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Cheng P, Song S, Li Y, Zhang Y, Yi J, Xu X, Zhou H, Zuo Z. Aberrant Functional Connectivity of the Posterior Cingulate Cortex in Type 2 Diabetes Without Cognitive Impairment and Microvascular Complications. Front Endocrinol (Lausanne) 2021; 12:722861. [PMID: 34759889 PMCID: PMC8573207 DOI: 10.3389/fendo.2021.722861] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to investigate the alterations of brain functional connectivity (FC) in type 2 diabetes mellitus (T2DM) patients without clinical evidence of cognitive impairment and microvascular complications (woCIMC-T2DM) using resting-state functional MRI (rs-fMRI) and to determine whether its value was correlated with clinical indicators. METHODS A total of 27 T2DM and 26 healthy controls (HCs) were prospectively examined. Cognitive impairment was excluded using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scales, and microvascular complications were excluded by fundus photography, microalbuminuria, and other indicators. The correlation maps, derived from rs-fMRI with posterior cingulate cortex (PCC) as the seed, were compared between T2DM patients and HCs. Pearson's correlation analysis was performed to determine the relationship between the FC of PCC and the clinical indicators. RESULTS Compared with HC, woCIMC-T2DM patients showed significantly decreased FCs with PCC (PCC-FCs) in the anterior cingulate cortex (ACC), right superior frontal gyrus, right medial frontal gyrus, and right angular gyrus. Meanwhile, increased PCC-FCs was observed in the right superior temporal gyrus and calcarine fissure (CAL). The FC of PCC-ACC was negatively correlated with glycosylated hemoglobin (HbA1c) and diabetes duration, and the FC of PCC-CAL was significantly positively correlated with HbA1c and diabetes duration. CONCLUSION The FC, especially of the PCC with cognitive and visual brain regions, was altered before clinically measurable cognitive impairment and microvascular complications occurred in T2DM patients. In addition, the FC of the PCC with cognitive and visual brain regions was correlated with HbA1c and diabetes duration. This indicates that clinicians should pay attention not only to blood glucose control but also to brain function changes before the occurrence of adverse complications, which is of great significance for the prevention of cognitive dysfunction and visual impairment.
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Affiliation(s)
- Panpan Cheng
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuyan Song
- College of Electrics and Information Engineering, South-Central University for Nationalities, Wuhan, China
| | - Yumin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Zhang
- Department of Endocrinology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yi
- Department of Psychiatry, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyang Xu
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongmei Zhou
- Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hongmei Zhou, ; Zhentao Zuo,
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- CAS Center for Excellence in Brain and Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, China
- *Correspondence: Hongmei Zhou, ; Zhentao Zuo,
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52
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Maria Teixeira M, Passos V, Barreto S, Inês Schmidt M, Duncan B, Beleigoli A, de Jesus Fonseca M, Vidigal P, Figueiredo R, Colosimo E, Araújo L, de Fátima Haueisen S Diniz M. Markers of adiposity, insulin resistance, prediabetes and cognitive function at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA - Brasil). Diabetes Res Clin Pract 2020; 170:108499. [PMID: 33068661 DOI: 10.1016/j.diabres.2020.108499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim of the study is to investigate whether adiposity markers, insulin resistance and prediabetes are associated with cognitive performance in middle-aged men and women without diabetes. METHODS Cross-sectional study with 11,115 adults without diabetes (34-64 years old). Cognitive performance was tested by word-list learning, word-list delayed recall, word recognition tests, semantic and phonemic verbal fluency tests and trail making test B. Linear regression models and generalized linear regression with logarithmic links between the cognitive tests and anthropometric indicators (body mass index [BMI]), insulin resistance (Homeostasis Model Assessment for Insulin Resistance [HOMA-IR]), and prediabetes (impaired glucose tolerance) were stratified by sex. The results were adjusted for age, education, comorbidities, health-related behaviors, waist circumference, and lipids. RESULTS Among women, higher BMI was associated with poorer performance on phonemic verbal fluency test (β-0.02 [-0.04; -0.01]) and memory tests (β-0.05 [-0.07; -0.02]). Higher HOMA-IR was associated with poorer cognitive performance in memory (β-0.11 [-0.19; -0.01]) and phonemic verbal fluency tests (β-0.12 [-0.20; -0.04]). In men, HOMA-IR (β-0.15 [-0.25; -0.04]) and prediabetes (β-0.35 [-0.69; -0.03]) were associated with poorer performance on memory tests. CONCLUSIONS We found a significant association of BMI and HOMA-IR with cognitive performance in young and middle-aged adult women without diabetes. In men, we found an association between HOMA-IR and prediabetes and poorer performance on memory tests.
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Affiliation(s)
| | - Valéria Passos
- Faculty of Medicine Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi Barreto
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Inês Schmidt
- Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce Duncan
- Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alline Beleigoli
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Pedro Vidigal
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Roberta Figueiredo
- Campus Centro Oeste Dona Lindu, Universidade Federal São João del Rey, Divinópolis, Brazil
| | - Enrico Colosimo
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Larissa Araújo
- Public Health School Universidade Federal do Ceará, Fortaleza, Brazil
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53
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Tanaka H, Gourley DD, Dekhtyar M, Haley AP. Cognition, Brain Structure, and Brain Function in Individuals with Obesity and Related Disorders. Curr Obes Rep 2020; 9:544-549. [PMID: 33064270 DOI: 10.1007/s13679-020-00412-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Obesity is one of the most serious public health concerns. Excess adipose tissue, particularly with a centralized distribution, is associated with cognitive decline. Indeed, obesity has been associated with a number of adverse changes in brain function and structure that can be detected by neuroimaging techniques. These obesity-associated changes in the brain are associated with cognitive dysfunction. RECENT FINDINGS While the pathways by which excess adipose tissue affects brain function are not fully understood, available evidence points towards insulin resistance, inflammation, and vascular dysfunction, as possible mechanisms responsible for the observed relations between obesity and cognitive impairment. It appears that weight loss is related to better brain and cognitive outcomes and that cognitive impairment due to obesity may be reversible.
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Affiliation(s)
- Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, USA.
| | - Drew D Gourley
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, USA
| | - Maria Dekhtyar
- Department of Psychology, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Andreana P Haley
- Department of Psychology, The University of Texas at Austin, Austin, TX, 78712, USA
- Biomedical Imaging Center, The University of Texas at Austin, Austin, TX, 78712, USA
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54
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Pan Y, Chen W, Yan H, Wang M, Xiang X. Glycemic traits and Alzheimer's disease: a Mendelian randomization study. Aging (Albany NY) 2020; 12:22688-22699. [PMID: 33202379 PMCID: PMC7746331 DOI: 10.18632/aging.103887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/25/2020] [Indexed: 02/06/2023]
Abstract
Previous observational studies have reported an association between impaired glucose metabolism and Alzheimer’s disease. This study aimed to examine the causal association of glycemic traits with Alzheimer’s disease. We used a two-sample Mendelian randomization approach to evaluate the causal effect of six glycemic traits (type 2 diabetes, fasting glucose, fasting insulin, hemoglobin A1c, homeostasis model assessment- insulin resistance and HOMA-β-cell function) on Alzheimer’s disease. Summary data on the association of single nucleotide polymorphisms with these glycemic traits were obtained from genome-wide association studies of the DIAbetes Genetics Replication And Meta-analysis and Meta-Analyses of Glucose and Insulin-related traits Consortium. Summary data on the association of single nucleotide polymorphisms with Alzheimer’s disease were obtained from the International Genomics of Alzheimer's Project. The Mendelian randomization analysis showed that 1-standard deviation higher fasting glucose and lower HOMA-β-cell function (indicating pancreatic β-cell dysfunction) were causally associated with a substantial increase in risk of Alzheimer’s disease (odds ratio=1.33, 95% confidence interval: 1.04-1.68, p=0.02; odds ratio=1.92, 95% confidence interval: 1.15-3.21, p=0.01). However, no significant association was observed for other glycemic traits. This Mendelian randomization analysis provides evidence of causal associations between glycemic traits, especially high fasting glucose and pancreatic β-cell dysfunction, and high risk of Alzheimer's disease.
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Affiliation(s)
- Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xianglong Xiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Toppala S, Ekblad LL, Lötjönen J, Helin S, Hurme S, Johansson J, Jula A, Karrasch M, Koikkalainen J, Laine H, Parkkola R, Viitanen M, Rinne JO. Midlife Insulin Resistance as a Predictor for Late-Life Cognitive Function and Cerebrovascular Lesions. J Alzheimers Dis 2020; 72:215-228. [PMID: 31561373 PMCID: PMC6839606 DOI: 10.3233/jad-190691] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Type 2 diabetes (T2DM) increases the risk for Alzheimer’s disease (AD) but not for AD neuropathology. The association between T2DM and AD is assumed to be mediated through vascular mechanisms. However, insulin resistance (IR), the hallmark of T2DM, has been shown to associate with AD neuropathology and cognitive decline. Objective: To evaluate if midlife IR predicts late-life cognitive performance and cerebrovascular lesions (white matter hyperintensities and total vascular burden), and whether cerebrovascular lesions and brain amyloid load are associated with cognitive functioning. Methods: This exposure-to-control follow-up study examined 60 volunteers without dementia (mean age 70.9 years) with neurocognitive testing, brain 3T-MRI and amyloid-PET imaging. The volunteers were recruited from the Finnish Health 2000 survey (n = 6062) to attend follow-up examinations in 2014–2016 according to their insulin sensitivity in 2000 and their APOE genotype. The exposure group (n = 30) had IR in 2000 and the 30 controls had normal insulin sensitivity. There were 15 APOEɛ4 carriers per group. Statistical analyses were performed with multivariable linear models. Results: At follow-up the IR+group performed worse on executive functions (p = 0.02) and processing speed (p = 0.007) than the IR- group. The groups did not differ in cerebrovascular lesions. No associations were found between cerebrovascular lesions and neurocognitive test scores. Brain amyloid deposition associated with slower processing speed. Conclusion: Midlife IR predicted poorer executive functions and slower processing speed, but not cerebrovascular lesions. Brain amyloid deposition was associated with slower processing speed. The association between midlife IR and late-life cognition might not be mediated through cerebrovascular lesions measured here.
