Vascular Risks and Incident Dementia: Results from a Cohort Study of the Very Old

Brayne, Carol; Gill, Caroline; Huppert, Felicia A.; Barkley, Claire; Gehlhaar, Eric; Girling, Deborah M.; O'Connor, Daniel William; Paykel, Eugene S.

doi:10.1159/000017043

Cited by 145 publications

(82 citation statements)

References 19 publications

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“…This ratio however in non-diabetic subjects correlates well with the degree of insulin resistance assessed with precise clamping techniques [28]. Several studies have found an increased risk of Alzheimer's disease in people with diabetes mellitus [3,4,17,29,30,31]. Other studies did not find this association or merely an association between diabetes mellitus and vascular dementia [32,33,34,35].…”

Section: Discussionmentioning

confidence: 84%

Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI

et al. 2003

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Aim/hypothesis. Type 2 diabetes increases the risk not only of vascular dementia but also of Alzheimer's disease. The question remains whether diabetes increases the risk of Alzheimer's disease by diabetic vasculopathy or whether diabetes influences directly the development of Alzheimer neuropathology. In vivo, hippocampal and amygdalar atrophy on brain MRI are good, early markers of the degree of Alzheimer neuropathology. We investigated the association between diabetes mellitus, insulin resistance and the degree of hippocampal and amygdalar atrophy on magnetic resonance imaging (MRI) accounting for vascular pathology. Methods. Data was obtained in a population-based study of elderly subjects without dementia between 60 to 90 years of age. The presence of diabetes mellitus and, in non-diabetic subjects, insulin resistance was assessed for 506 participants in whom hippocampal and amygdalar volumes on MRI were measured. We assessed the degree of vascular morbidity by rating carotid atherosclerosis, and brain white matter lesions and infarcts on MRI.Results. Subjects with diabetes mellitus had more hippocampal and amygdalar atrophy on MRI compared to subjects without diabetes mellitus. Furthermore, increasing insulin resistance was associated with more amygdalar atrophy on MRI. The associations were not due to vascular morbidity being more pronounced in persons with diabetes mellitus. Conclusions/interpretation. Type 2 diabetes is associated with hippocampal and amygdalar atrophy, regardless of vascular pathology. This could suggest that Type 2 diabetes directly influences the development of Alzheimer neuropathology. [Diabetologia (2003[Diabetologia ( ) 46:1604[Diabetologia ( -1610

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Section: Discussionmentioning

confidence: 84%

Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI

et al. 2003

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“…To date, a limited number of studies have examined the effect of diabetes on cognition longitudinally (for a review, see [6,7]). The majority of these studies address the development of dementia and usually show an increased incidence of both Alzheimer's disease and vascular dementia in older (mean age 69-77) diabetes patients [21][22][23]. There are only seven populationbased longitudinal studies that have examined cognitive function by means of a cognitive test battery [24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

The impact of diabetes mellitus on cognitive decline in the oldest of the old: a prospective population-based study

et al. 2006

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Aims/hypothesis Diabetes mellitus is a risk factor for the development of cognitive impairment and dementia in the general population up to 75 years of age. As part of the Leiden 85-plus Study we studied the effects of diabetes on cognition in the oldest old. Subjects and methods The Leiden 85-plus Study is a prospective population-based study of 599 persons from age 85 onward. Cognitive function was assessed each year from ages 85 to 90 by means of four neuropsychological tests. The presence of diabetes and vascular disease was recorded at baseline, HbA 1c was assessed by means of a blood sample at ages 85 and 90. The cross-sectional and prospective associations between diabetes and cognitive function were analysed with linear mixed models, adjusted for sex and level of education. Results At age 85, diabetes was associated with a lower level of cognitive functioning on the Letter Digit Coding test and the Stroop Test. Diabetes was not associated with accelerated cognitive decline during follow-up. Within the group of diabetic patients, macrovascular disease was the most important determinant of cognitive dysfunction. Conclusions/interpretation The association between diabetes and accelerated cognitive decline, which has been documented previously in patients up to 75 years of age, may be less evident after age 85. This suggests that the damage occurs in previous years and that therapies aimed at preventing cognitive decline and dementia should focus on the younger old.

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“…104,[116][117][118] A significant correlation with hypertension exists in all forms of vascular dementia. [118][119][120][121] Other risk factors include increasing age, 122 low education, 123 coronary heart disease, 122,124 atrial fibrillation, 125 diabetes, [126][127][128] transient ischaemic attacks and cerebrovascular accidents, 124 high hematocrit level 120 and smoking. 126 …”

Section: Vascular Dementiamentioning

confidence: 99%

Cerebral complications of hypertension

Rigaud

Staessen

et al. 2000

J Hum Hypertens

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Ischaemic and degenerative brain diseases are a major health problem leading to a devastating loss of autonomy. Hypertension has been shown to carry an increased risk not only for cerebrovascular morbidity and mortality but also for cognitive impairment and dementia. Although diastolic blood pressure is considered an important risk factor, it is now clear that isolated systolic hypertension and elevated pulse pressure also play an important role in the development of brain complications. Therefore the treatment of these conditions must urgently become a widespread tool of prevention. All the randomised placebo-controlled trials completed for the last 30 years have shown a reduction in fatal and/or non-fatal strokes. In the most recent trials in isolated systolic hypertension in older patients, the benefit was even greater because of the higher risk in these populations. The new classes of drugs, in particular, calcium-channels blockers and angiotensin-

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Vascular Risks and Incident Dementia: Results from a Cohort Study of the Very Old

Cited by 145 publications

References 19 publications

Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI

Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI

The impact of diabetes mellitus on cognitive decline in the oldest of the old: a prospective population-based study

Cerebral complications of hypertension

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