Type 2 diabetes and/or its treatment leads to less cognitive impairment in Alzheimer's disease patients

Domínguez, Raúl; Marschoff, Enrique; González, Silvia; Repetto, Marisa G.; Serra, Jorge A.

doi:10.1016/j.diabres.2012.05.013

Cited by 48 publications

(42 citation statements)

References 42 publications

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“…Moreover, pioglitazone prevented the accumulation of amyloid-b by increasing cerebral blood flow in patients with diabetes and Alzheimer's disease, which resulted in a significant improvement in MMSE scores [27]. Effective prevention of dementia onset by improvement in insulin resistance has been reported in several studies [28,29]. These studies may support our finding that pioglitazone was associated with a reduced risk of abnormal cognition by 50 %.…”

Section: Discussionsupporting

confidence: 78%

Risk factors associated with abnormal cognition in Japanese outpatients with diabetes, hypertension or dyslipidemia

et al. 2014

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Aims According to the recent increase in life expectancy in patients with diabetes, the incidence of dementia with diabetes is increasing drastically in Japan. However, the number of studies on the prevalence of abnormal cognition and the associated risk factors in a large number of outpatients with diabetes in a primary care setting is very limited. Methods The Mini-Mental State Examination (MMSE) test was performed in 1,449 outpatients aged C50 years with diabetes, hypertension or dyslipidemia (126 without and 1,323 with diabetes). Prevalence of abnormal cognition defined as an MMSE score \24 and the associated risk factors were explored. Results Prevalence of abnormal cognition was 5.8 % in total, and was 8.3 % in outpatients aged C65 years with diabetes. Logistic regression analysis after adjustment for age, sex, BMI and smoking indicated that abnormal cognition was associated with lower serum albumin and higher uric acid levels in all subjects. In subjects with diabetes, in addition to the associations with serum albumin and uric acid levels, lower renal function, retinopathy, use of insulin and a-glucosidase inhibitor, and non-use of pioglitazone and metformin were significantly associated with abnormal cognition independent of the effect of duration of diabetes, hypertension, dyslipidemia, and history of coronary heart disease and stroke. Conclusions Because of the higher prevalence of abnormal cognition in aged outpatients with diabetes found in primary care practice and significant associations with serum albumin, uric acid, renal function, retinopathy and antidiabetic drugs, there is a need for early diagnosis and strategies against dementia.

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Section: Discussionsupporting

confidence: 78%

Risk factors associated with abnormal cognition in Japanese outpatients with diabetes, hypertension or dyslipidemia

et al. 2014

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“…Before being downloaded, the scans were corrected as previously described. 15,16 FreeSurfer (version 5.1) was then used to extract MRI data for volumetric and cortical thickness measurements. Since MRI scanner types and acquisition protocols varied for the 3 ADNI phases (ADNI-1 5 1.5 tesla; ADNI-GO/2 5 3 tesla), MRI field strength was included as a covariate for the MRI data analyses along with age, sex, intracranial volume, and APOE e4 carrier status.…”

Section: Methods Alzheimer's Disease Neuroimaging Initiativementioning

confidence: 99%

Type 2 diabetes mellitus is associated with brain atrophy and hypometabolism in the ADNI cohort