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Affiliation(s)
- Sini Toppala
- Turku PET Centre, University of Turku, Finland.,Turku City Hospital, University of Turku, Finland
| | | | | | - Semi Helin
- Turku PET Centre, University of Turku, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Finland
| | - Jarkko Johansson
- Turku PET Centre, University of Turku, Finland.,Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Antti Jula
- National Institute for Health and Welfare, Turku, Finland
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | | | - Hanna Laine
- Turku City Hospital, University of Turku, Finland.,Department of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, Turku University and Turku University Hospital, Turku, Finland
| | - Matti Viitanen
- Turku City Hospital, University of Turku, Finland.,Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Juha O Rinne
- Turku PET Centre, University of Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
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56
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Berlanga-Acosta J, Guillén-Nieto G, Rodríguez-Rodríguez N, Bringas-Vega ML, García-del-Barco-Herrera D, Berlanga-Saez JO, García-Ojalvo A, Valdés-Sosa MJ, Valdés-Sosa PA. Insulin Resistance at the Crossroad of Alzheimer Disease Pathology: A Review. Front Endocrinol (Lausanne) 2020; 11:560375. [PMID: 33224105 PMCID: PMC7674493 DOI: 10.3389/fendo.2020.560375] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/13/2020] [Indexed: 12/16/2022] Open
Abstract
Insulin plays a major neuroprotective and trophic function for cerebral cell population, thus countering apoptosis, beta-amyloid toxicity, and oxidative stress; favoring neuronal survival; and enhancing memory and learning processes. Insulin resistance and impaired cerebral glucose metabolism are invariantly reported in Alzheimer's disease (AD) and other neurodegenerative processes. AD is a fatal neurodegenerative disorder in which progressive glucose hypometabolism parallels to cognitive impairment. Although AD may appear and progress in virtue of multifactorial nosogenic ingredients, multiple interperpetuative and interconnected vicious circles appear to drive disease pathophysiology. The disease is primarily a metabolic/energetic disorder in which amyloid accumulation may appear as a by-product of more proximal events, especially in the late-onset form. As a bridge between AD and type 2 diabetes, activation of c-Jun N-terminal kinase (JNK) pathway with the ensued serine phosphorylation of the insulin response substrate (IRS)-1/2 may be at the crossroads of insulin resistance and its subsequent dysmetabolic consequences. Central insulin axis bankruptcy translates in neuronal vulnerability and demise. As a link in the chain of pathogenic vicious circles, mitochondrial dysfunction, oxidative stress, and peripheral/central immune-inflammation are increasingly advocated as major pathology drivers. Pharmacological interventions addressed to preserve insulin axis physiology, mitochondrial biogenesis-integral functionality, and mitophagy of diseased organelles may attenuate the adjacent spillover of free radicals that further perpetuate mitochondrial damages and catalyze inflammation. Central and/or peripheral inflammation may account for a local flood of proinflammatory cytokines that along with astrogliosis amplify insulin resistance, mitochondrial dysfunction, and oxidative stress. All these elements are endogenous stressor, pro-senescent factors that contribute to JNK activation. Taken together, these evidences incite to identify novel multi-mechanistic approaches to succeed in ameliorating this pandemic affliction.
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Affiliation(s)
- Jorge Berlanga-Acosta
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Tissue Repair and Cytoprotection Research Group, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Gerardo Guillén-Nieto
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Tissue Repair and Cytoprotection Research Group, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Nadia Rodríguez-Rodríguez
- Tissue Repair and Cytoprotection Research Group, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Maria Luisa Bringas-Vega
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Cuban Neurosciences Center, Cubanacan, Havana, Cuba
| | | | - Jorge O. Berlanga-Saez
- Applied Mathematics Department, Institute of Mathematics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ariana García-Ojalvo
- Tissue Repair and Cytoprotection Research Group, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Mitchell Joseph Valdés-Sosa
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Cuban Neurosciences Center, Cubanacan, Havana, Cuba
| | - Pedro A. Valdés-Sosa
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Cuban Neurosciences Center, Cubanacan, Havana, Cuba
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57
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Willmann C, Brockmann K, Wagner R, Kullmann S, Preissl H, Schnauder G, Maetzler W, Gasser T, Berg D, Eschweiler GW, Metzger F, Fallgatter AJ, Häring HU, Fritsche A, Heni M. Insulin sensitivity predicts cognitive decline in individuals with prediabetes. BMJ Open Diabetes Res Care 2020; 8:8/2/e001741. [PMID: 33203727 PMCID: PMC7674089 DOI: 10.1136/bmjdrc-2020-001741] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Epidemiological studies indicate an association between type 2 diabetes and cognitive dysfunction that appear to start already in the prediabetic state. Although cross-sectional studies have linked insulin resistance to impaired cognition, the potential predictive value of insulin resistance has not yet been sufficiently studied longitudinally without confounding by overt diabetes (and its pharmacological treatment). RESEARCH DESIGN AND METHODS We investigated longitudinal data from participants of the 'Tübinger Evaluation of Risk Factors for Early Detection of Neurodegeneration' Study. Subjects underwent a neurocognitive assessment battery (CERAD Plus battery; Consortium to Establish a Registry for Alzheimer's Disease) at baseline and followed every 2 years (median follow-up 4.0 Q1-3: 2.2-4.3 years). Subjects within a pre-diabetic glycated hemoglobin range of 5.6%-6.5% underwent 5-point 75 g oral glucose tolerance tests (OGTTs) with assessment of insulin sensitivity and insulin secretion (n=175). Subjects with newly diagnosed diabetes mellitus or with major depressivity (Beck Depression Inventory >20) were excluded (n=15). Data were analyzed by mixed models using sex, age and glycemic trait as fixed effects. Subject and time since first measurement were used as random effects. RESULTS Insulin sensitivity was positively associated with the CERAD sum score (higher is better) in a time-dependent manner (p=0.0057). This result is mainly driven by a steeper decrease in the memory domain associated with lower insulin sensitivity (p=0.029). The interaction between age and insulin sensitivity was independent of glycemia (p=0.02). There was also no association between insulin secretion and cognition. CONCLUSIONS Insulin resistance rather than sole elevation of blood glucose predicts cognitive decline, specifically in the memory domain, in persons with prediabetes. Treatments of diabetes that improve insulin sensitivity might therefore have the potential to postpone or even prevent cognitive decline in patients with diabetes.
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Affiliation(s)
- Caroline Willmann
- Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Helmholtz Center Munich, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Robert Wagner
- Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Helmholtz Center Munich, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Helmholtz Center Munich, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Hubert Preissl
- Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Helmholtz Center Munich, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Institute for Diabetes and Obesity, Helmholtz Diabetes Centre at Helmholtz Zentrum München, German Research Centre for Environmental Health (GmbH), Neuherberg, Germany
- Department of Pharmacy and Biochemistry, Institute of Pharmaceutical Sciences, University of Tübingen, Tübingen, Germany
| | - Günter Schnauder
- Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Thomas Gasser
- Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, Center of Neurology, University of Tübingen, Tübingen, Germany
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Geriatric Center at the University Hospital of Tübingen, Tübingen, Germany
| | - Florian Metzger
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Geriatric Center at the University Hospital of Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Vitos Hospital Haina, Haina, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Geriatric Center at the University Hospital of Tübingen, Tübingen, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Helmholtz Center Munich, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas Fritsche
- Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Helmholtz Center Munich, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Martin Heni
- Department of Internal Medicine IV, University Hospital of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Helmholtz Center Munich, Tübingen, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, Tübingen, Germany
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58
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Kim GR, Choi DW, Nam CM, Jang SI, Park EC. Synergistic association of high-sensitivity C-reactive protein and body mass index with insulin resistance in non-diabetic adults. Sci Rep 2020; 10:18417. [PMID: 33116232 PMCID: PMC7595183 DOI: 10.1038/s41598-020-75390-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/22/2020] [Indexed: 11/15/2022] Open
Abstract
Epidemiological evidence has indicated that inflammatory markers and obesity are strongly correlated with insulin resistance (IR). However, there is a paucity of studies assessing the complex interaction between elevated hs-CRP and body mass index (BMI), particularly among Asians. This study investigated the additive interaction between hs-CRP and BMI on IR, using cross-sectional data from the 7th Korea National Health and Nutrition Examination Survey (2016–2018). A total of 5706 men and 6707 women aged 20 years or older were evaluated, and a multiple logistic regression analysis was used to assess the association of serum hs-CRP and BMI with IR, as measured by the triglyceride-glucose index (TyG index). Sex-specific median values were used to dichotomise the continuous TyG index variable into insulin-sensitive and IR categories. Biological interaction was evaluated using the Relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI). The joint effects of high hs-CRP and overweight/obesity on IR were greater than would be expected from the effects of the individual exposures alone. Relative to those with low hs-CRP and BMI < 23, having both exposures was related to increased IR with an adjusted OR of 2.97 (95% CI 2.50–3.52) in men and 3.08 (95% CI 2.67–3.56) in women with significant additive interactions. These findings demonstrate that IR prevention strategies that reduce both systematic inflammation and BMI may exceed the expected benefits based on targeting these risk factors separately.
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Affiliation(s)
- Gyu Ri Kim
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea.,Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Dong-Woo Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.,Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea.,Department of Biostatistics, College of Medicine, Yonsei University, Seoul, Korea
| | - Sung-In Jang
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea.,Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea. .,Institute of Health Services Research, Yonsei University, Seoul, Korea.
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Batsis JA, Haudenschild C, Roth RM, Gooding TL, Roderka MN, Masterson T, Brand J, Lohman MC, Mackenzie TA. Incident Impaired Cognitive Function in Sarcopenic Obesity: Data From the National Health and Aging Trends Survey. J Am Med Dir Assoc 2020; 22:865-872.e5. [PMID: 34248422 DOI: 10.1016/j.jamda.2020.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives The prevalence of obesity with sarcopenia is increasing in adults aged ≥65 years. This geriatric syndrome places individuals at risk for synergistic complications that leads to long-term functional decline. We ascertained the relationship between sarcopenic obesity and incident long-term impaired global cognitive function in a representative US population. Design A longitudinal, secondary data set analysis using the National Health and Aging Trends Survey. Setting Community-based older adults in the United States. Participants Participants without baseline impaired cognitive function aged ≥65 years with grip strength and body mass index measures. Methods Sarcopenia was defined using the Foundation for the National Institutes of Health Sarcopenia Project grip strength cut points (men <35.5 kg; women <20 kg), and obesity was defined using standard body mass index (BMI) categories. Impaired global cognition was identified as impairment in the Alzheimer's Disease-8 score or immediate/delayed recall, orientation, clock-draw test, date/person recall. Proportional hazard models ascertained the risk of impaired cognitive function over 8 years (referent = neither obesity or sarcopenia). Results Of the 5822 participants (55.7% women), median age category was 75 to 80, and mean grip strength and BMI were 26.4 kg and 27.5 kg/m2, respectively. Baseline prevalence of sarcopenic obesity was 12.9%, with an observed subset of 21.2% participants having impaired cognitive function at follow-up. Compared with those without sarcopenia or obesity, the risk of impaired cognitive function was no different in obesity alone [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82-1.16]), but was significantly higher in sarcopenia (HR 1.60; 95% CI 1.42-1.80) and sarcopenic obesity (HR 1.20; 95% CI 1.03-1.40). There was no significant interaction term between sarcopenia and obesity. Conclusions Both sarcopenia and sarcopenic obesity are associated with an increased long-term risk of impaired cognitive function in older adults.
