sixteen studies met the inclusion criteria. Compared with the lowest levels of weight fluctuation, the highest levels were associated with an increased risk of all-cause dementia (HR 1.40, 95% CI 1.29-1.52), Alzheimer's disease (HR 1.33, 95% CI 1.21-1.45), and vascular dementia (HR 1.39, 95% CI 1.16-1.67). No significant association was observed with cognitive decline. No clear source of heterogeneity was identified. High body weight fluctuation is associated with an elevated risk of dementia, particularly Alzheimer's disease and vascular dementia. These findings highlight weight stability as a potential target for dementia prevention strategies. Further high-quality studies are warranted to clarify underlying mechanisms and long-term implications.

Cognitive Decline Before and During COVID-19 Pandemic Among Older People With Multimorbidity: A Longitudinal Study.

BackgroundWith the global aging population, frailty in older adults has emerged as a critical focus in health and aging research. As a dynamic and multifactorial process, the transition to frailty is shaped by not only biological factors but also a range of social, psychological, and environmental influences. Identifying the key factors that drive the progression of frailty is essential for developing preventive interventions for at-risk individuals and for implementing more effective health practices and healthcare strategies for older adults.MethodsData for this study were drawn from the Fourth Sample Survey of the Aged Population in Urban and Rural China, organized by the China National Committee on Ageing. The baseline data were collected from older individuals who participated in the 2017 survey, and the follow-up data were from the 2019 survey. Frailty in older adults was assessed using the Frailty Index (FI) model, which was used to examine the current frailty status among older adults in China and to prospectively analyze the developmental trajectory of frailty. Logistic regression was used to identify the factors influencing the progression of frailty.ResultsA total of 9,093 older adults were included in the analysis. FI values increased with age and were consistently higher in women than in men, indicating that older women had higher levels of frailty. During the two-year follow-up period, frailty status remained stable in most older adults (56.2%, 5,111/9,093), while 1,292 (14.2%, 1,292/9,093) experienced an improvement and 2,690 (29.6%, 2,690/9,093) experienced a worsening of frailty. Transitions to a more frail state were more common than transitions to an improved state. Additionally, transitions between adjacent frailty statuses were much more frequent than transitions across multiple frailty categories (3,669 (40.3%) versus 313 (3.4%)). Logistic regression analysis identified several factors influencing the progression of frailty status in older adults, including demographic factors (age, sex, residence, education, and marital status); family and economic status (living alone, employment, pension receipt, home ownership, financial status); health and medical factors (exercise, recent illness, annual medical checkups, hospitalizations); caregiver support; and social participation (public welfare participation, involvement in senior associations, helping seniors in need, recreational participation, and regular internet access).ConclusionThe worsening of frailty with age is more common in older adults than the improvement of frailty. Among robust and pre-frail individuals, older women are more likely to experience a deterioration in frailty status. The factors influencing frailty transitions are multifaceted and complex. Therefore, when intervening in the progression of frailty among older adults, it is essential to comprehensively assess frailty risks and influencing factors based on the diverse characteristics and current status of individuals. Individualized, comprehensive, and targeted interventions and management strategies, tailored to different frailty stages and transition pathways, can help improve frailty in older adults.

Frailty and malnutrition have emerged as critical public health issues amidst global population aging. Malnutrition not only significantly contributes to frailty but also intensifies its clinical symptoms, severely affecting the quality of life and health outcomes in older adults. Research in this field has accelerated in recent years; however, a comprehensive analysis of key research trends and hotspots remains absent. This study employs bibliometric methods to systematically analyze core themes and emerging research directions related to nutritional status and frailty in older adults, identifying potential research frontiers and guiding future development. A comprehensive search was conducted in the Web of Science Core Collection (WoSCC) database on November 6, 2024, using keywords relevant to frailty and nutrition status in older adults. Bibliometric analyses and knowledge mapping were performed using CiteSpace, VOSviewer, and R software. Between 2005 and 2024, 2,357 publications on frailty and nutrition status in older adults were produced by 13,080 researchers from 3,987 institutions across 88 countries. The volume of publications has shown a consistent upward trajectory over the past two decades (R2 = 0.84), with projections indicating a continued increase, peaking at 315 publications by 2033. This sustained growth underscores the field's significance and ongoing research interest. Early research has centered on the "home-living elderly" demographic, while current investigations have shifted focus from molecular biology, genetics, and health nursing to more clinical and medical domains. Key areas of emphasis now include nutrition and dietetics, geriatrics, oncology, and pharmacology. Emerging research hotspots involve the early identification and management of malnutrition to reduce frailty-related health risks and improve health outcomes and quality of life for older adults. Notable trends include the keywords "prediction," "nutritional assessment MNA," "intervention," and "infection." This bibliometric analysis offers a comprehensive examination of the research evolution, hotspots, and emerging frontiers in frailty and nutrition status among older adults over the past two decades. The findings provide an objective overview of the academic landscape, offering valuable insights for future research, resource allocation, and policymaking.

