101
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Camargo LC, Campos GAA, Galante P, Biolchi AM, Gonçalves JC, Lopes KS, Mortari MR. Peptides isolated from animal venom as a platform for new therapeutics for the treatment of Alzheimer's disease. Neuropeptides 2018; 67:79-86. [PMID: 29198480 DOI: 10.1016/j.npep.2017.11.010] [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: 08/03/2017] [Revised: 11/09/2017] [Accepted: 11/23/2017] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease that deeply affects patients, their family and society. Although scientists have made intense efforts in seeking the cure for AD, no drug available today is able to stop AD progression. In this context, compounds isolated from animal venom are potentially successful drugs for neuroprotection, since they selectively bind to nervous system targets. In this review, we presented different studies using peptides isolated from animal venom for the treatment of AD. This is a growing field that will be very helpful in understanding and even curing neurodegenerative diseases, especially AD.
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Affiliation(s)
- L C Camargo
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - G A A Campos
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - P Galante
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - A M Biolchi
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - J C Gonçalves
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - K S Lopes
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil
| | - M R Mortari
- Laboratory of Neuropharmacology, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília, Brasília, Brazil.
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102
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Schmitz N, Deschênes SS, Burns RJ, Danna SM, Franco OH, Ikram MA, Kivimäki M, Singh-Manoux A, Tiemeier H. Cardiometabolic dysregulation and cognitive decline: potential role of depressive symptoms. Br J Psychiatry 2018; 212:96-102. [PMID: 29436332 DOI: 10.1192/bjp.2017.26] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous studies have examined associations of cardiometabolic factors with depression and cognition separately. Aims To determine if depressive symptoms mediate the association between cardiometabolic factors and cognitive decline in two community studies. METHOD Data for the analyses were drawn from the Rotterdam Study, the Netherlands (n = 2940) and the Whitehall II study, UK (n = 4469). RESULTS Mediation analyses suggested a direct association between cardiometabolic factors and cognitive decline and an indirect association through depression: poorer cardiometabolic status at time 1 was associated with a higher level of depressive symptoms at time 2 (standardised regression coefficient 0.07 and 0.06, respectively), which, in turn, was associated with greater cognitive decline between time 2 and time 3 (standardised regression coefficient of -0.15 and -0.41, respectively). CONCLUSIONS Evidence from two independent cohort studies suggest an association between cardiometabolic dysregulation and cognitive decline and that depressive symptoms tend to precede this decline. Declaration of interest None.
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Affiliation(s)
- Norbert Schmitz
- Department of Psychiatry,McGill University,Montreal,Douglas Mental Health University Institute,Montreal and Montreal Diabetes Research Centre,Montreal,Quebec,Canada
| | - Sonya S Deschênes
- Department of Psychiatry,McGill University,Montreal,and Douglas Mental Health University Institute,Montreal Quebec,Canada
| | - Rachel J Burns
- Department of Psychiatry,McGill University,Montreal,and Douglas Mental Health University Institute,Montreal Quebec,Canada
| | - Sofia M Danna
- Department of Epidemiology and Biostatistics,McGill University,Montreal,Quebec,Canada
| | - Oscar H Franco
- Department of Epidemiology,Erasmus MC-University Medical Center Rotterdam,Rotterdam,the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology,Erasmus MC-University Medical Center Rotterdam,Rotterdam,the Netherlands
| | - Mika Kivimäki
- Department of Epidemiology and Public Health,University College London (UCL),London,UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health,University College London (UCL),London,UK and INSERM U1018,Center for Research in Epidemiology and Population Health,Paul Brousse Hospital,Villejuif,France
| | - Henning Tiemeier
- Department of Epidemiology,Department of Psychiatry and Department of Child and Adolescent Psychiatry,Erasmus MC-University Medical Center Rotterdam,Rotterdam,the Netherlands
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103
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Kotsani M, Chatziadamidou T, Economides D, Benetos A. Higher prevalence and earlier appearance of geriatric phenotypes in old adults with type 2 diabetes mellitus. Diabetes Res Clin Pract 2018; 135:206-217. [PMID: 29155152 DOI: 10.1016/j.diabres.2017.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/10/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022]
