After Alzheimer's disease, the second leading cause of dementia is stroke. A stroke occurs when blood supply to part of the brain is interrupted. Neurons, like cells elsewhere in the body, require a continuous supply of blood-borne oxygen in order to function and remain viable. When blood flow to the brain is reduced or obstructed during a stroke, neurons are starved for nourishment and may die.

Even "silent" strokes—those that cause few or no observable symptoms—can cause dementia. A large study published in the New England Journal of Medicine in 2003 found that people who had silent strokes were more than twice as likely to develop dementia within three and a half years compared with people who did not have silent strokes. Even those who didn't develop dementia exhibited a sharper decline in performance on memory tests and overall intellectual functioning compared with people who did not have strokes.

Stroke may act synergistically with underlying Alzheimer's pathology to produce clinical disease. In a widely publicized study of aging nuns, researchers at the University of Kentucky reported in the Journal of the American Medical Association (JAMA) in 1997 that participants who had sustained stroke were much more likely to have a diagnosis of dementia than their counterparts who had an equivalent degree of plaque and tangle pathology in their brains but who had not had a stroke. In other words, a stroke, in many cases quite small, lowered the amount of Alzheimer's pathology necessary to cause symptoms of dementia.

Hypertension, hypercholesterolemia (high cholesterol), and diabetes increase your risk for stroke. Although genetic heritage has a lot to do with your likelihood of developing these diseases, lifestyle factors and behaviors are at least as important. You can reduce your risk of these illnesses by avoiding smoking, eating a healthy diet, maintaining a normal weight, and being physically active on a regular basis. If you have hypertension or high cholesterol, make sure you get it under control with a combination of appropriate treatment and improved lifestyle choices and habits.

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