The role of prenatal factors in cognitive decline and dementia

Worldwide, people are living longer and the number of people living with dementia is rising. Several lifestyle factors have been identified as risk factors for premature aging, cognitive decline and dementia, including smoking, obesity and reduced social contact. As the majority of brain development occurs prenatally and brain size, structure and function are shaped by the conditions during the prenatal period, prenatal factors may also play a role.
In this thesis we therefore aimed to investigate prenatal factors in relation to the later risk for cognitive decline, dementia and mortality. We systematically reviewed the evidence for the prenatal origins of dementia as well directly assessed the relationship between prenatal undernutrition and later risk for cognitive decline, dementia and mortality by using observational data from the Dutch famine birth cohort as well as Dutch registry data.
Although much remains unclear regarding causal pathways and differences between the sexes, and not all studies in this thesis found evidence for increased cognitive decline and dementia after prenatal undernutrition, the overall findings in this thesis suggest that prenatal factors may play an important role in the aging process. Our findings further emphasize that prenatal exposure to war and hunger may result in negative health outcomes in the developing child decades later. For the health of future generations it is thus essential to protect unborn children and their parents in conditions of adversity. In addition, it would be of great importance to investigate how we can improve the health trajectories of those already exposed to adverse conditions in utero.