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Affiliation(s)
- John A Batsis
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christian Haudenschild
- Geisel School of Medicine at Dartmouth, Hanover, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Robert M Roth
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Neuropsychology Program, Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Tyler L Gooding
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - John Brand
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Todd A Mackenzie
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
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Zhou J, Zhang Z, Zhou H, Qian G. Diabetic Cognitive Dysfunction: From Bench to Clinic. Curr Med Chem 2020; 27:3151-3167. [PMID: 30727866 DOI: 10.2174/1871530319666190206225635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/30/2018] [Accepted: 01/30/2019] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes increases the risk of developing cognitive dysfunction in the elderly in the form of short-term memory and executive function impairment. Genetic and diet-induced models of type 2 diabetes further support this link, displaying deficits in working memory, learning, and memory performance. The risk factors for diabetic cognitive dysfunction include vascular disease, hypoglycaemia, hyperlipidaemia, adiposity, insulin resistance, lifestyle factors, and genetic factors. Using neuronal imaging technologies, diabetic patients with cognitive dysfunction show atrophy of the whole brain, particularly the grey matter, hippocampus and amygdala; increased volume of the ventricular and white matter; brain infarcts; impaired network integrity; abnormal microstructure; and reduced cerebral blood flow and amplitude of low-frequency fluctuations. The pathogenesis of type 2 diabetes with cognitive dysfunction involves hyperglycaemia, macrovascular and microvascular diseases, insulin resistance, inflammation, apoptosis, and disorders of neurotransmitters. Large clinical trials may offer further proof of biomarkers and risk factors for diabetic cognitive dysfunction. Advanced neuronal imaging technologies and novel disease animal models will assist in elucidating the precise pathogenesis and to provide better therapeutic interventions and treatment.
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Affiliation(s)
- Jiyin Zhou
- National Drug Clinical Trial Institution, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Zuo Zhang
- National Drug Clinical Trial Institution, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Hongli Zhou
- National Drug Clinical Trial Institution, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Guisheng Qian
- Institute of Respiratory Diseases, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
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Zhao Y, Zhou X, Zhao X, Yu X, Wang A, Chen X, Qi H, Han TL, Zhang H, Baker PN. Metformin administration during pregnancy attenuated the long-term maternal metabolic and cognitive impairments in a mouse model of gestational diabetes. Aging (Albany NY) 2020; 12:14019-14036. [PMID: 32697764 PMCID: PMC7425475 DOI: 10.18632/aging.103505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022]
Abstract
Background: Gestational diabetes mellitus (GDM) is a metabolic disease that can have long-term adverse effects on the cognitive function of mothers. In our study, we explored the changes in metabolic health and cognitive function in mice of middle- and old- age after exposure to GDM, and whether metformin therapy during pregnancy provided long-term benefits. Results: Mice with GDM demonstrated significant cognitive impairment in old age, which was associated with insulin resistance. Gestational metformin therapy was shown to increase insulin sensitivity and improve cognition. The ovarian aging rate was also accelerated in mice exposed to GDM during pregnancy, which may be related to fatty acid metabolism in the ovaries. Conclusion: Treatment with metformin during pregnancy was shown to improve fatty acid metabolism in ovarian tissues. Method: During pregnancy, mice were fed with a high-fat diet (GDM group) or a low-fat diet (Control group), and a third group received metformin while receiving a high-fat diet (Treatment group). At 12 months old, the mice completed an oral glucose tolerance test, insulin tolerance test, Morris water maze test, female sex hormones were measured, and metabolite profiles of tissue from the ovaries, hypothalamus, and pituitary glands were analysed using gas chromatography-mass spectrometry.
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Affiliation(s)
- Yalan Zhao
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.,Department of Obstetrics, The First People's Hospital of Yunnan Province, Kunming, China
| | - Xiaobo Zhou
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xue Zhao
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyang Yu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Andi Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuyang Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongbo Qi
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting-Li Han
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Hua Zhang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Philip N Baker
- College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK
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Zhang Y, Li Y, Wang R, Sha G, Jin H, Ma L. Elevated Urinary AD7c-NTP Levels in Older Adults with Hypertension and Cognitive Impairment. J Alzheimers Dis 2020; 74:237-244. [PMID: 32007954 DOI: 10.3233/jad-190944] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Yaxin Zhang
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yun Li
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Rong Wang
- Central Laboratory, Xuanwu Hospital Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer’s Disease, Beijing Institute for Brain Disorders, Beijing, China
| | - Guiming Sha
- Department of Geriatrics, Beijing Geriatric Hospital, Beijing, China
| | - He Jin
- Central Laboratory, Xuanwu Hospital Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer’s Disease, Beijing Institute for Brain Disorders, Beijing, China
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
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Gonçalves RA, Wijesekara N, Fraser PE, De Felice FG. Behavioral Abnormalities in Knockout and Humanized Tau Mice. Front Endocrinol (Lausanne) 2020; 11:124. [PMID: 32226410 PMCID: PMC7080660 DOI: 10.3389/fendo.2020.00124] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/24/2020] [Indexed: 12/30/2022] Open
Abstract
Microtubule-associated protein tau assists in stabilizing microtubules and has been particularly implicated in Alzheimer's disease (AD). Given the importance of tau to AD pathogenesis and therapies, it is important to understand non-classic physiological functions for this protein inside and outside the central nervous system (CNS). Our group has previously shown that tau ablation triggers glucose intolerance and pancreatic dysfunction in mice, suggesting that tau plays a role in peripheral metabolic regulation. Little is known about the role of tau in anxiety. Moreover, inconsistent results have been generated regarding the effects of tau deletion in memory. Here, we characterize systemic insulin resistance, anxiety-related behavior and memory in 15 to 20 weeks old Wild-Type (WT), Tau knockout (TauKO) and a distinct hTau mouse model consisting of tau knockout expressing the longest isoform (2N4R) of a non-mutant WT human Tau protein under the prion promoter (hTau). Our findings demonstrate that tau deletion leads to anxiety-related behavior, impaired contextual and cued fear memory. The presence of a human Tau transgene did not ameliorate the phenotypes observed in animals lacking the mouse tau protein and it elicited impairments in learning, memory, and peripheral insulin sensitivity. Our results suggest that tau protein plays a role in memory and anxiety-related behavior. Our findings also indicate that previously unrecognized functions for tau protein may be a complicating factor in using animal models on the TauKO background. Understanding the link between tau pathophysiology and cognitive and metabolic alterations is of great importance to establish the complete contribution of tau protein to AD pathogenesis.
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Affiliation(s)
- Rafaella Araujo Gonçalves
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Nadeeja Wijesekara
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Paul E. Fraser
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- *Correspondence: Paul E. Fraser
| | - Fernanda G. De Felice
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Fernanda G. De Felice
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Li G, Hu J, Zhang S, Fan W, Wen L, Wang G, Zhang D. Changes in Resting-State Cerebral Activity in Women With Polycystic Ovary Syndrome: A Functional MR Imaging Study. Front Endocrinol (Lausanne) 2020; 11:603279. [PMID: 33362718 PMCID: PMC7758505 DOI: 10.3389/fendo.2020.603279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/13/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Previous studies have found that women with polycystic ovary syndrome (PCOS) have some degree of brain function change as well as cognitive function and emotions, such as poor executive functioning and memory, anxiety and depressive symptoms. However, the neurobiological mechanisms underlying these alterations have not yet been clarified. METHOD Fasting serum hormone testing, neuropsychological testing and resting-state magnetic resonance imaging (rs-fMRI) were performed in 41 women with newly diagnosed PCOS and 41 healthy controls matched by age and education during their 2-5 days of menstrual period. Analysis of the amplitude of low-frequency fluctuation (ALFF) was used to calculate the seed points. Then, the functional connectivity (FC) values between these abnormal seed points and other voxels in the whole brain were calculated. Finally, the correlations among clinical indexes, neuropsychological evaluation scores, and neuroimaging data were analyzed. RESULTS Compared with the control group, the PCOS group showed higher luteinizing hormone (LH) and serum insulin levels, worse sleep quality, increased depressive and anxiety state scores, and memory and executive function impairments. Pearson's correlation analysis showed that the decreased ALFF value in the left middle frontal gyrus (MFG.L), which is related to poor executive performance and depressive disorders, was negatively correlated with the plasma insulin level in subjects with insulin resistance. Furthermore, the increased FC strength between the MFG.L and left inferior frontal gyrus (IFG.L) was positively correlated with the serum testosterone level. The enhanced FC strength between the left posterior cingulate gyrus (PCG.L) and triangular part of the left inferior frontal gyrus (IFGtriang.L) was negatively correlated with the plasma LH level. When use the right middle occipital gyrus (MOG.R) as the seed point, the FC strength with the right inferior occipital gyrus (IOG.R), which is associated with impaired memory, was decreased. CONCLUSION The ALFF and FC results elucidated brain functional abnormalities at the regional and network levels in women with PCOS, while correlation analyses simultaneously demonstrated that these alterations were associated with serum hormones and cognitive function. These results may provide useful information regarding the potential mechanisms of cognitive impairment and emotional changes in this population.