Li¹,

Risacher²,

Huang³

et al. 2016

Neurology

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Objective: We investigated type 2 diabetes mellitus (T2DM) as a risk factor for brain atrophy and glucose hypometabolism in older adults with or at risk of cognitive impairment.Methods: Participants with the T2DM were identified from the Alzheimer's Disease Neuroimaging Initiative (ADNI-1/GO/2 cohorts). Analysis of covariance models were used to compare participants with and without T2DM, controlling for potential confounding factors.Results: Whole brain volume and whole brain [18 F]-fluorodeoxyglucose (FDG) uptake were significantly different as a function of T2DM status, independent of baseline clinical diagnosis. On post hoc analysis, a lower whole brain volume was seen in participants with both mild cognitive impairment (MCI) and T2DM (n 5 76) compared with participants who had MCI but not T2DM (n 5 747; p 5 0.009). Similarly, mean FDG uptake in gray matter and white matter was lower in participants with both MCI and T2DM (n 5 72) than in participants with MCI without T2DM (n 5 719; p 5 0.04). Subsequent regional analysis revealed that the decreased FDG uptake in participants with both MCI and T2DM was mainly manifested in 3 brain regions: frontal lobe, sensory motor cortex, and striatum. Type 2 diabetes mellitus (T2DM) is a risk factor for cognitive impairment, 1 as more than 30% of patients with T2DM have mild cognitive impairment (MCI).2,3 T2DM not only is associated with a high MCI prevalence but may also shorten the conversion time from normal cognition to MCI. 4,5 In 1997, a population-based cohort study reported that T2DM could significantly increase Alzheimer disease (AD) risk. 6 In 1999, the Rotterdam Study reported that T2DM could almost double the AD risk.7 However, no direct link has been found between T2DM and AD from the pathophysiologic perspective.8 In addition, it is not clear how T2DM interacts with existing cognitive impairment in the form of MCI or AD. Thus, the goal of this study was to evaluate how T2DM affects brain structure and glucose metabolism in participants with normal cognition, MCI, or AD. Specifically, the effects of T2DM were examined in a secondary data analysis of the structural brain atrophy and glucose metabolism measures from older adults with normal cognition, MCI, or AD, who were enrolled in the Alzheimer's Disease Neuroimaging Initiative (ADNI). The findings may provide important insight into the biological mechanisms by which T2DM increases the risk of cognitive impairment.From Master of Physician Assistant Studies,

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“…On one hand, T2DM could worsen already impaired cognition functions through additive or synergistic effects with AD [90]. On the other hand, insulin therapy was shown to be effective in slowing cognitive decline in patients with both AD and T2DM [91].…”

Section: T2dm As a Risk Factor For Admentioning

confidence: 99%

An Update on Type 2 Diabetes Mellitus as a Risk Factor for Dementia

Huang

2016

JAD

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With the rapidly expanding evidence on brain structural and functional changes in type 2 diabetes mellitus (T2DM) patients, there is an increasing need to update our understanding on how T2DM associates with dementia as well as the underlying pathophysiological mechanisms. A literature search of T2DM and dementia or cognition impairments was carried out in electronic databases Medline, EMBASE, and Google Scholar. In this review, the chosen evidence was limited to human subject studies only, and data on either type 1 diabetes mellitus (T1DM) or non-classified diabetes were excluded. T2DM is a risk factor for both vascular dementia (VaD) and Alzheimer's disease (AD), although AD pathological marker studies have not provided sufficient evidence. T2DM interacts additively or synergistically with many factors, including old age, hypertension, total cholesterol, and APOE 4 carrier status for impaired cognition functions seen in patients with T2DM. In addition, comorbid T2DM can worsen the clinical presentations of patients with either AD or VaD. In summary, T2DM increases the risk for AD through different mechanisms for VaD although some mechanisms may overlap. Tau-related neurofibrillary tangles instead of amyloid-␤ plaques are more likely to be the pathological biomarkers for T2DM-related dementia. Degeneration of neurons in the brain, impaired regional blood supply/metabolism, and genetic predisposition are all involved in T2DM-associated dementia or cognitive impairments.

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Type 2 diabetes and/or its treatment leads to less cognitive impairment in Alzheimer's disease patients

Cited by 48 publications

References 42 publications

Risk factors associated with abnormal cognition in Japanese outpatients with diabetes, hypertension or dyslipidemia

Risk factors associated with abnormal cognition in Japanese outpatients with diabetes, hypertension or dyslipidemia

Type 2 diabetes mellitus is associated with brain atrophy and hypometabolism in the ADNI cohort

An Update on Type 2 Diabetes Mellitus as a Risk Factor for Dementia

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