Abstract
AIMS To compare the prevalence of cognitive dysfunction, depression, lower mobility performance, disability and falls in older community-dwelling individuals with type 2 diabetes mellitus (T2DM) and in controls of similar age. METHODS We conducted a cross-sectional study in primary health care settings in 3 semi-urban regions in Greece. Were assessed 403 community-dwelling older persons (age ≥65 years, median: 73), 198 with and 205 without diabetes. Common geriatric syndromes were studied using structured individual interviews and widely-used screening scales. An ensuing secondary analysis per age group was performed. RESULTS After adjusting for several confounding factors, the diabetes group presented a 2-fold greater odds of having abnormal scores in Mini Mental State Examination (95%CI: 1.2-3.4, p = 0.006), a 1.5-fold greater odds of abnormal performance in the Clock Drawing Test (95%CI: 1.0-2.4, p = 0.05) and a 2-fold greater odds of slower performance in Timed-Up-And-Go test (95%CI: 1.1-3.4, p = 0.022). In the analysis per age group, impaired cognitive and mobility performances were observed in individuals with diabetes of the younger subgroup (65-74 years), while in the older subgroup (≥75 years), those differences disappeared. CONCLUSIONS In a community-dwelling population aged ≥65 years, cognitive and physical fragilisation is more frequent and is observed at an earlier age in individuals with T2DM than in those without.
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Affiliation(s)
- Marina Kotsani
- Second Department of Internal Medicine, Hippokratio University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Constantinoupoleos Str 49, 54642 Thessaloniki, Greece; Department of Geriatric Medicine, University Hospital Center of Nancy, University of Lorraine, CHRU Nancy Brabois, 5 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - Thekla Chatziadamidou
- Second Department of Internal Medicine, Hippokratio University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Constantinoupoleos Str 49, 54642 Thessaloniki, Greece; Health Center of Diabata, Genimatas General Hospital, Eleftheriou Venizelou Str 5, 54008, Diavata Thessalonikis, Thessaloniki, Greece.
| | - Dimitrios Economides
- Second Department of Internal Medicine, Hippokratio University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Constantinoupoleos Str 49, 54642 Thessaloniki, Greece.
| | - Athanase Benetos
- Department of Geriatric Medicine, University Hospital Center of Nancy, University of Lorraine, CHRU Nancy Brabois, 5 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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104
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Palta P, Carlson MC, Crum RM, Colantuoni E, Sharrett AR, Yasar S, Nahin RL, DeKosky ST, Snitz B, Lopez O, Williamson JD, Furberg CD, Rapp SR, Golden SH. Diabetes and Cognitive Decline in Older Adults: The Ginkgo Evaluation of Memory Study. J Gerontol A Biol Sci Med Sci 2017; 73:123-130. [PMID: 28510619 PMCID: PMC5861864 DOI: 10.1093/gerona/glx076] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 05/05/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Previous studies have shown that individuals with diabetes exhibit accelerated cognitive decline. However, methodological limitations have limited the quality of this evidence. Heterogeneity in study design, cognitive test administration, and methods of analysis of cognitive data have made it difficult to synthesize and translate findings to practice. We analyzed longitudinal data from the Ginkgo Evaluation of Memory Study to test our hypothesis that older adults with diabetes have greater test-specific and domain-specific cognitive declines compared to older adults without diabetes. METHODS Tests of memory, visuo-spatial construction, language, psychomotor speed, and executive function were administered. Test scores were standardized to z-scores and averaged to yield domain scores. Linear random effects models were used to compare baseline differences and changes over time in test and domain scores among individuals with and without diabetes. RESULTS Among the 3,069 adults, aged 72-96 years, 9.3% reported diabetes. Over a median follow-up of 6.1 years, participants with diabetes exhibited greater baseline differences in a test of executive function (trail making test, Part B) and greater declines in a test of language (phonemic verbal fluency). For the composite cognitive domain scores, participants with diabetes exhibited lower baseline executive function and global cognition domain scores, but no significant differences in the rate of decline. CONCLUSIONS Identifying cognitive domains most affected by diabetes can lead to targeted risk modification, possibly in the form of lifestyle interventions such as diet and physical activity, which we know to be beneficial for improving vascular risk factors, such as diabetes, and therefore may reduce the risk of executive dysfunction and possible dementia.
