A NOVEL study has revealed that cerebrovascular pathologic changes (CVPC), a condition often associated with dementia in individuals aged 90 and older, may not be linked to traditional cardiovascular risk factors such as hypertension, diabetes, or hyperlipidaemia. The research, conducted as part of The 90+ Study, raises intriguing questions about the role of these risk factors in cerebrovascular health among the very elderly.
Researchers analysed data from 267 participants, with a mean age of 98 at the time of death, 75% of whom were female. The study utilised logistic regression models to examine the relationship between CVPC presence and self-reported vascular risk factors. Adjustments were made for age, sex, and education.
The findings showed no significant associations between traditional risk factors and the presence of CVPC. Interestingly, the use of certain cardiovascular medications appeared to have protective effects. Diuretics were linked to lower odds of atherosclerosis, with an odds ratio (OR) of 0.55, while β-blockers (OR 0.57) and vasodilators (OR 0.40) were associated with reduced odds of cerebral amyloid angiopathy (CAA), a condition frequently implicated in dementia.
The researchers suggest three potential explanations for the results. First, vascular risk factors may not play a significant role in CVPC development at such advanced ages. Alternatively, the use of cardiovascular medications might mitigate these risks. Lastly, survival bias—the phenomenon where healthier individuals outlive those with more severe risk profiles—could obscure any associations between risk factors and CVPC.
These findings add to the growing body of evidence indicating that cardiovascular health in advanced age may differ significantly from that in younger populations. They also highlight the potential importance of antihypertensive medications in reducing specific cerebrovascular changes, even among the oldest old.
The study underscores the need for further research to unravel the complex interactions between age, vascular health, and cerebrovascular conditions, which could inform more targeted prevention and treatment strategies for dementia in ageing populations.
Reference
Rajmohan R et al. Vascular risk factors and cerebrovascular pathologic changes on autopsy: the 90+ Study. Alzheimers Dement. 2025;DOI:10.1002/alz.14454.