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Guo D, Yuan Y, Huang R, Tian S, Wang J, Lin H, An K, Han J, Wang S. Association between plasma adipsin level and mild cognitive impairment in Chinese patients with type 2 diabetes: a cross-sectional study. BMC Endocr Disord 2019; 19:108. [PMID: 31651303 PMCID: PMC6814099 DOI: 10.1186/s12902-019-0431-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The adipokine adipsin contributes to insulin resistance (IR), inflammation, and obesity, which are all regarded as high-risk factors for mild cognitive impairment (MCI) in patients with type 2 diabetes mellitus. This research aimed to uncover the role of adipsin in Chinese type 2 diabetes mellitus (T2DM) population with early cognitive dysfunction and determine whether adipsin contributes to diabetic MCI caused by IR. METHODS In our study, 126 patients with T2DM were enrolled. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive impairment. Demographic data and neuropsychological test results were evaluated. Plasma adipsin level was measured by enzyme-linked immunosorbent assay. RESULTS The MCI group (n = 57) presented higher plasma adipsin levels compared with the healthy controls (p = 0.018). After adjustment for educational attainment, and age, begative correlations were found between plasma adipsin levels and MoCA, Mini Mental State Exam, and Verbal Fluency Test scores(r = - 0.640, p < 0.001; r = - 0.612, p < 0.001; r = - 0.288, p = 0.035; respectively). Correlation analysis demonstrated that adipsin levels were significantly positively correlated with fasting C-peptide; homeostasis model of assessment for insulin resistance (HOMA-IR) (r = 0.368, p < 0.001; r = 0.494, p < 0.001; respectively). Multivariable regression analysis further indicated that high plasma adipsin level was a significant independent determinant of MCI in the Chinese population withT2DM (p = 0.017). CONCLUSIONS Elevated plasma adipsin level was associated with MCI in Chinese T2DM patients. Further large-scale studies should be designed to determine whether adipsin is linked to IR-associated susceptibility to early cognitive decline in T2DM patients.
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Affiliation(s)
- Dan Guo
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing, 210009 People’s Republic of China
- School of Medicine, Southeast University, Nanjing, People’s Republic of China 210009
| | - Yang Yuan
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing, 210009 People’s Republic of China
- School of Medicine, Southeast University, Nanjing, People’s Republic of China 210009
| | - Rong Huang
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing, 210009 People’s Republic of China
| | - Sai Tian
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing, 210009 People’s Republic of China
| | - Jiaqi Wang
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing, 210009 People’s Republic of China
| | - Hongyan Lin
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing, 210009 People’s Republic of China
| | - Ke An
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing, 210009 People’s Republic of China
| | - Jin Han
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing, 210009 People’s Republic of China
| | - Shaohua Wang
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing, 210009 People’s Republic of China
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Someya Y, Tamura Y, Kaga H, Nojiri S, Shimada K, Daida H, Ishijima M, Kaneko K, Aoki S, Miida T, Hirayama S, Konishi S, Hattori N, Motoi Y, Naito H, Kawamori R, Watada H. Skeletal muscle function and need for long-term care of urban elderly people in Japan (the Bunkyo Health Study): a prospective cohort study. BMJ Open 2019; 9:e031584. [PMID: 31530621 PMCID: PMC6756356 DOI: 10.1136/bmjopen-2019-031584] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The proportion of elderly individuals (age ≥65 years) in Japan reached 27.7% in 2017, the highest in the world. A serious social problem in a super-aged society is the rise in the number of elderly people who need long-term care (LTC), which is mainly due to cerebrovascular disease, dementia, age-related frailty, falls and fractures, and joint disease. We hypothesised that decreased muscle mass, muscle strength and insulin sensitivity are the common risk factors for these diseases related to needing LTC. We developed a prospective cohort study of elderly subjects in an urban community to test this hypothesis. The primary objective is to prospectively investigate associations between muscle mass, muscle strength, and insulin sensitivity and incidence of main disease and risk factors of needing LTC. The primary outcomes are the incidence of cerebrovascular disease and cognitive decline. PARTICIPANTS Participants were 1629 people aged 65-84 years living in 13 communities in an urban area (Bunkyo-ku, Tokyo, Japan). Average age was 73.1±5.4 years. FINDINGS TO DATE We obtained baseline data on cognitive function, cerebral small vessel disease (SVD) determined by brain MRI, body composition, bone mineral density, arteriosclerosis, physical function, muscle mass, muscle strength and insulin sensitivity. Mild cognitive impairment and dementia were observed in 18.1% and 3.3% of participants, respectively. The prevalence of cerebral SVD was 24.8%. These characteristics are similar to those previously reported in elderly Japanese subjects. FUTURE PLANS We will ask participants about their health status, including incidence of cerebrovascular disease, falls, fractures and other diseases every year by mail. We plan to re-evaluate cognitive function, brain MRI parameters and other parameters at 5 and 10 years after the baseline evaluation. We will evaluate whether low muscle function (muscle mass, muscle strength or insulin sensitivity) is a risk factor for cognitive decline or cerebrovascular disease.
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Affiliation(s)
- Yuki Someya
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Juntendo University Graduate School of Health and Sports Science, Chiba, Japan
| | - Yoshifumi Tamura
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideyoshi Kaga
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Clinical Research Support Center, Juntendo University, Tokyo, Japan
| | - Kazunori Shimada
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Miida
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Hirayama
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Seiki Konishi
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yumiko Motoi
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Diagnosis, Prevention and Treatment of Dementia, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hisashi Naito
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Juntendo University Graduate School of Health and Sports Science, Chiba, Japan
| | - Ryuzo Kawamori
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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He X, Long G, Quan C, Zhang B, Chen J, Ouyang W. Insulin Resistance Predicts Postoperative Cognitive Dysfunction in Elderly Gastrointestinal Patients. Front Aging Neurosci 2019; 11:197. [PMID: 31440156 PMCID: PMC6694405 DOI: 10.3389/fnagi.2019.00197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/15/2019] [Indexed: 01/01/2023] Open
Abstract
Background Members of the aging population who undergo surgery are at risk of postoperative cognitive dysfunction (POCD). Exploring an effective and reliable early predictor of POCD is essential to the identification of high-risk patients and to making prospective decisions. The purpose of this study was to examine whether preoperative insulin resistance is an independent predictor of POCD. Methods A total of 124 patients aged 60 years and older and who were scheduled for gastrointestinal surgery were enrolled in a prospective observational clinical study. All participants completed a battery of neuropsychological tests before surgery and 7 days later. POCD was defined as a decline of at least 1.5 SD on two or more of neuropsychological tests. Plasma concentration of the tumor necrosis factor α (TNF-α), C-reactive protein (CRP), and S-100β protein were measured. The status of insulin resistance was assessed by Homeostasis Model Assessment–Insulin Resistance (HOMA-IR). The relationship between HOMA-IR and POCD was assessed by Multivariable logistic regression models and the receiver operating characteristic (ROC) curve. Results Fifty one patients (41.1%) were diagnosed with POCD at 7 days after surgery. Preoperative HOMA-IR values of the POCD group were significantly higher than the non-POCD group. Furthermore, CRP and TNF-α levels of the POCD group were significantly higher at each postoperative time point (P < 0.05). The preoperative HOMA-IR value was an independent predictor of POCD (adjusted OR 1.88, 95% CI, 1.18–2.99) even after adjust for confounding variables, and when dichotomized, individuals above the HOMA-IR threshold (HOMA-IR > 2.6) had a three-times higher risk of POCD (OR 3.26; 95% CI, 1.07–9.91) compared to individuals below the threshold. The areas under the ROC curve of HOMA-IR was 0.804 (95% CI, 0.725–0.883; P < 0.001). The optimal cut-off value was found to be 0.583, with a sensitivity of 84.3% and specificity of 74%. The HOMA-IR value was positively associated with the TNF-α concentration at baseline (R2 = 0.43, P < 0.01) and 1 day after surgery (R2 = 0.3861, P < 0.01). Conclusion Preoperative insulin resistance is an effective predictor for the occurrence of POCD. Targeted prevention and treatment strategies of insulin resistance may be effective interventions of patients at risk for POCD.
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Affiliation(s)
- Xi He
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ge Long
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Chengxuan Quan
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Bin Zhang
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia Chen
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Wen Ouyang
- Department of Anesthesia, The Third Xiangya Hospital of Central South University, Changsha, China
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Huang X, Wang C, Tian S, Huang R, Guo D, Zhang H, Shi J, Wang S. Higher Plasma Level of Nampt Presaging Memory Dysfunction in Chinese Type 2 Diabetes Patients with Mild Cognitive Impairment. J Alzheimers Dis 2019; 70:303-314. [PMID: 31177228 DOI: 10.3233/jad-190269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Xi Huang
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, PR China
| | - Chenchen Wang
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, PR China
- Medical School of Southeast University, Nanjing, PR China
| | - Sai Tian
- Medical School of Southeast University, Nanjing, PR China
| | - Rong Huang
- Medical School of Southeast University, Nanjing, PR China
| | - Dan Guo
- Medical School of Southeast University, Nanjing, PR China
| | - Haoqiang Zhang
- Medical School of Southeast University, Nanjing, PR China
| | - Jijing Shi
- Medical School of Southeast University, Nanjing, PR China
| | - Shaohua Wang
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, PR China
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70
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Uranga RM, Keller JN. The Complex Interactions Between Obesity, Metabolism and the Brain. Front Neurosci 2019; 13:513. [PMID: 31178685 PMCID: PMC6542999 DOI: 10.3389/fnins.2019.00513] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/06/2019] [Indexed: 12/22/2022] Open
Abstract
Obesity is increasing at unprecedented levels globally, and the overall impact of obesity on the various organ systems of the body is only beginning to be fully appreciated. Because of the myriad of direct and indirect effects of obesity causing dysfunction of multiple tissues and organs, it is likely that there will be heterogeneity in the presentation of obesity effects in any given population. Taken together, these realities make it increasingly difficult to understand the complex interplay between obesity effects on different organs, including the brain. The focus of this review is to provide a comprehensive view of metabolic disturbances present in obesity, their direct and indirect effects on the different organ systems of the body, and to discuss the interaction of these effects in the context of brain aging and the development of neurodegenerative diseases.
