Midlife cholesterol level and dementia 32 years later

Interest has increased over the past decade in the hypothesis that risk factors experienced in childhood, young adulthood, or middle age contribute to late-life dementia. Such a view opens up new hope for primary prevention, which relies on effective modification of risk factors before the development of irreversible subclinical pathology. Since neurodegenerative pathology underlying dementia is initiated decades before clinical symptoms appear, primary prevention of dementia might be effectively targeted at risk factors in younger and middle-aged adults, whereas in older persons, prevention is most likely to be deemed successful if symptoms are delayed. Any evidence that modifiable early and midlife factors, such as cholesterol level, influence late life-dementia offers the greatest hope for primary prevention.

In this issue, Mielke et al.¹ present results from a unique study of dementia in 5 birth cohorts of Swedish women, aged 38–60 years in 1968, followed for 32 years. The study focuses on the association between total cholesterol in midlife and dementia in late life. Midlife total cholesterol had no association with development of dementia, but decline over 32 years in 5 measures of total cholesterol was associated with increased dementia risk.

Many …