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Affiliation(s)
- Priya Palta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rosa M Crum
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard L Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland
| | - Steven T DeKosky
- Department of Neurology, University of Florida College of Medicine, Gainesville
| | - Beth Snitz
- Department of Neurology, University of Pittsburgh, Pennsylvania
| | - Oscar Lopez
- Department of Neurology, University of Pittsburgh, Pennsylvania
| | - Jeff D Williamson
- Division of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Curt D Furberg
- Division of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Stephen R Rapp
- Division of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Sherita Hill Golden
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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105
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High Hemoglobin A1c and Diabetes Predict Memory Decline in the Health and Retirement Study. Alzheimer Dis Assoc Disord 2017; 31:48-54. [PMID: 28225507 DOI: 10.1097/wad.0000000000000182] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is an established risk factor for dementia, but evidence for T2D and memory decline is less consistent. Understanding how T2D and blood glucose relate to memory decline is crucial to elucidating the mechanisms linking T2D and dementia. MATERIALS AND METHODS For 8888 Health and Retirement Study participants aged 50+, glycosylated hemoglobin (HbA1c) was measured in either 2006 or 2008 and physician's diagnosis of diabetes was self-reported in the same year. Composite memory (z scored) was assessed biennially through 2012 using immediate and delayed word list recall or the Informant Questionnaire for Cognitive Decline. Marginal mean regression models for repeated outcomes were specified to predict memory decline as a function of diabetes or HbA1c, using age as the timescale and adjusting for health and social confounders. RESULTS Diabetes was associated with a 10% faster rate of memory decline [β=-0.04 per decade; 95% confidence interval (CI), -0.06 to -0.01). A 1 U increase in HbA1c corresponded with a 0.05 SD decrease in memory score per decade (95% CI, -0.08 to -0.03). Even among individuals with HbA1c<6.5% (threshold for diabetes), higher HbA1c was associated with memory decline (β=-0.05 per decade; 95% CI, -0.08 to -0.03). DISCUSSION Diabetes accelerated memory loss and higher HbA1c predicted memory decline even in nondiabetics.
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106
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Elovainio M, Sommerlad A, Hakulinen C, Pulkki-Råback L, Virtanen M, Kivimäki M, Singh-Manoux A. Structural social relations and cognitive ageing trajectories: evidence from the Whitehall II cohort study. Int J Epidemiol 2017; 47:701-708. [PMID: 29121238 DOI: 10.1093/ije/dyx209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/30/2017] [Accepted: 09/06/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Social relations are important for health, particularly at older ages. We examined the salience of frequency of social contacts and marital status for cognitive ageing trajectories over 21 years, from midlife to early old age. METHODS Data are from the Whitehall II cohort study, including 4290 men and 1776 women aged 35-55 years at baseline (1985-88). Frequency of social contacts and marital status were measured in 1985-88 and 1989-90. Assessment of cognitive function on five occasions (1991-94, 1997-99, 2003-04, 2007-09 and 2012-13) included the following tests: short-term memory, inductive reasoning, verbal fluency (phonemic and semantic) and a combined global score. Cognitive trajectories over the study period were analysed using longitudinal latent growth class analyses, and the associations of these latent classes (trajectory memberships) with social relations were analysed using multinominal logistic regression. RESULTS More frequent social contacts [relative risk (RRR) 0.96, 95% confidence interval (CI) 0.94 - 0.98] and being married (RRR 0.70, 95% CI 0.58 - 0.84) were associated with lower probability of being on a low rather than high cognitive performance trajectory over the subsequent 21 years. These associations persisted after adjustment for covariates. Of the sub-tests, social relations variables had the strongest association with phonemic fluency (RRR 0.95, 95% CI 0.94 - 0.97 for frequent contact; RRR 0.59, 95% CI 0.48 - 0.71 for being married). CONCLUSIONS More frequent social contacts and having a spouse were associated with more favourable cognitive ageing trajectories. Further studies are needed to examine whether interventions designed to improve social connections affect cognitive ageing.