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Affiliation(s)
- Romina María Uranga
- Instituto de Investigaciones Bioquímicas de Bahía Blanca, Universidad Nacional del Sur-Consejo Nacional de Investigaciones Científicas y Técnicas, Bahía Blanca, Argentina
- Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur, Bahía Blanca, Argentina
| | - Jeffrey Neil Keller
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
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71
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Park S, Jeon SM, Jung SY, Hwang J, Kwon JW. Effect of late-life weight change on dementia incidence: a 10-year cohort study using claim data in Korea. BMJ Open 2019; 9:e021739. [PMID: 31110079 PMCID: PMC6530413 DOI: 10.1136/bmjopen-2018-021739] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The association between body mass index (BMI) in late-life and dementia risk remains unclear. We investigated the association between BMI changes over a 2-year period and dementia in an elderly Korean population. METHODS We examined 67 219 participants aged 60-79 years who underwent BMI measurement in 2002/2003 and 2004/2005 as part of the National Health Insurance Service-Health Screening Cohort. Baseline characteristics including BMI, socioeconomic status and cardiometabolic risk factors were measured at baseline (2002/2003). The difference between BMI at baseline and at the next health screening (2004/2005) was used to calculate the BMI change. After 2 years, the incidence of dementia was monitored for a mean 5.3 years from 2008 to 2013. Multivariate HRs for dementia incidence were estimated on the basis of baseline BMI and its changes after adjusting for various other risk factors. A subgroup analysis was conducted to determine the effects of baseline BMI and BMI changes. RESULTS We demonstrated a significant association between late-life BMI changes and dementia in both sexes (men: >-10% HR=1.26, 95% CI 1.08 to 1.46, >+10% HR=1.25, 95% CI 1.08 to 1.45; women: >-10% HR=1.15, 95% CI 1.03 to 1.29, >+10% HR=1.17, 95% CI 1.05 to 1.31). However, the baseline BMI was not associated with dementia, except in underweight men. After stratification based on the baseline BMI, the BMI increase over 2 years was associated with dementia in men with a BMI of <25 kg/m2 and women with a BMI of 18.5-25 kg/m2, but not in the obese subgroup in either sex. However, BMI decrease was associated with dementia in those with a BMI of ≥18.5 kg/m2, but not in the underweight subgroup in either sex. CONCLUSION Both weight gain and weight loss may be significant risk factors associated with dementia. Continuous weight control and careful monitoring of weight changes are necessary to prevent dementia development.
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Affiliation(s)
- Susan Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Soo-Min Jeon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jinseub Hwang
- Division of Mathematics and Big Data Science, Daegu University, Gyeongsan, Republic of Korea
| | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
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72
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Otsuka R, Nishita Y, Tange C, Tomida M, Ando F, Shimokata H. Hemoglobin A1c and 10-year information processing speed in Japanese community dwellers. Environ Health Prev Med 2019; 24:24. [PMID: 31014232 PMCID: PMC6480813 DOI: 10.1186/s12199-019-0778-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/02/2019] [Indexed: 01/21/2023] Open
Abstract
Background Hyperglycemia is believed to be a risk factor for cognitive decline, but the longitudinal relationship between hyperglycemia and cognitive decline in the Japanese population is unclear. The present study aimed to clarify the association between blood glucose levels and information processing ability in middle-aged and older adults. Methods The subjects were 866 men and 815 women aged 40–79 years not taking medication for diabetes who participated in the first study wave (1997–2000) and then participated at least once in the subsequent six study waves (2000–2012) of the National Institute for Longevity Sciences—Longitudinal Study of Aging, Japan. Hemoglobin A1c (HbA1c) levels were categorized into four groups (< 5.6, 5.6 to < 6.0, 6.0 to < 6.5, ≥ 6.5%), and a mixed-effects model was used to evaluate the effects of the HbA1c level (four groups) on repeated measures of information processing speed. The models also included baseline age, body mass index, ethanol intake, smoking status, educational level, family income, and history of stroke, hypertension, heart disease, and dyslipidemia as covariates. Results Mean (standard deviation) HbA1c and follow-up time in participants were 5.2 (0.5) % and 10.0 (3.6) years, respectively. A linear mixed model showed that the main effect of the four HbA1c groups on information processing ability was not significant in either men or women, but the interaction of HbA1c and time with information processing speed in the higher HbA1c level groups (≥ 6.5% group in men, 6.0 to < 6.5% and ≥ 6.5% groups in women) was significant compared to the lower HbA1c level (< 5.6%) group (P < 0.05). When the slope of information processing speed by HbA1c level at baseline was examined, the slope of information processing speed in the higher HbA1c level (≥ 6.5%) group was higher than in the lower HbA1c level (< 5.6%) group, both in men (− 0.31/year) and in women (− 0.30/year), as well as in women with an HbA1c level of 6.0 to < 6.5% (− 0.40/year). Conclusions Higher baseline HbA1c was associated with greater subsequent decline in information processing ability in Japanese community dwellers, even with the pre-clinical HbA1c level (6.0 to < 6.5%) in women. The results suggest that good glycemic control or prevention of hyperglycemia may contribute to maintaining information processing ability. Electronic supplementary material The online version of this article (10.1186/s12199-019-0778-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rei Otsuka
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan.
| | - Yukiko Nishita
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Chikako Tange
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Makiko Tomida
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Fujiko Ando
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan.,Faculty of Health and Medical Sciences, Aichi Shukutoku University, Katahira 2- 9, Nagakute, Aichi, 480-1197, Japan
| | - Hiroshi Shimokata
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan.,Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Takenoyama 57, Iwasaki-cho, Nisshin, Aichi, 470-0196, Japan
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73
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Hooshmand B, Rusanen M, Ngandu T, Leiviskä J, Sindi S, von Arnim CAF, Falkai P, Soininen H, Tuomilehto J, Kivipelto M. Serum Insulin and Cognitive Performance in Older Adults: A Longitudinal Study. Am J Med 2019; 132:367-373. [PMID: 30502316 DOI: 10.1016/j.amjmed.2018.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of this study was to examine the association of serum glucose, insulin, and insulin resistance with cognitive functioning 7 years later in a longitudinal population-based study of Finnish older adults. METHODS Serum glucose and insulin were measured at baseline in 269 dementia-free individuals aged 65-79 years, from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study. Insulin resistance was estimated with the homeostasis model assessment (HOMA-IR). Participants were reexamined 7 years later, and global cognition, episodic memory, executive functioning, verbal expression, and psychomotor speed were assessed, both at baseline and at follow-up. Multiple linear regression was used to investigate the associations with cognitive performance at follow-up, after adjusting for several potential confounders, including common vascular risk factors. RESULTS In the multivariable-adjusted linear regression models, no associations of insulin resistance with cognitive functioning were observed. After excluding 19 incident dementia cases, higher baseline HOMA-IR values were related to worse performance in global cognition (β [standard error (SE)] -.050 [0.02]; P = .043) and psychomotor speed (β [SE] -.064 [.03]; P = [.043]) 7 years later. Raised serum insulin levels were associated with lower scores on global cognition (β [SE] -.054 [.03]; P = .045) and tended to relate to poorer performance in psychomotor speed (β [SE] -.061 [.03]; P = .070). CONCLUSIONS Serum insulin and insulin resistance may be independent predictors of cognitive performance 7 years later in elderly individuals without dementia. Randomized controlled trials are needed to determine this issue.
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Affiliation(s)
- Babak Hooshmand
- Aging Research Center, Karolinska Institute, Stockholm, Sweden; Department of Neurology, Ulm University Hospital, Germany.
| | - Minna Rusanen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Chronic Disease Prevention Unit, Department of Public Health Solutions, National Institute for Health and Welfare, University of Helsinki, Finland
| | - Tiia Ngandu
- Chronic Disease Prevention Unit, Department of Public Health Solutions, National Institute for Health and Welfare, University of Helsinki, Finland
| | - Jaana Leiviskä
- Genomics and Biomarkers Unit, Department of Public Health Solutions, National Institute for Health and Welfare, University of Helsinki, Finland
| | - Shireen Sindi
- Aging Research Center, Karolinska Institute, Stockholm, Sweden
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurocenter, Neurology, Kuopio University Hospital, Finland
| | - Jaakko Tuomilehto
- Genomics and Biomarkers Unit, Department of Public Health Solutions, National Institute for Health and Welfare, University of Helsinki, Finland; Department of Public Health, HJELT Institute, University of Helsinki, Finland; University of Helsinki, Helsinki University Central Hospital, Finland; South Ostrobothnia Central Hospital, Seinäjoki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Miia Kivipelto
- Aging Research Center, Karolinska Institute, Stockholm, Sweden; Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Stockholm, Sweden
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Noh HM, Han J, Kim YJ, Jung JH, Roh YK, Song HJ. Sex differences in the relationship between cognitive impairment and overweight or obesity in late life: A 3-year prospective study. Medicine (Baltimore) 2019; 98:e14736. [PMID: 30817627 PMCID: PMC6831333 DOI: 10.1097/md.0000000000014736] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The relationship between body weight changes in late life and cognitive function is controversial.We investigated whether weight gain or loss in late life affected cognitive function in community-dwelling older adults over a 3-year period.Our study used data from the Survey of Living Conditions and Welfare Needs of Korean Older Persons and included 3859 subjects (aged ≥65 years) with normal cognition at baseline. At baseline and the 3-year follow-up, body weight and height were measured, and cognitive function was assessed using the mini-mental state examination. Based on their body mass index (BMI) at baseline and follow-up, we divided the subjects into 4 groups: weight gain (baseline BMI <23 kg/m and follow-up BMI ≥23 kg/m); weight loss (baseline BMI ≥23 kg/m and follow-up BMI <23 kg/m); stable overweight/obese (BMI ≥23 kg/m at both visits); and stable non-overweight/obese (BMI <23 kg/m at both visits). Incidence rates (IRs) of cognitive impairment per 100 persons and IR ratios (IRRs) were calculated for each group and adjusted for confounding variables.At the 3-year follow-up, 610 cases of cognitive impairment (15.8%) were identified. The stable overweight/obese group had the lowest IR (14.0, 95% confidence interval [CI] 12.45-15.71) and was therefore used as the reference group when calculating IRRs for cognitive impairment. When men and women were evaluated separately, IRs between groups were significantly different only for women. The stable non-overweight/obese group (IRR 1.65, 95% CI 1.22-2.22) and the weight gain group (IRR 1.93, 95% CI 1.24-3.01) had higher IRs than those in the stable overweight/obese group. As a gain or loss of adiposity, the IR of the weight gain group (IRR 1.17, 95% CI 0.74-1.84) was not different from that of the stable non-overweight/obese group. Also, the IR of weight loss group (IRR 1.09, 95% CI 0.71-1.67) was not significantly different from that of the stable overweight/obese group.We suggest that overweight or obese older women at baseline had cognitive benefits. However, additional gain or loss of adiposity in late life did not affect the risk of cognitive impairment.
