Figure 9.

Proposed pathways from atherosclerotic cardiovascular risk factors for dementia to the development of disease. (1) The body mass index is influenced by the level of physical activity and diet, and the gut microbiome is influenced by diet composition. (2) The body mass index influences LDL cholesterol and triglyceride concentrations, blood pressure, and risk of diabetes and NAFLD. (3) Smoking, LDL cholesterol, triglycerides, blood pressure, and diabetes are all risk factors for developing atherosclerosis. (4) Atherosclerosis can cause long-term reduced cerebral blood flow and hypoxia if vessels are not completely blocked, leading to neuronal energy crisis, neurodegeneration, and eventually, Alzheimer’s disease. Atherosclerosis can also cause acute hypoxia due to strokes, leading to vascular dementia. The association between high levels of HDL cholesterol and a high risk of dementia might be due to reverse causation caused by a low body mass index or due to high alcohol consumption. All risk factors can be influenced by genetics. Created with Biorender.com.