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Affiliation(s)
- Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Institute for Health and Welfare, Helsinki, Finland
| | | | - Christian Hakulinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK.,Clinicum and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK.,INSERM U1018, Hôpital Paul Brousse, Villejuif, France
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107
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Macpherson H, Formica M, Harris E, Daly RM. Brain functional alterations in Type 2 Diabetes - A systematic review of fMRI studies. Front Neuroendocrinol 2017; 47:34-46. [PMID: 28687473 DOI: 10.1016/j.yfrne.2017.07.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/30/2017] [Accepted: 07/02/2017] [Indexed: 02/07/2023]
Abstract
Type 2 Diabetes (T2DM) is emerging as a major global health issue. T2DM can adversely affect cognition and increase dementia risk. This systematic review aimed to examine the functional brain changes that may underlie cognitive dysfunction in adults with T2DM. Studies were restricted to those which used functional magnetic resonance imaging (fMRI). Nineteen independent studies were identified, mostly comprised of middle aged or older adults. Resting-state studies demonstrated that compared to controls, connectivity of the Default Mode Network (DMN) was reduced and the majority of task-based studies identified reduced activation in T2DM patients in regions relevant to task performance. Abnormalities of low frequency spontaneous brain activity were observed, particularly in visual regions. As most studies demonstrated that alterations in fMRI were related to poorer neuropsychological task performance, these results indicate that functional brain abnormalities in T2DM have consequences for cognition.
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Affiliation(s)
- Helen Macpherson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
| | - Melissa Formica
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Harris
- Centre for Human Psychopharmacology, Swinburne University, Hawthorn, VIC, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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108
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Wennberg AMV, Hagen CE, Gottesman RF, Zipunnikov V, Kaufmann CN, Albert MS, Rebok GW, Kasper JD, Spira AP. Longitudinal association between diabetes and cognitive decline: The National Health and Aging Trends Study. Arch Gerontol Geriatr 2017; 72:39-44. [PMID: 28544945 PMCID: PMC5967846 DOI: 10.1016/j.archger.2017.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 03/27/2017] [Accepted: 05/09/2017] [Indexed: 12/29/2022]
Abstract
Type II diabetes mellitus (DM) is associated with increased risk of dementia; however, few studies have examined the longitudinal association between DM and cognitive outcomes in large nationally representative cohorts. We investigated these associations in 7605 participants enrolled in the National Health and Aging Trends Study, a nationally representative prospective study of Medicare beneficiaries ≥65, from 2011 to 2015. Participants or proxy respondents reported DM and dementia diagnosis, and participants completed immediate and delayed recall word list learning tests and the Clock Drawing Test. In multivariable-adjusted generalized linear mixed models, baseline DM diagnosis was associated with decline on immediate and delayed word recall and the Clock Drawing Test. In Cox proportional hazards models, DM also predicted incident dementia in older age groups at baseline. These findings further support the notion that DM is associated with cognitive outcomes, suggesting that treatment and prevention of DM may reduce the risk of these outcomes. However, more studies are needed to better understand whether DM treatments affect this relationship.
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Affiliation(s)
| | - Clinton E Hagen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | | | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
| | | | - Marilyn S Albert
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States; Johns Hopkins Center on Aging and Health, United States
| | - Judith D Kasper
- Johns Hopkins Center on Aging and Health, United States; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States; Johns Hopkins Center on Aging and Health, United States; Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, United States
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109
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Xu H, Zhang Y, Wu B. Association between migration and cognitive status among middle-aged and older adults: a systematic review. BMC Geriatr 2017; 17:184. [PMID: 28818064 PMCID: PMC5561610 DOI: 10.1186/s12877-017-0585-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/09/2017] [Indexed: 12/22/2022] Open
Abstract
Background This study aimed to synthesize the current literature examining the association between migration and cognitive function among middle-aged and older adults. Methods We used the PRISMA as a guideline for this systematic review and searched the following databases: PubMed, CINAHL, EMBASE, and Global Health. Results Twenty-five published studies were included. Twenty-two studies were focused on international migrants, while only 3 studied internal migrants. Fourteen studies were conducted in the United States, followed by UK (n = 2), Israel (n = 2), India (n = 2) and other countries like Canada and Australia. Some studies showed that middle-aged and older migrants demonstrated poorer cognitive function comparing to non-migrants in hosting places; while other studies indicated no association between migration and cognitive function. A higher level of acculturation was associated with better performance on cognitive function tests among migrants. Conclusion It is unclear how or whether migration and cognitive function are related. The quality of current literature suffered from methodological deficiencies. Additional research is needed to examine the linkages using more comprehensive measures of migration and cognitive function.
