Dementia and Diabetes

[Rekarb]

Here's one more thing to put in the worry box along with blindness and amputations.

http://cme.medscape.com/viewarticle/...p&uac=139503HY

[Russell A.]

Oh, Boy! Just what I ALWAYS wanted!

Russell

[foxl]

BOTH my parents had senile dementia, Alzheimer's type.

Neither had a diagnosis of D ... but I do wonder ... and I just have to hope to h3ll that low-carbing and good glucose control helps.

[Jan B]

Both my grandmas had/have dementia/ Alzheimers.

I read something very interesting about Alzheimers not progressing so quickly among diabetics. That would be one positive among all these negatives. Also, some are calling Alzheimers "Type 3 diabetes".

I get a "password protected" when trying to access the article.

[plattb1]

I get a "password protected" when trying to access the article.

Me, too, Jan B. I thought maybe I had already succumbed to dementia since I couldn't remember how to get to the article ...

[Rekarb]

Sorry didn't recognize that problem.

January 19, 2010 — Results of a new study confirm that the presence of diabetes mellitus in people with mild cognitive impairment (MCI) is associated with an increased risk for progression to dementia.

Although previous studies have shown a link between diabetes and both MCI and dementia, it has not been clear whether diabetes increases the risk for conversion from one to the other, the researchers write.

"Our study demonstrates that individuals with mild cognitive impairment and diabetes are at increased risk of developing dementia," the researchers, with lead author Latha Velayudhan, DNB (Psychiatry), from the Institute of Psychiatry, King's College London, United Kingdom, conclude. "This suggests the need for studies of improved diabetes control and related approaches as possible strategies for early intervention."

Their findings are published in the January issue of the British Journal of Psychiatry.

Early Identification

People with MCI are at increased risk of developing dementia, although conversion rates range from 1% to more than 25% per year, depending on the study, the investigators write. "Prediction of progression to dementia — conversion — is of considerable clinical importance," they note. "To date, there is no variable other than cognitive impairment itself that unequivocally increases the risk of conversion."

Type 2 diabetes mellitus has been linked to accelerated cognitive decline in elderly people, development of MCI, and increased risk for dementia, including Alzheimer's disease and vascular dementia. However, although the association between diabetes and dementia risk is "robust," they note, it is not yet clear whether diabetes increases the risk for conversion from MCI to dementia.

In this article, Dr. Velayudhan and colleagues looked at the association between diabetes and dementia conversion in a population of 103 people with MCI by Peterson's criteria.

During 4 years of follow-up, 19 progressed to dementia, mostly probable or possible Alzheimer's disease, the diagnosis in 84%. After adjustment for sociodemographic factors, presence of the apolipoprotein E4 (APOE) risk allele, premorbid IQ, and other health conditions, only diabetes mellitus was significantly associated with progression to dementia .

Table. Risk of Conversion to Dementia Associated With Diabetes Mellitus

Factor Hazard Ratio 95% CI
Diabetes mellitus 2.9 1.1 – 1.73
CI = confidence interval

This cohort was mostly white European participants, they note. Repeating this investigation in different populations where diabetes prevalence is higher, such as some ethnic groups, would be of interest.

Possible mechanisms by which diabetes might increase dementia risk include insulin resistance syndrome, disturbances in insulin homeostasis in the brain, and/or hyperinsulinemia, among others, the study authors write.

"Whatever the mechanism, with an expected increase in prevalence of diabetes in people of all ages, including older adults, the risk of developing dementia may increase," they conclude. "Identification of those at particular risk of progression might help to target early treatment — both pharmacological and social."

Findings Not Surprising

Asked for comment on these new findings, Bill Thies, PhD, chief medical and science officer for the Alzheimer's Association, pointed out that there is now a "pretty solid body of evidence" linking diabetes and Alzheimer's disease, at least at the epidemiologic level.

However, "exactly what the mechanism might be is not entirely clear," Dr. Thies added. Type 2 diabetes increases vascular risk, for example, which in turn has been linked to Alzheimer's disease, or the link may have something more directly to do with glucose metabolism or some other effect of insulin in the brain. Although trials of rosiglitazone, used to treat type 2 diabetes, had no effect in patients with Alzheimer's disease, some small studies have suggested that inhaled insulin may improve performance on some measures in Alzheimer's disease, he added.

In that context, then, the findings of the current study are not surprising, Dr. Thies concluded, but "it's always a good thing to document that the things you think are true really are."

The study was funded by the Alzheimer's Research Trust and the UK Medical Research Council and through the National Institute for Health Research, Specialist Biomedical Research Center for Mental Health at the South London & Maudsley National Health Service Foundation Trust, and King's College London. The authors have disclosed no relevant financial relationships.

Br J Psychiatry. 2010;196:36-40.

Clinical Context

Persons with MCI are at increased risk of developing dementia, with estimated risk ranging from 1% to 25% or more annually. Predicting which individuals with MCI will develop dementia would be helpful in research studies and might allow initiation of treatment as early as possible, when chances of success would be greater.

Type 2 diabetes mellitus has been associated with an increased rate of cognitive decline in elderly people, development of MCI, and increased risk for Alzheimer's disease and vascular dementia. Despite these associations, it is not clear whether the presence of diabetes in individuals with MCI is associated with increased risk for progression to dementia.