The longitudinal patterns of change in physical frailty and their associations with the subsequent dementia risk remain unclear. This study aimed to (1) explore the long-term trajectories of physical frailty over a 6-year period in older adults without dementia at baseline; (2) identify the socio-demographic and health-related factors associated with different physical frailty trajectories; and (3) examine the longitudinal relationships between different physical frailty trajectories and subsequent risk of dementia. This national cohort study used data from the National Health and Aging Trends Study (NHATS) conducted in the United States from 2015 to 2021 and included adults aged ≥65 without dementia (n=2245) at baseline in 2015. Group-based trajectory modeling was used to describe the longitudinal changes. Socio-demographic and health-related characteristics were compared across the identified physical frailty trajectories using bivariate analyses, employing Rao-Scott chi-square tests for categorical variables and design-based F-tests for continuous variables. Multinomial logistic regression analyses were conducted to examine the relationships between different frailty trajectories and subsequent dementia status. Three frailty trajectories were identified: low-stable (74.00%), low-increasing (21.14%), and high-level (4.86%). Participants in the low-increasing and high-level groups were predominantly older, female, minorities, unmarried, and less educated and had a lower income, more comorbidities, and greater anxiety and depression symptoms (p<0.001). Compared with the low-stable group, older adults in the low-increasing group had higher risk of possible dementia (RRR: 2.37, 95% CI: 1.41-3.97, p<0.001) and probable dementia (RRR: 1.71, 95% CI: 1.08-2.73, p=0.02); similarly, older adults in the high-level group had higher risks of possible dementia (RRR: 4.24, 95% CI: 1.74-10.36, p<0.001) and probable dementia (RRR: 2.99, 95% CI: 1.32-6.76, p=0.01). No significant differences were found in the risk of dementia between the high-level frailty group and the low-increasing frailty group (p>0.05). This study highlighted the importance of regular frailty monitoring for early detection and informed future interventions that could delay frailty progression and potentially reduce dementia risk.

Introduction: Although increased cholesterol level has been acknowledged as a risk factor for dementia, evidence synthesis based on published data has yielded mixed results. This is especially relevant in older adults where individual studies report non-linear relationships between cholesterol and cognition and, in some cases, find higher cholesterol associated with a lower risk of subsequent cognitive decline or dementia. Prior evidence synthesis based on published results has not allowed us to focus on older adults or to standardize analyses across studies. Given our ageing population, an increased risk of dementia in older adults, and the need for proportionate treatment in this age group, an individual participant data (IPD) meta-analysis is timely. Method: We combined data from 8 studies and over 21,000 participants aged 60 years and over in a 2-stage IPD to examine the relationship between total, high-density, and low-density lipoprotein (HDL and LDL) cholesterol and subsequent incident dementia or cognitive decline, with the latter categorized using a reliable change index method. Results: Meta-analyses found no relationship between total, HDL, or LDL cholesterol (per millimoles per litre increase) and risk of cognitive decline in this older adult group averaging 76 years of age. For total cholesterol and cognitive decline: odds ratio (OR) 0.93 (95% confidence interval [CI] 0.86: 1.01) and for incident dementia: OR 1.01 [95% CI 0.89: 1.13]. This was not altered by rerunning the analyses separately for statin users and non-users or by the presence of an APOE e4 allele. Conclusion: There were no clear consistent relationships between cholesterol and cognitive decline or dementia in this older adult group, nor was there evidence of effect modification by statin use. Further work is needed in younger populations to understand the role of cholesterol across the life-course and to identify any relevant intervention points. This is especially important if modification of cholesterol is to be further evaluated for its potential influence on risk of cognitive decline or dementia.

