Which factors contribute to the development of vascular dementia? (Select all that apply)

Rationale: A. Traumatic brain injury (TBI) can cause cognitive impairment and increase the risk of certain neurocognitive disorders, particularly Alzheimer’s disease and chronic traumatic encephalopathy. However, TBI is not a primary contributor to vascular dementia, as vascular dementia specifically results from cerebrovascular disease causing ischemic or hemorrhagic injury to the brain. B. Hypertension is one of the most significant risk factors for vascular dementia. Chronic high blood pressure damages arterial walls, promotes arteriosclerosis, and increases the risk of small vessel disease and stroke. These vascular changes reduce cerebral perfusion and can cause cumulative brain injury, directly contributing to vascular cognitive decline. C. Chronic heavy alcohol intake contributes to vascular dementia by increasing blood pressure, promoting cardiomyopathy, and causing small vessel cerebrovascular disease. Alcohol also has neurotoxic effects that can exacerbate cognitive impairment. D. Amyloid plaques are a hallmark of Alzheimer’s disease and are not a causative factor in vascular dementia. While mixed dementia can involve both amyloid pathology and vascular injury, amyloid deposition alone does not define vascular dementia. E. Smoking accelerates atherosclerosis and damages endothelial cells in blood vessels, including cerebral arteries. This increases the risk of ischemic brain events, microvascular damage, and ultimately contributes to the development of vascular dementia. F. Stroke is a major cause of vascular dementia. Infarcts from ischemic strokes destroy brain tissue and disrupt neural networks. Multiple small strokes (multi-infarct dementia) or a single large stroke can impair cognition, making ischemic events a primary mechanism of vascular cognitive decline. G. Myocardial infarction reflects systemic atherosclerotic cardiovascular disease, which often affects cerebral vessels as well. A history of MI indicates increased risk of cerebrovascular compromise, contributing indirectly to vascular dementia by reducing cerebral blood flow and promoting ischemic injury. H. Diabetes damages blood vessels through hyperglycemia-induced endothelial dysfunction, atherosclerosis, and microvascular injury. These vascular complications increase the risk of ischemic strokes, chronic hypoperfusion, and ultimately cognitive decline consistent with vascular dementia.