Eliminating Cerebrovascular Disease May Prevent One-Third of US Dementia Cases

A study suggests that eliminating cerebrovascular disease from the US population could prevent 27% to 33% of dementia cases.¹

“There is good evidence from several studies that the burden of VCID is higher in Black groups, Hispanic groups (any race), American Indian groups, Alaska Native groups, and native Hawaiian groups compared with White groups and Asian groups,” wrote study investigator Eric E. Smith, MD, MPH, chair of the American Heart Association Stroke Council on Cardiovascular and Stroke Nursing/ Peripheral Vascular Disease, and colleagues.¹ “The potential implication is that population-wide interventions to address hypertension, diabetes, smoking, and other risk factors may reduce the race- and ethnicity-based disparities in dementia incidence.”

Often, vascular health contributes to cognitive impairment and dementia, a most preventable cause. Vascular disease can be prevented by managing diabetes, high cholesterol, and hypertension, along with regular exercise, a healthy diet, a healthy weight, reduced stress, tobacco avoidance, and movement once an hour.²

Although common, the estimated prevalence and incidence of vascular dementia in the United States are lacking. Investigators sought to assess the prevalence and incidence of vascular dementia by reviewing epidemiological studies, neuropathological data of cerebrovascular contributions to dementia, and neuroimaging data of covert cerebrovascular disease on PubMed and EMBASE between April 28 and May 12, 2024.¹

In this study, investigators assumed 5.58 million people lived with dementia in 2020, with 1.28 million new dementia cases. The dementia prevalence was based on a nationally weighted study, and the dementia incidence was based on a prospective longitudinal study of randomly selected participants in a health plan in the northwest United States. The number of Americans aged ≥ 65 years by age and sex was collected from the 2020 US census.

The review found variability in estimates of vascular dementia, with a greater prevalence in prospective epidemiological and autopsy-based studies than in physician diagnoses studies. Additionally, investigators found more studies on vascular contributions to dementia than to mild cognitive impairment.¹

Epidemiological studies showed that 2.7 million US individuals over 65 years old lived with vascular dementia or mixed dementia with a vascular contribution in 2020. These studies also showed that, in 2020, 603,000 individuals developed new vascular dementia or mixed vascular dementia. Moreover, healthcare billing data indicated that 809,000 people were diagnosed with vascular dementia in 2020, with 102,000 new cases.¹

The review also found that, in 2020, there were approximately 11.3 million people with covert brain infarcts, 11.1 million with high volumes of white matter hyperintensity, and 19.9 million with cerebral microbleeds. These cerebral microbleeds can be potentially detected by magnetic resonance imaging and prevented by risk factor modification.¹

Investigators estimated that eliminating cerebrovascular disease would prevent 27% to 33% of dementia cases, corresponding to 1.5 to 1.8 million fewer people with dementia in 2020.¹

The review showed that the overall dementia prevalence and incidence varied by race and ethnicity. Three studies using Medicare data reported a greater dementia prevalence and incidence among Black and Hispanic groups compared with non-Hispanic groups. An analysis of Medicare beneficiaries aged ≥ 68 years in 2013 found that a greater proportion of vascular dementia cases among non-Hispanic Black participants compared with White participants (19.2% vs 14.4%).³ Another study showed that the non-White race (97% Black) was a strong risk factor for incident vascular dementia (hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.16 – 5.41) or mixed vascular and Alzheimer Disease (HRR, 1.9; 95% CI, 1.06 – 3.27).⁴

The review also found that while women may have a greater dementia prevalence, men may have a greater risk of vascular dementia. One study showed that 15.3% of men had vascular dementia compared with 14% of women.³ Another analysis demonstrated that the incidence rate of vascular dementia was greater in men than women (1.7% vs 1.3%).⁵

“This scientific statement frames the burden of VCID in the US population and underscores the urgent need to control vascular risk factors, demonstrating that they not only contribute to cardiovascular disease and stroke but also place millions of Americans at risk for dementia,” investigators wrote.¹ “Integrating vascular risk reduction strategies into public health initiatives is essential to safeguarding brain health and reducing the burden of dementia.”

References

1. Smith EE, Aparicio HJ, Gottesman RF, et al. Vascular Contributions to Cognitive Impairment and Dementia in the United States: Prevalence and Incidence: A Scientific Statement From the American Heart Association. Stroke. Published online August 18, 2025. doi:10.1161/STR.0000000000000494

2. Vascular Disease (Vasculopathy). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17604-vascular-disease. Accessed August 19, 2025.

3. Goodman RA, Lochner KA, Thambisetty M, Wingo TS, Posner SF, Ling SM. Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011-2013. Alzheimers Dement. 2017;13(1):28-37. doi:10.1016/j.jalz.2016.04.002

4. Kuller LH, Lopez OL, Jagust WJ, et al. Determinants of vascular dementia in the Cardiovascular Health Cognition Study. Neurology. 2005;64(9):1548-1552. doi:10.1212/01.WNL.0000160115.55756.DE

5. Ruitenberg A, Ott A, van Swieten JC, Hofman A, Breteler MM. Incidence of dementia: does gender make a difference? Neurobiol Aging. 2001;22:575–580. doi: 10.1016/s0197-4580(01)00231-7