Affiliations: [a] Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, Genoa, Italy
| [b] Department of Internal Medicine and Medical Specialties, DIMI, Section of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| [c] Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
| [d] IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Correspondence:
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Correspondence to: Dr. Fiammetta Monacelli, Associate Professor in Geriatrics, DIMi, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy. Tel.: Fax: 00390103351055; E-mail: fiammetta.monacelli@unige.it.
Abstract: Dementia is an age-related clinical condition, with higher incidence rates in older ages. However, there is some evidence that a reverse epidemiology is also observed. Namely, the cohort analysis of dementia incidence rates by birth in selected populations demonstrated a decreased incidence of dementia in late life across the last twenty years, possibly due to decreased incidence of cardiovascular disorders and increased education and cognitive reserve. In line with that, age is probably a proxy for other pathophysiological processes rather than a strictly causative factor for the onset of dementia, especially in oldest old persons. The present narrative review provides an update on the clinical interplay between the spectrum of brain aging, cardiovascular morbidity, dementia pathologies, and their clinical expression in the oldest old patients. Available evidence suggests that vascular prevention in the perspective of dementia largely involve middle ages, with an apparent reverse epidemiology in oldest old. Similarly, the present findings underline how cognitive resilience and frailty may be key relevant mediators in the modulation of the clinical expression of brain mixed neuropathologies in persons over 85 years old, providing a new integrated conceptual framework.
