Modifiable factors that alter the size of the hippocampus with ageing

Majid Fotuhi, David Do, Clifford Jack

Research output: Contribution to journalReview articlepeer-review

197 Scopus citations


The hippocampus is particularly vulnerable to the neurotoxic effects of obesity, diabetes mellitus, hypertension, hypoxic brain injury, obstructive sleep apnoea, bipolar disorder, clinical depression and head trauma. Patients with these conditions often have smaller hippocampi and experience a greater degree of cognitive decline than individuals without these comorbidities. Moreover, hippocampal atrophy is an established indicator for conversion from the normal ageing process to developing mild cognitive impairment and dementia. As such, an important aim is to ascertain which modifiable factors can have a positive effect on the size of the hippocampus throughout life. Observational studies and preliminary clinical trials have raised the possibility that physical exercise, cognitive stimulation and treatment of general medical conditions can reverse age-related atrophy in the hippocampus, or even expand its size. An emerging concept - the dynamic polygon hypothesis - suggests that treatment of modifiable risk factors can increase the volume or prevent atrophy of the hippocampus. According to this hypothesis, a multidisciplinary approach, which involves strategies to both reduce neurotoxicity and increase neurogenesis, is likely to be successful in delaying the onset of cognitive impairment with ageing. Further research on the constellation of interventions that could be most effective is needed before recommendations can be made for implementing preventive and therapeutic strategies.

Original languageEnglish (US)
Pages (from-to)189-202
Number of pages14
JournalNature Reviews Neurology
Issue number4
StatePublished - Apr 2012

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience


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