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YOU don't have to have a stroke to show signs of cognitive deficits. Just having risk factors for a stroke puts your mind in jeopardy. That's the conclusion of a study being presented Thursday at the American Medical Association's stroke conference in New York City.

The study, which will also appear in the February issue of the American Heart Association journal Stroke, found that people with multiple risk factors for stroke performed worse in cognitive function tests than did people with fewer risk factors.

Some of the biggest risk factors for stroke include age, high blood pressure, antihypertensive medication, smoking, diabetes, a history of cardiovascular disease, and other heart disorders, according to the study.

"This is probably the highest quality study confirming something we've thought for a long time," says Dr. Robert Felberg, director of the stroke program at Ochsner Clinic Foundation Hospital in New Orleans.

"The risk factors for heart disease and stroke can also cause a dementia-type picture. A lot of these dementia syndromes don't start when you're 65. They start when you're 30 or even younger."

In the current study, researchers from Boston University calculated the stroke risk for more than 2,000 men and women who participated in the Framingham Offspring Study. The average age of the study participants was 60 and most were white. The researchers had each volunteer undergo numerous cognitive function tests.

The researchers found a decline in cognitive performance for each 10 percent increment in the 10-year stroke risk. Abstract reasoning, visual-spatial memory, visual organization, concentration, and visual scanning and tracking were the cognitive tasks most affected by the increase in stroke risk. Verbal memory did not appear to be significantly affected.

"This study is the tip of the iceberg," says Dr. John Gilroy, chief of neurology at William Beaumont Hospital in Royal Oak, Mich. Gilroy says there are probably multiple factors, some genetic, that contribute to both Alzheimer's disease and stroke.

Felberg notes that this is another study that shows the importance of controlling risk factors.

Age-related cognitive decline doesn't have to happen, he explains. "High blood pressure and other risk factors for stroke prematurely age the brain and the heart," he says. He adds that it's never too late or too early to start prevention efforts, and that one of the most important risks to control is high blood pressure.

Researchers from Johns Hopkins University School of Medicine also were presenting a study at the conference that looked at cognitive changes in the brain. Preliminary results from this study suggest that reducing stress and increasing physical and mental activity could improve brain health. The authors also think vitamin E may have a protective effect.

In other research presented at the conference, doctors from the Mayo Clinic compared cognitive ability and alertness to come up with new ways to distinguish normal aging from Alzheimer's disease and from a disorder called Lewy body dementia that may account for up to 35 percent of all dementia cases.

They found that 63 percent of the people with Lewy body dementia experienced daytime sleepiness and lethargy, fell asleep more than two hours during the day, stared into space for long periods, and had episodes of disorganized speech.

Only 11 percent of the normally aging group showed one or two of these behaviors, and the people with Alzheimer's also generally only exhibited one or two of these particular symptoms.

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