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Three articles in this issue of Neurology® address the question of risk factors for late life dementia. There is already a very large literature on this topic, but these three reports show that more precise definitions can make a difference in interpretation. The new observations create a fresh picture of vascular risk factors. One of the hypotheses that emerges is that the roots of dementia with cerebrovascular features ultimately extend back to childhood.
One study1 found an association between early childhood mental achievement testing and late life dementia. Indeed, such results have been observed before, including by the same group.2 The new findings showed that the association was limited to a late life dementia with cerebrovascular features, clinically diagnosed as vascular dementia. The association did not hold for dementia without cerebrovascular disease. How can this be? Perhaps the most plausible explanation is that childhood academic achievement is correlated with socioeconomic status. Socioeconomic status is strongly associated with stroke risk.3 Cerebrovascular risk factors that include diabetes, …
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