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Affiliation(s)
- Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Anyang
| | - Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University
| | - Yeo Jin Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon
| | - Jin-Hyung Jung
- Biostatistics, Biomedicine & Health Sciences, Catholic University
| | - Yong Kyun Roh
- Department of Family Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Hong Ji Song
- Department of Family Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Anyang
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75
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Ekblad LL, Toppala S, Johansson JK, Koskinen S, Sundvall J, Rinne JO, Puukka P, Viitanen M, Jula A. Albuminuria and Microalbuminuria as Predictors of Cognitive Performance in a General Population: An 11-Year Follow-Up Study. J Alzheimers Dis 2019; 62:635-648. [PMID: 29480195 DOI: 10.3233/jad-170972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Microalbuminuria, defined as urine albumin-to-creatinine ratio (UACR)>3.0 mg/mmol and ≤ 30 mg/mmol, is an early marker of endothelial damage of the renal glomeruli. Recent research suggests an association among microalbuminuria, albuminuria (UACR > 3.0 mg/mmol), and cognitive impairment. Previous studies on microalbuminuria, albuminuria, and cognition in the middle-aged have not provided repeated cognitive testing at different time-points. We hypothesized that albuminuria (micro- plus macroalbuminuria) and microalbuminuria would predict cognitive decline independently of previously reported risk factors for cognitive decline, including cardiovascular risk factors. In addition, we hypothesized that UACR levels even below the cut-off for microalbuminuria might be associated with cognitive functioning. These hypotheses were tested in the Finnish nationwide, population-based Health 2000 Survey (n = 5,921, mean age 52.6, 55.0% women), and its follow-up, Health 2011 (n = 3,687, mean age at baseline 49.3, 55.6% women). Linear regression analysis was used to determine the associations between measures of albuminuria and cognitive performance. Cognitive functions were assessed with verbal fluency, word-list learning, word-list delayed recall (at baseline and at follow-up), and with simple and visual choice reaction time tests (at baseline only). Here, we show that micro- plus macroalbuminuria associated with poorer word-list learning and a slower reaction time at baseline, with poorer word-list learning at follow-up, and with a steeper decline in word-list learning during 11 years after multivariate adjustments. Also, higher continuous UACR consistently associated with poorer verbal fluency at levels below microalbuminuria. These results suggest that UACR might have value in evaluating the risk for cognitive decline.
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Affiliation(s)
- Laura L Ekblad
- Turku PET Centre, University of Turku, c/o Turku University Hospital, Turku, Finland
| | - Sini Toppala
- Turku PET Centre, University of Turku, c/o Turku University Hospital, Turku, Finland.,Turku City Hospital, University of Turku, Turku, Finland
| | - Jouni K Johansson
- National Institute for Health and Welfare, Turku, Finland.,Welfare Division of Turku City, Turku, Finland
| | - Seppo Koskinen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jouko Sundvall
- National Institute for Health and Welfare, Helsinki, Finland
| | - Juha O Rinne
- Turku PET Centre, University of Turku, c/o Turku University Hospital, Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Pauli Puukka
- National Institute for Health and Welfare, Turku, Finland
| | - Matti Viitanen
- Turku City Hospital, University of Turku, Turku, Finland.,Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Antti Jula
- National Institute for Health and Welfare, Turku, Finland
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76
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Pappas C, Small BJ, Andel R, Laczó J, Parizkova M, Ondrej L, Hort J. Blood Glucose Levels May Exacerbate Executive Function Deficits in Older Adults with Cognitive Impairment. J Alzheimers Dis 2019; 67:81-89. [DOI: 10.3233/jad-180693] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Colleen Pappas
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, USA
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa, FL, USA
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Jan Laczó
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- Department of Neurology, Memory Clinic, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Martina Parizkova
- Department of Neurology, Memory Clinic, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Lerch Ondrej
- Department of Neurology, Memory Clinic, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Jakub Hort
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- Department of Neurology, Memory Clinic, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
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77
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Copper in Glucose Intolerance, Cognitive Decline, and Alzheimer Disease. Alzheimer Dis Assoc Disord 2019; 33:77-85. [DOI: 10.1097/wad.0000000000000280] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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78
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Inflammation in the hippocampus affects IGF1 receptor signaling and contributes to neurological sequelae in rheumatoid arthritis. Proc Natl Acad Sci U S A 2018; 115:E12063-E12072. [PMID: 30509997 PMCID: PMC6305002 DOI: 10.1073/pnas.1810553115] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aberrant insulin-like growth factor 1 receptor (IGF1R)/insulin receptor signaling in brain has recently been linked to neurodegeneration in diabetes mellitus and in Alzheimer’s disease. In this study, we demonstrate that functional disability and pain in patients with rheumatoid arthritis (RA) and in experimental RA are associated with hippocampal inflammation and inhibition of IGF1R/insulin receptor substrate 1 (IRS1) signal, reproducing an IGF1/insulin-resistant state. This restricts formation of new neurons in the hippocampus, reduces hippocampal volume, and predisposes RA patients to develop neurological symptoms. Improving IRS1 function through down-regulation of IGF1R disinhibits neurogenesis and can potentially ameliorate neurological symptoms. This opens perspectives for drugs that revert IGF1/insulin resistance as an essential complement to the antirheumatic and antiinflammatory arsenal. Rheumatoid arthritis (RA) is an inflammatory joint disease with a neurological component including depression, cognitive deficits, and pain, which substantially affect patients’ quality of daily life. Insulin-like growth factor 1 receptor (IGF1R) signaling is one of the factors in RA pathogenesis as well as a known regulator of adult neurogenesis. The purpose of this study was to investigate the association between IGF1R signaling and the neurological symptoms in RA. In experimental RA, we demonstrated that arthritis induced enrichment of IBA1+ microglia in the hippocampus. This coincided with inhibitory phosphorylation of insulin receptor substrate 1 (IRS1) and up-regulation of IGF1R in the pyramidal cell layer of the cornus ammoni and in the dentate gyrus, reproducing the molecular features of the IGF1/insulin resistance. The aberrant IGF1R signaling was associated with reduced hippocampal neurogenesis, smaller hippocampus, and increased immobility of RA mice. Inhibition of IGF1R in experimental RA led to a reduction of IRS1 inhibition and partial improvement of neurogenesis. Evaluation of physical functioning and brain imaging in RA patients revealed that enhanced functional disability is linked with smaller hippocampus volume and aberrant IGF1R/IRS1 signaling. These results point to abnormal IGF1R signaling in the brain as a mediator of neurological sequelae in RA and provide support for the potentially reversible nature of hippocampal changes.
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79
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Lee J, Kim J, Shin SA, Park S, Yoon DH, Kim H, Kim YK, Moon MK, Koo BK, Lee JY. Moderating Effect of Insulin Resistance on the Relationship between Gray Matter Volumes and Cognitive Function. J Clin Med 2018; 7:jcm7110413. [PMID: 30400348 PMCID: PMC6262494 DOI: 10.3390/jcm7110413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/24/2018] [Accepted: 11/01/2018] [Indexed: 11/16/2022] Open
Abstract
Background: It is controversial whether exposure to insulin resistance accelerates cognitive deterioration. The present study aimed to investigate the association between insulin resistance and gray matter volume loss to predict the cognitive decline. Methods: We recruited 160 participants (78 with Alzheimer’s disease and 82 without Alzheimer’s disease). Insulin resistance, regional gray matter volume, and cognitive function were assessed. A hierarchical moderated multiple regression (MMR) model was used to determine any associations among insulin resistance, structural changes in the brain, and cognitive decline. Results: The volumes of 7 regions in the gray matter were negatively related to insulin resistance in Alzheimer’s disease (p =0.032). Hierarchical MMR analysis indicated that insulin resistance did not directly affect the cognitive decline but moderated the cognitive decline through the decrease in gray matter volume in the key brain regions, i.e., inferior orbitofrontal gyrus (left), middle cingulate gyrus (right), hippocampus (right), and precuneus (right) (p < 0.05 in each case). Conclusion: Insulin resistance appears to exacerbate the cognitive decline associated with several gray matter volume loss.
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Affiliation(s)
- Jiyeon Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
| | - Jihyeon Kim
- College of Medicine, Seoul National University, Seoul 03080, Korea.
| | - Seong A Shin
- Department of Biomedical Sciences, Seoul National University, Seoul 08826, Korea.
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea.
| | - Soowon Park
- Department of Education, Sejong University, Seoul 05006, Korea.
| | - Dong Hyun Yoon
- Department of Psychiatry and Behavioral Science, SMG-SNU Boramae Medical Center, Seoul 07061, Korea.
| | - Hongrae Kim
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea.
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Korea.
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Korea.
| | - Jun-Young Lee
- Department of Psychiatry and Neuroscience Research Institute, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul 07061, Korea.
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Porf-2 = Arhgap39 = Vilse: A Pivotal Role in Neurodevelopment, Learning and Memory. eNeuro 2018; 5:eN-REV-0082-18. [PMID: 30406180 PMCID: PMC6220574 DOI: 10.1523/eneuro.0082-18.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 01/06/2023] Open
Abstract
Small GTP-converting enzymes, GTPases, are essential for the efficient completion of many physiological and developmental processes. They are regulated by GTPase activating proteins (GAPs) and guanine nucleotide exchange factors (GEFs). Arhgap39, also known as preoptic regulatory factor-2 (Porf-2) or Vilse, a member of the Rho GAP group, was first identified in 1990 in the rat CNS. It has since been shown to regulate apoptosis, cell migration, neurogenesis, and cerebral and hippocampal dendritic spine morphology. It plays a pivotal role in neurodevelopment and learning and memory. Homologous or orthologous genes are found in more than 280 vertebrate and invertebrate species, suggesting preservation through evolution. Not surprisingly, loss of the Arhgap39/Porf-2 gene in mice manifests as an embryonic lethal condition. Although Arhgap39/Porf-2 is highly expressed in the brain, it is also widely distributed throughout the body, with potential additional roles in oncogenesis and morphogenesis. This review summarizes, for the first time, the known information about this gene under its various names, in addition to considering its transcripts and proteins. The majority of findings described have been made in rats, mice, humans, and fruit flies. This work surveys the known functions, functional mediators, variables modifying expression and upstream regulators of expression, and potential physiological and pathological roles of Arhgap39/Porf-2 in health and disease.