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Affiliation(s)
- Hanzhang Xu
- Duke University School of Nursing, Durham, NC, USA. .,Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA.
| | - Yinan Zhang
- Chinese Center for Health Education, Beijing, China
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY, USA
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110
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Rawlings AM, Sharrett AR, Mosley TH, Ballew SH, Deal JA, Selvin E. Glucose Peaks and the Risk of Dementia and 20-Year Cognitive Decline. Diabetes Care 2017; 40:879-886. [PMID: 28500217 PMCID: PMC5481977 DOI: 10.2337/dc16-2203] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/30/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hemoglobin A1c (HbA1c), a measure of average blood glucose level, is associated with the risk of dementia and cognitive impairment. However, the role of glycemic variability or glucose excursions in this association is unclear. We examined the association of glucose peaks in midlife, as determined by the measurement of 1,5-anhydroglucitol (1,5-AG) level, with the risk of dementia and 20-year cognitive decline. RESEARCH DESIGN AND METHODS Nearly 13,000 participants from the Atherosclerosis Risk in Communities (ARIC) study were examined. Dementia was ascertained from surveillance, neuropsychological testing, telephone calls with participants or their proxies, or death certificate dementia codes. Cognitive function was assessed using three neuropsychological tests at three visits over 20 years and was summarized as z scores. We used Cox and linear mixed-effects models. 1,5-AG level was dichotomized at 10 μg/mL and examined within clinical categories of HbA1c. RESULTS Over a median time of 21 years, dementia developed in 1,105 participants. Among persons with diabetes, each 5 μg/mL decrease in 1,5-AG increased the estimated risk of dementia by 16% (hazard ratio 1.16, P = 0.032). For cognitive decline among participants with diabetes and HbA1c <7% (53 mmol/mol), those with glucose peaks had a 0.19 greater z score decline over 20 years (P = 0.162) compared with those without peaks. Among participants with diabetes and HbA1c ≥7% (53 mmol/mol), those with glucose peaks had a 0.38 greater z score decline compared with persons without glucose peaks (P < 0.001). We found no significant associations in persons without diabetes. CONCLUSIONS Among participants with diabetes, glucose peaks are a risk factor for cognitive decline and dementia. Targeting glucose peaks, in addition to average glycemia, may be an important avenue for prevention.
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Affiliation(s)
- Andreea M Rawlings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Shoshana H Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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111
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Xu H, Dupre ME, Gu D, Wu B. The impact of residential status on cognitive decline among older adults in China: Results from a longitudinal study. BMC Geriatr 2017; 17:107. [PMID: 28506252 PMCID: PMC5430605 DOI: 10.1186/s12877-017-0501-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/09/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Residential status has been linked to numerous determinants of health and well-being. However, the influence of residential status on cognitive decline remains unclear. The purpose of this research was to assess the changes of cognitive function among older adults with different residential status (urban residents, rural-to-urban residents, rural residents, and urban-to-rural residents), over a 12-year period. METHODS We used five waves of data (2002, 2005, 2008/2009, 2011/2012, and 2014) from the Chinese Longitudinal Healthy Longevity Survey with 17,333 older adults age 65 and over who were interviewed up to five times. Cognitive function was measured by the Mini Mental State Examination (MMSE). Multilevel models were used regarding the effects of residential status after adjusting for demographic characteristics, socioeconomic factors, family support, health behaviors, and health status. RESULTS After controlling for covariates, significant differences in cognitive function were found across the four groups: rural-to-urban and rural residents had a higher level of cognition than urban residents at baseline. On average, cognitive function decreased over the course of the study period. Rural-to-urban and rural residents demonstrated a faster decline in cognitive function than urban residents. CONCLUSIONS This study suggests that residential status has an impact on the rate of changes in cognition among older adults in China. Results from this study provide directions for future research that addresses health disparities, particularly in countries that are undergoing significant socioeconomic transitions.
