Modifiable Risk Factors Impact Brain White Matter and Protein Accumulation in Dementia

Smoking, elevated blood pressure, and diabetes influence brain changes associated with dementia differently, according to researchers from Lund University. The study, published in The Journal of Prevention of Alzheimer's Disease (JPAD), examined the biological mechanisms underlying the two most common forms of dementia: Alzheimer's disease and vascular dementia.

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Dementia

It is known that nearly half of dementia cases are linked to modifiable risk factors, including lifestyle choices, cardiovascular health, and metabolic conditions. However, most previous studies treated dementia as a single condition, without differentiating between its biological subtypes.

In the new study, researchers followed almost 500 adults with an average age of 65 and preserved cognitive function over four years. Participants underwent repeated MRI brain scans and biomarker analyses for Alzheimer's disease proteins — amyloid-β and tau — as well as white matter changes characteristic of vascular dementia.

"The analysis revealed that most modifiable risk factors — smoking, cardiovascular disease, high blood lipids, and elevated blood pressure — were primarily associated with vascular brain damage and accelerated white matter changes. These processes impair blood flow and may eventually lead to vascular dementia,” the researchers noted.

In contrast, Alzheimer's disease showed different associations. Diabetes was linked to faster amyloid-β accumulation, while low body mass index was associated with increased tau protein levels.

The study authors emphasize that many patients exhibit both vascular and Alzheimer-type pathological changes simultaneously. Therefore, controlling blood pressure, quitting smoking, and correcting metabolic disorders are important not only for preventing vascular dementia but also for slowing overall cognitive decline.