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81
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Ganmore I, Beeri MS. The chicken or the egg? Does glycaemic control predict cognitive function or the other way around? Diabetologia 2018; 61:1913-1917. [PMID: 30003308 DOI: 10.1007/s00125-018-4689-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023]
Abstract
The association between type 2 diabetes and cognitive dysfunction is well established. Prevention of the development of type 2 diabetes and its complications, as well as cognitive dysfunction and dementia, are leading goals in these fields. Deciphering the causality direction of the interplay between type 2 diabetes and cognitive dysfunction, and understanding the timeline of disease progression, are crucial for developing efficient prevention strategies. The prevailing perception is that type 2 diabetes leads to cognitive dysfunction and dementia. There is substantial evidence showing that accelerated cognitive decline in type 2 diabetes starts in midlife (mean age 40-60 years) and that it may even begin at the prediabetes stage. However, in this issue of Diabetologia, Altschul et al (doi: https://doi.org/10.1007/s00125-018-4645-8 ) show evidence for the reverse causality hypothesis, i.e. that lower cognitive function precedes poor glycaemic control. They found that cognitive function at early adolescence (age 11 years) predicts both HbA1c levels and cognitive function at age 70 years. Moreover, they found that lower cognitive function at age 70 is associated with an increase in HbA1c from age 70 to 79 years. Based on these findings, future studies should explore whether developing prevention strategies that target young adolescents with lower cognitive function will result in prevention of type 2 diabetes, breaking the vicious cycle of type 2 diabetes and cognitive dysfunction.
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Affiliation(s)
- Ithamar Ganmore
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Department of Neurology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
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82
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Saetung S, Nimitphong H, Siwasaranond N, Sumritsopak R, Jindahra P, Krairit O, Thakkinstian A, Anothaisintawee T, Reutrakul S. The relationship between sleep and cognitive function in patients with prediabetes and type 2 diabetes. Acta Diabetol 2018; 55:917-925. [PMID: 29872969 DOI: 10.1007/s00592-018-1166-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/22/2018] [Indexed: 12/14/2022]
Abstract
AIMS Diabetes is linked to cognitive impairment. Sleep plays a role in memory consolidation. Sleep disturbances, commonly found in patients with diabetes, were shown to be related to cognitive dysfunction. This study explored the role of sleep in cognitive function of patients with abnormal glucose tolerance. METHODS A total of 162 patients (81 type 2 diabetes and 81 prediabetes) participated. Sleep duration and sleep efficiency (an indicator of sleep quality) were obtained using 7-day actigraphy recordings. Obstructive sleep apnea (OSA) was screened using an overnight in-home monitor. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Three sub-scores of MoCA, visuoexecutive function, attention and delayed recall, were also analyzed. RESULTS Mean age was 54.8 (10.2) years. OSA was diagnosed in 123 participants (76.9%). Mean sleep duration was 6.0 (1.0) h and sleep efficiency was 82.7 (8.1) %. Sleep duration and OSA severity were not related to MoCA scores. Higher sleep efficiency was associated with higher MoCA scores (p = 0.003), and having diabetes (vs. prediabetes) was associated with lower MoCA scores (p = 0.001). After adjusting covariates, both having diabetes (vs. prediabetes) (B = - 1.137, p = 0.002) and sleep efficiency (B = 0.085, p < 0.001) were independently associated with MoCA scores. In addition, diabetes (B = - 0.608, p < 0.001) and sleep efficiency (B = 0.038, p < 0.001) were associated with visuoexecutive function. Sleep parameters were not related to delayed recall or attention scores. CONCLUSION Lower sleep efficiency is independently associated with lower cognitive function in patients with abnormal glucose tolerance. Whether sleep optimization may improve cognitive function in these patients should be explored.
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Affiliation(s)
- Sunee Saetung
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Hataikarn Nimitphong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Nantaporn Siwasaranond
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Rungtip Sumritsopak
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Panitha Jindahra
- Division of Neurology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Orapitchaya Krairit
- Division of Geriatrics, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Thunyarat Anothaisintawee
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand.
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott St, Suite 625E, M/C 640, Chicago, IL, 60612, USA.
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83
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Altschul DM, Starr JM, Deary IJ. Cognitive function in early and later life is associated with blood glucose in older individuals: analysis of the Lothian Birth Cohort of 1936. Diabetologia 2018; 61:1946-1955. [PMID: 29860628 PMCID: PMC6096629 DOI: 10.1007/s00125-018-4645-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/30/2018] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine whether cognitive function in early and later life, and decline in cognitive function from age 70 to 79 years, are associated with high blood glucose, as measured by HbA1c, at baseline (age 70), and changes in blood glucose from age 70 to 79. METHODS Participants (n = 1091) in the Lothian Birth Cohort of 1936 were examined. Fourteen tests were used to assess cognitive functions, grouped into four domains: visuospatial ability, processing speed, memory and crystallised ability. Test results, and measurements of HbA1c and other health variables, were collected at each of four waves of assessment: at the mean age of 70, 73, 76 and 79 years. Data on cognitive function at age 11 was also available for this cohort. Latent growth curve modelling was performed and statistical controls for known risk factors were introduced. RESULTS Higher age 11 cognitive function predicted lower HbA1c level at age 70 (p < 0.001). Higher cognitive function at age 70 was related to a comparatively smaller increase in HbA1c levels from age 70 to 79 (p < 0.001). HbA1c from age 70 to 79 did not have any consistent association with change in cognitive function from age 70 to 79. These associations survived adjustments for age, sex, education, APOE*ε4, smoking history, cardiovascular disease history, hypertension history, BMI and corrections for multiple testing. CONCLUSIONS/INTERPRETATION Our results show that, among older individuals, high blood glucose is consistently predicted by lower cognitive function. Clinical care that examines and tracks cognitive function, while also taking the positive effects of maintaining cognitive function and emulating healthy behaviours associated with higher cognitive function into account, may be one approach for protecting at-risk individuals from elevated blood glucose and subsequent type 2 diabetes mellitus.
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Affiliation(s)
- Drew M Altschul
- Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK.
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK.
| | - John M Starr
- Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Geriatric Medicine Unit, Western General Hospital, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
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84
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Åberg F, Helenius-Hietala J, Puukka P, Färkkilä M, Jula A. Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population. Hepatology 2018; 67:2141-2149. [PMID: 29164643 DOI: 10.1002/hep.29631] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
Abstract
UNLABELLED The metabolic syndrome and alcohol risk use are both associated with a high prevalence of hepatic steatosis, but only a minority develop liver failure or liver cancer. Few general population studies have analyzed metabolic predictors of such severe liver complications. We studied which metabolic factors best predict severe liver complications, stratified by alcohol consumption, in 6732 individuals without baseline liver disease who participated in the Finnish population-based Health 2000 Study (2000-2001), a nationally representative cohort. Follow-up data from national registers until 2013 were analyzed for liver-related admissions, mortality, and liver cancer. Baseline alcohol use and metabolic factors were analyzed by backward stepwise Cox regression analysis. Eighty-four subjects experienced a severe liver event during follow-up. In the final multivariate model, factors predictive of liver events were age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.004-1.04), sex (women: HR, 0.55; 95% CI, 0.34-0.91), alcohol use (HR, 1.002; 95% CI, 1.001-1.002), diabetes (HR, 2.73; 95% CI, 1.55-4.81), low-density lipoprotein (LDL) cholesterol (HR, 0.74; 95% CI, 0.58-0.93), and homeostasis model assessment of insulin resistance (HOMA-IR) (HR, 1.01; 95% CI, 1.004-1.02). Among alcohol risk users (≥210 g/week for men, ≥ 140 g/week for women), diabetes (HR, 6.79; 95% CI, 3.18-14.5) was the only significant predictor. Among nonrisk drinkers, age, alcohol use, smoking, waist circumference, low LDL cholesterol and HOMA-IR were significant independent predictors. The total-to-LDL cholesterol ratio and waist circumference-to-body mass index ratio emerged as additional independent predictors. CONCLUSION Multiple components of the metabolic syndrome independently affected the risk for severe liver disease. Alcohol was significant even when average alcohol consumption was within the limits currently defining nonalcoholic fatty liver disease. (Hepatology 2018;67:2141-2149).
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Jaana Helenius-Hietala
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Pauli Puukka
- Department of Health, National Institute for Health and Welfare, Turku, Finland
| | - Martti Färkkilä
- Department of Gastroenterology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Antti Jula
- Department of Health, National Institute for Health and Welfare, Turku, Finland
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85
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Benedict C, Grillo CA. Insulin Resistance as a Therapeutic Target in the Treatment of Alzheimer's Disease: A State-of-the-Art Review. Front Neurosci 2018; 12:215. [PMID: 29743868 PMCID: PMC5932355 DOI: 10.3389/fnins.2018.00215] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/19/2018] [Indexed: 01/10/2023] Open
Abstract
Research in animals and humans has shown that type 2 diabetes and its prodromal state, insulin resistance, promote major pathological hallmarks of Alzheimer's disease (AD), such as the formation of amyloid plaques and neurofibrillary tangles (NFT). Worrisomely, dysregulated amyloid beta (Aβ) metabolism has also been shown to promote central nervous system insulin resistance; although the role of tau metabolism remains controversial. Collectively, as proposed in this review, these findings suggest the existence of a mechanistic interplay between AD pathogenesis and disrupted insulin signaling. They also provide strong support for the hypothesis that pharmacologically restoring brain insulin signaling could represent a promising strategy to curb the development and progression of AD. In this context, great hopes have been attached to the use of intranasal insulin. This drug delivery method increases cerebrospinal fluid concentrations of insulin in the absence of peripheral side effects, such as hypoglycemia. With this in mind, the present review will also summarize current knowledge on the efficacy of intranasal insulin to mitigate major pathological symptoms of AD, i.e., cognitive impairment and deregulation of Aβ and tau metabolism.
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Affiliation(s)
| | - Claudia A Grillo
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina-School of Medicine, Columbia, SC, United States
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86
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Assuncao N, Sudo FK, Drummond C, de Felice FG, Mattos P. Metabolic Syndrome and cognitive decline in the elderly: A systematic review. PLoS One 2018; 13:e0194990. [PMID: 29579115 PMCID: PMC5868841 DOI: 10.1371/journal.pone.0194990] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/14/2018] [Indexed: 12/30/2022] Open
Abstract
Background Metabolic Syndrome (MetS) refers to a cluster of metabolic disturbances which is associated with increased risk for vascular and degenerative conditions in general population. Although the relationship between vascular risk factors and dementia is undisputable, additional hazard for cognitive decline in older population with concurrent metabolic disorders still waits to be demonstrated. The present review aims to analyze data on MetS and risk for cognitive decline in elderly persons. Methods Database searches were performed in Medline, ISI and PsycINFO for articles assessing cognitive performances of older subjects with MetS. Results Of a total of 505 studies, 25 were selected for the review. Risk of selection biases was identified in all the studies. Although all articles followed recognized diagnostic recommendations for MetS, minor criteria modifications were detected in most of them. Hyperglycemia was consistently associated with impaired cognitive performances in older individuals, but the role of MetS for cognitive decline and for the onset of dementia showed heterogeneous results. Discussion Current available data in the literature concerning the impact of MetS on the cognition of older population is inconclusive and based on inconsistent evidence. Differential effects of individual MetS components and factors associated with the age of the sample may have accounted for divergent findings among articles, but larger and higher quality studies in this field are still needed.