Study Highlights

The objective of this prospective, community-based study was to evaluate the association between diabetes mellitus and progression to dementia in people older than 65 years with MCI.
Peterson's criteria were used to define MCI (memory complaint, preferably corroborated by an informant; objective memory impairment; normal general cognitive function; intact activities of daily living; and no diagnosis of dementia).
At primary care practices in south London, United Kingdom, 103 white European subjects with MCI were identified.
At baseline, Mini-Mental State Examination score was 25 to 27, and participants' scores were 1.5 SDs below the published norms for any of the Consortium to Establish a Registry for Alzheimer's Disease domains (relative to age, education, and sex).
Age at baseline was 79.4 ± 6.3 years, and 66 participants (64%) were women.
Of 95 participants who had APOE genotyping, 30 (32%) had at least 1 APOE4 allele.
Of 92 participants evaluated for mood with the Geriatric Depression Scale, 31 (29%) were positive for current depression.
Diabetes, as determined from participant self-report and from information provided by general practitioners, was present in 16% of the study sample.
After baseline assessment, participants were evaluated annually from 2001 through 2007; 61 patients (59%) were successfully followed up for 4 years.
Of the 61 subjects, 19 (31%) progressed to dementia, and of these, 84% were thought to have probable or possible Alzheimer's disease.
2 of the participants (3%) improved to apparently normal cognition, and 40 (59%) remained stable. Of the 19 participants with dementia, 7 had diabetes.
Subjects with diabetes were 3 times more likely to progress to dementia than those without diabetes (hazard ratio, 2.9; 95% CI, 1.1 - 7.3).
After adjustment for sociodemographic factors, APOE4, premorbid IQ, and other health conditions, only diabetes mellitus was associated with progression to dementia.
Individuals with diabetes had greater prevalence of cardiovascular and cerebrovascular disease (stroke, transient ischemic attack, angina, myocardial infarction, and coronary artery bypass grafting).
Although stroke or transient ischemic attack was associated with increased risk for progression to dementia, this association did not remain when adjusted for presence and duration of diabetes, age, and sex.
On the basis of these findings, the investigators concluded that diabetes mellitus increases not only the risks for dementia and MCI but also the risk for progression from MCI to dementia.
The authors also recommend identifying those at particular risk of progressing to dementia to help target early treatment, as well as studying improved diabetes control and related approaches as possible strategies for early intervention.
Limitations of this study include lack of measures of glycemia, modest sample size, and limited generalizability.
Clinical Implications

The presence of diabetes mellitus increases not only the risks for dementia and MCI but also the risk for progression from MCI to dementia, based on a white European cohort. Subjects with diabetes were 3 times more likely to progress from MCI to dementia than those without diabetes.
After adjustment for sociodemographic factors, APOE4, premorbid IQ, and other health conditions, only diabetes mellitus was associated with progression to dementia. Although stroke or transient ischemic attack was associated with increased risk for progression to dementia, this association did not remain after adjustment for presence and duration of diabetes, age, and sex.

[plattb1]

Maybe I was better off when I couldn't access the article!

Mmmm .... you're right. Something else to worry about.

This definition of mild cognitive impairment: "memory complaint, preferably corroborated by an informant; objective memory impairment; normal general cognitive function; intact activities of daily living; and no diagnosis of dementia" would seem to fit a lot of people in this age group (and younger) regardless of other medical issues.

I notice they don't theorize that inflammation plays a role. I wonder?

And, this is a really small ... and homogeneous ... sample.

[foxl]

I notice they don't theorize that inflammation plays a role. I wonder?

Well I am pretty durn sure I have read that it does, elsewhere!

http://www.google.com/#hl=en&source=...5311d5ec9ae78f

[plattb1]

Well I am pretty durn sure I have read that it does, elsewhere!

Me, too, which leads me to believe that if you reduce inflammation, you reduce BOTH problems ...

[foxl]

Me, too, which leads me to believe that if you reduce inflammation, you reduce BOTH problems ...

SURELY you do ....

[Jan B]

Diabetics with Alzheimer's have slower memory loss

That is the good piece of news.

Also, some researchers believe inflammation may play a huge role in developing Alzheimers.

[Caravaggio]

Another thing to worry about. So, I'll forget about all these risks, and just concentrate on controlling my blood glucose. Worrying raises stress which raises blood sugar which will likely bring about the very thing one worries about.

Ah, what was I saying again?

[fgummett]

Diabetics with Alzheimer's have slower memory loss

That is the good piece of news.

Also, some researchers believe inflammation may play a huge role in developing Alzheimers.

The team said it was not clear why the rate of memory loss was slower in diabetics, but it could be related to some of the drugs diabetics were taking, the team said.

They said older diabetics were more likely to be taking heart medications such as statins, aspirin or drugs to lower blood pressure. "These drugs have been reported to decrease the risk of developing Alzheimer's disease and also the rate of cognitive decline in people with Alzheimer's disease," the team wrote.

I can't believe the study was not controlled to allow for such obvious variables as medications

IIRC Gary Taubes write in "Good Calories Bad Calories" about a link between the metabolic processes of D and Alzheimer's... the suggestion is that the same kind of process that leads to the Glycation of Haemoglobin (as measured in the A1c test) also leads to Advanced Glycation End-products (AGEs)

[ant hill]

Oh Bother , I have worked in a mental hospital and seeing the patients with this condition and now think I could have this too as my mom had Dementa with Alzheimer's too. My god this is so sad. I'm blind in my right eye, Isn't that enough.