Evidence on the association between osteoporosis and dementia is not fully clear. This study aimed to investigate the potential association between osteoporosis and the subsequent risk of dementia among older adults. We performed a cohort study of 176 150 community-dwelling older adults aged ≥65 years and free of cognitive impairment between 2018 and 2022 using integrated healthcare data from Shenzhen, China. Diagnoses of osteoporosis, osteoporotic fractures, and dementia were identified through linked outpatient and inpatient medical records and death registration records. Multivariate Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of incident dementia associated with osteoporosis and osteoporotic fractures. The mean (SD) age of the total study population was 70.7 (5.4) years, and 9 605 had a previous diagnosis of osteoporosis. Over a median follow-up of 2.2 (IQR: 1.8–4.3, maximum: 5.5) years, corresponding to 505 423 person-years at risk, 1 367 incident all-cause dementia cases, including 617 Alzheimer’s disease and 298 vascular dementia cases, occurred. Physician-diagnosed osteoporosis was associated with a higher risk of all-cause dementia (HR: 1.80, 95% CI: 1.53–2.12). The increased dementia risk tended to be more prominent among patients with osteoporotic fractures (HR: 2.43, 95% CI: 1.83–3.23) than those without (HR: 1.63, 95% CI: 1.35–1.97). Results were similar for Alzheimer’s disease and vascular dementia. This study provides evidence that older adults with osteoporosis, especially those with osteoporotic fractures, have an elevated risk of incident dementia. Effective prevention and management of osteoporosis among the older population may be promising to mitigate the dual burden of osteoporosis and dementia.

Dietary protein and beef consumption predict for markers of muscle mass and nutrition status in older adults.

A two-year longitudinal study of the impact of cognitive status and depression on frailty status in older adults following hip fracture.

Objective We aimed to investigate the association between gait speed and cognitive status in outpatient older adults from a resource-limited setting in Peru. Methods We performed a cross-sectional study including older adults aged ≥60 years attending a geriatrics outpatient clinic between July 2017 and February 2020. Gait speed was measured over a 10-meters distance without considering the first and last meter traveled. Cognitive status was assessed through the Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE). We used a multivariate binomial logistic regression to conduct both an epidemiological and fully adjusted models. Results We included 519 older adults (mean age: 75 years; IQR = 10), of whom 95 (18.3%) and 151 (31.5%) were cognitively impaired according to the SPMSQ and MMSE, respectively. Gait speed was slower among patients with poorer cognitive status as assessed by both tools (p < 0.001). Malnutrition (PR: 1.74; CI: 1.45–2.08) and functional dependency (PR: 4.35; CI: 2.68–7.08) were associated with a greater prevalence of cognitive impairment according to the SPMSQ, whereas a faster gait speed (PR: 0.27, CI: 0.14–0.52) and longer years of education (PR: 0.83, CI: 0.77–0.88) were associated with a less prevalence. Conclusions Slower gait speed was associated with poorer cognitive status in outpatient older adults. Gait speed may be a complementary tool in the cognitive assessment of older adults from resource-limited settings.

Growing evidence supports a strong and likely causal association between cardiovascular disease (CVD), and its risk factors, with incidence of cognitive decline and Alzheimer's disease. Individuals with subclinical CVD are at higher risk for dementia and Alzheimer's. Several cardiovascular risk factors are also risk factors for dementia, including hypertension, high LDL cholesterol, low HDL cholesterol and especially diabetes. Moderate alcohol appears to be protective for both CVD and dementia. In contrast, inflammatory markers predict cardiovascular risk, but not dementia, despite biological plausibility for such a link. The substantial overlap in risk factors points to new avenues for research and prevention.