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Affiliation(s)
- Naima Assuncao
- Memory Clinic, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Institute of Biomedical Sciences–Morphological Sciences Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe Kenji Sudo
- Memory Clinic, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Claudia Drummond
- Memory Clinic, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Speech and Hearing Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Guarino de Felice
- Institute of Biomedical Sciences–Morphological Sciences Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo Mattos
- Memory Clinic, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Institute of Biomedical Sciences–Morphological Sciences Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Psychiatry and Forensic Medicine, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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87
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Ekblad LL, Johansson J, Helin S, Viitanen M, Laine H, Puukka P, Jula A, Rinne JO. Midlife insulin resistance, APOE genotype, and late-life brain amyloid accumulation. Neurology 2018; 90:e1150-e1157. [PMID: 29476033 PMCID: PMC5880630 DOI: 10.1212/wnl.0000000000005214] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/21/2017] [Indexed: 01/01/2023] Open
Abstract
Objective To examine whether midlife insulin resistance is an independent risk factor for brain amyloid accumulation in vivo after 15 years, and whether this risk is modulated by APOE ε4 genotype. Methods This observational study examined 60 elderly volunteers without dementia (mean age at baseline 55.4 and at follow-up 70.9 years, 55.5% women) from the Finnish population-based, nationwide Health2000 study with [11C]Pittsburgh compound B–PET imaging in 2014–2016. The participants were recruited according to their homeostatic model assessment of insulin resistance (HOMA-IR) values in the year 2000, and their APOE ε4 genotype. The exposure group (IR+, n = 30) consisted of individuals with HOMA-IR >2.17 at baseline (highest tertile of the Health2000 study population), and the control group (IR−, n = 30) consisted of individuals with HOMA-IR <1.25 at baseline (lowest tertile). The groups were enriched for APOE ε4 carriers, resulting in 50% (n = 15) APOE ε4 carriers in both groups. Analyses were performed with multivariate logistic and linear regression. Results An amyloid-positive PET scan was found in 33.3% of the IR− group and 60.0% of the IR+ group (odds ratio 3.0, 95% confidence interval 1.1–8.9, p = 0.04). The increased risk was seen in carriers and noncarriers of APOE ε4 genotype. Higher midlife, but not late-life continuous HOMA-IR was associated with a greater brain amyloid burden at follow-up after multivariate adjustments for other cognitive and metabolic risk factors (β = 0.11, 95% confidence interval 0.002–0.22, p = 0.04). Conclusions These results indicate that midlife insulin resistance is an independent risk factor for brain amyloid accumulation in elderly individuals without dementia.
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Affiliation(s)
- Laura L Ekblad
- From the Turku PET Centre (L.L.E., J.J., S.H., J.O.R.) and Department of Geriatrics (M.V., H.L.), Turku City Hospital (M.V., H.L.), University of Turku, Finland; Department of Radiation Sciences (J.J.), Umeå University; Clinical Geriatrics (M.V.), Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden; Department of Medicine, University of Turku (H.L.), and Division of Clinical Neurosciences (J.O.R.), Turku University Hospital; and National Institute for Health and Welfare (P.P., A.J.), Turku, Finland.
| | - Jarkko Johansson
- From the Turku PET Centre (L.L.E., J.J., S.H., J.O.R.) and Department of Geriatrics (M.V., H.L.), Turku City Hospital (M.V., H.L.), University of Turku, Finland; Department of Radiation Sciences (J.J.), Umeå University; Clinical Geriatrics (M.V.), Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden; Department of Medicine, University of Turku (H.L.), and Division of Clinical Neurosciences (J.O.R.), Turku University Hospital; and National Institute for Health and Welfare (P.P., A.J.), Turku, Finland
| | - Semi Helin
- From the Turku PET Centre (L.L.E., J.J., S.H., J.O.R.) and Department of Geriatrics (M.V., H.L.), Turku City Hospital (M.V., H.L.), University of Turku, Finland; Department of Radiation Sciences (J.J.), Umeå University; Clinical Geriatrics (M.V.), Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden; Department of Medicine, University of Turku (H.L.), and Division of Clinical Neurosciences (J.O.R.), Turku University Hospital; and National Institute for Health and Welfare (P.P., A.J.), Turku, Finland
| | - Matti Viitanen
- From the Turku PET Centre (L.L.E., J.J., S.H., J.O.R.) and Department of Geriatrics (M.V., H.L.), Turku City Hospital (M.V., H.L.), University of Turku, Finland; Department of Radiation Sciences (J.J.), Umeå University; Clinical Geriatrics (M.V.), Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden; Department of Medicine, University of Turku (H.L.), and Division of Clinical Neurosciences (J.O.R.), Turku University Hospital; and National Institute for Health and Welfare (P.P., A.J.), Turku, Finland
| | - Hanna Laine
- From the Turku PET Centre (L.L.E., J.J., S.H., J.O.R.) and Department of Geriatrics (M.V., H.L.), Turku City Hospital (M.V., H.L.), University of Turku, Finland; Department of Radiation Sciences (J.J.), Umeå University; Clinical Geriatrics (M.V.), Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden; Department of Medicine, University of Turku (H.L.), and Division of Clinical Neurosciences (J.O.R.), Turku University Hospital; and National Institute for Health and Welfare (P.P., A.J.), Turku, Finland
| | - Pauli Puukka
- From the Turku PET Centre (L.L.E., J.J., S.H., J.O.R.) and Department of Geriatrics (M.V., H.L.), Turku City Hospital (M.V., H.L.), University of Turku, Finland; Department of Radiation Sciences (J.J.), Umeå University; Clinical Geriatrics (M.V.), Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden; Department of Medicine, University of Turku (H.L.), and Division of Clinical Neurosciences (J.O.R.), Turku University Hospital; and National Institute for Health and Welfare (P.P., A.J.), Turku, Finland
| | - Antti Jula
- From the Turku PET Centre (L.L.E., J.J., S.H., J.O.R.) and Department of Geriatrics (M.V., H.L.), Turku City Hospital (M.V., H.L.), University of Turku, Finland; Department of Radiation Sciences (J.J.), Umeå University; Clinical Geriatrics (M.V.), Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden; Department of Medicine, University of Turku (H.L.), and Division of Clinical Neurosciences (J.O.R.), Turku University Hospital; and National Institute for Health and Welfare (P.P., A.J.), Turku, Finland
| | - Juha O Rinne
- From the Turku PET Centre (L.L.E., J.J., S.H., J.O.R.) and Department of Geriatrics (M.V., H.L.), Turku City Hospital (M.V., H.L.), University of Turku, Finland; Department of Radiation Sciences (J.J.), Umeå University; Clinical Geriatrics (M.V.), Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden; Department of Medicine, University of Turku (H.L.), and Division of Clinical Neurosciences (J.O.R.), Turku University Hospital; and National Institute for Health and Welfare (P.P., A.J.), Turku, Finland
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88
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Kong SH, Park YJ, Lee JY, Cho NH, Moon MK. Insulin Resistance is Associated with Cognitive Decline Among Older Koreans with Normal Baseline Cognitive Function: A Prospective Community-Based Cohort Study. Sci Rep 2018; 8:650. [PMID: 29330465 PMCID: PMC5766537 DOI: 10.1038/s41598-017-18998-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/20/2017] [Indexed: 11/19/2022] Open
Abstract
We evaluated whether metabolic factors were associated with cognitive decline, compared to baseline cognitive function, among geriatric population. The present study evaluated data from an ongoing prospective community-based Korean cohort study. Among 1,387 participants who were >65 years old, 422 participants were evaluated using the Korean mini-mental status examination (K-MMSE) at the baseline and follow-up examinations. The mean age at the baseline was 69.3 ± 2.9 years, and 222 participants (52.6%) were men. The mean duration of education was 7.1 ± 3.6 years. During a mean follow-up of 5.9 ± 0.1 years, the K-MMSE score significantly decreased (−1.1 ± 2.7 scores), although no significant change was observed in the homeostasis model assessment of insulin resistance (HOMA-IR) value. Participants with more decreased percent changes in K-MMSE scores had a shorter duration of education (p = 0.001), older age (p = 0.022), higher baseline K-MMSE score (p < 0.001), and increased insulin resistance (∆HOMA-IR, p = 0.002). The correlation between the percent changes in K-MMSE and ∆HOMA-IR values remained significant after multivariable adjustment (B = −0.201, p = 0.002). During a 6-year follow-up of older Koreans with normal baseline cognitive function, increased insulin resistance was significantly correlated with decreased cognitive function.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry and Behavioral Science, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Min Kyong Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
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89
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Ekblad LL, Rinne JO, Puukka P, Laine H, Ahtiluoto S, Sulkava R, Viitanen M, Jula A. Response to Comment by Ayubi and Safiri. Insulin Resistance Predicts Cognitive Decline: An 11-Year Follow-up of a Nationally Representative Adult Population Sample. Diabetes Care 2017;40:751-758. Diabetes Care 2017; 40:e136. [PMID: 28830969 DOI: 10.2337/dci17-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Juha O Rinne
- Turku PET Centre, University of Turku, Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Pauli Puukka
- National Institute for Health and Welfare, Turku, Finland
| | - Hanna Laine
- Turku City Hospital, University of Turku, Turku, Finland.,Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | | | | | - Matti Viitanen
- Turku City Hospital, University of Turku, Turku, Finland.,Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Antti Jula
- National Institute for Health and Welfare, Turku, Finland
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90
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Ayubi E, Safiri S. Comment on Ekblad et al. Insulin Resistance Predicts Cognitive Decline: An 11-Year Follow-up of a Nationally Representative Adult Population Sample. Diabetes Care 2017;40:751-758. Diabetes Care 2017; 40:e135. [PMID: 28830968 DOI: 10.2337/dc17-0876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Erfan Ayubi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
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