Alzheimer's disease (AD) is the most commonly diagnosed sub-type of dementia in persons older than 65 years of age; vascular dementia (VaD) is the second most common sub-type of dementia. Traditionally AD has been studied as an etiologically distinct disease from VaD, that is characterized neuropathologically by neuritic plaques and neurofibrillary tangles. In recent years however, through the insight gained from population-based neuroimaging and neuropathologic studies, it is increasingly recognized that older persons with a diagnosis of AD have multiple pathologies in their brain that could contribute to the pathophysiology or clinical picture of AD. Some of these pathologies are vascular in origin. This has lead to a test of the association between cardiovascular risk factors and the risk for AD in population-based epidemiologic studies. In particular, characterization of vascular risk factors measured in mid-life have been shown to be important predictors of late-life AD. Mid-life levels of vascular risk factors may better reflect exposure than measures made close to the diagnosis of dementia, which may be influenced by the dementing disease process. The proposition that mid-life risk factors influence late life risk for AD is discussed using data from the Honolulu Asia Aging Study (HAAS), which is based on a cohort of Japanese American men followed since 1965 when they were 40-65 years of age.
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