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Affiliation(s)
- Hanzhang Xu
- Duke University School of Nursing, Durham, NC USA
- Duke Global Health Institute, Duke University Medical Center, Durham, NC USA
| | - Matthew E. Dupre
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC USA
- Department of Sociology, Duke University, Durham, NC USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC USA
| | - Danan Gu
- United Nations Population Division, New York, NY USA
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY USA
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112
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Simó R, Ciudin A, Simó-Servat O, Hernández C. Cognitive impairment and dementia: a new emerging complication of type 2 diabetes-The diabetologist's perspective. Acta Diabetol 2017; 54:417-424. [PMID: 28210868 DOI: 10.1007/s00592-017-0970-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/30/2017] [Indexed: 12/24/2022]
Abstract
Type 2 diabetes mellitus (T2D) and Alzheimer's disease (AD) are two of the most common diseases of aging around the world. Given the frequency with which T2D and AD occur, the notion that people with T2D may be at increased risk for AD has large societal consequences, and understanding the mechanistic links between these diseases is imperative for the development of effective AD prevention and treatment strategies. Apart from being an accelerator of AD, T2D is associated with a progressive cognitive decline. Impaired insulin signaling, inflammation, the accumulation of advanced glycation end-products and oxidative stress all play an essential role in the pathogenesis of both AD and diabetic complications. Therefore, it is reasonable to postulate that these pathways are involved in the increased risk of dementia that occurs in the T2D population. The early diagnosis of cognitive impairment and the identification of the subset of patients at a higher risk of developing AD is a challenge for healthcare providers, and meeting it will permit us to implement a personalized medicine, which is an essential issue in diabetes care with significant therapeutic implications. The main gaps that should be filled to achieve this objective are examined.
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Affiliation(s)
- Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Andreea Ciudin
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Olga Simó-Servat
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Davis WA, Zilkens RR, Starkstein SE, Davis TME, Bruce DG. Dementia onset, incidence and risk in type 2 diabetes: a matched cohort study with the Fremantle Diabetes Study Phase I. Diabetologia 2017; 60:89-97. [PMID: 27717960 DOI: 10.1007/s00125-016-4127-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS The study aimed to assess the incidence, age of onset, survival and relative hazard of dementia in well-categorised community-based patients with type 2 diabetes compared with a matched cohort of individuals without diabetes. METHODS A longitudinal observational study was undertaken involving 1291 participants with type 2 diabetes from the Fremantle Diabetes Study and 5159 matched residents without documented diabetes. Linkage with health-related databases was used to detect incident dementia. Relative hazards were assessed using both cause-specific and subdistribution proportional hazards models. RESULTS During 13.8 ± 5.8 years of follow-up, incident dementia occurred in 13.9% and 12.4% of the groups of participants with and without diabetes, respectively (p = 0.15). With type 2 diabetes, the incidence of dementia was higher (incidence rate ratio [IRR] 1.28, 95% CI 1.08, 1.51), as was the competing risk of death (IRR 1.50, 95% CI 1.38, 1.64). The ages when dementia was first recorded and when death with dementia occurred were both earlier with diabetes, by 1.7 (95% CI 0.6, 2.9) and 2.3 (95% CI 1.1, 3.6) years, respectively (both p ≤ 0.004). Type 2 diabetes was associated with an adjusted subdistribution HR of 1.18 (95% CI 1.00, 1.39), and a cause-specific HR of 1.51 (95% CI 1.27, 1.78) for all-cause dementia. CONCLUSIONS/INTERPRETATION Type 2 diabetes is associated with an increased incidence of dementia, and dementia onset occurs at a younger age. The relative hazards of both dementia and premature mortality are increased and, as a consequence, the increased risk of dementia in type 2 diabetes is not as marked as suggested by cause-specific HRs.
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Affiliation(s)
- Wendy A Davis
- School of Medicine and Pharmacology, The University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
| | - Renate R Zilkens
- Centre for Population Health Research, School of Public Health, Curtin University of Technology, Perth, WA, Australia
| | - Sergio E Starkstein
- School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Fremantle Hospital, Fremantle, WA, Australia
| | - Timothy M E Davis
- School of Medicine and Pharmacology, The University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia
| | - David G Bruce
- School of Medicine and Pharmacology, The University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia.
- School of Medicine and Pharmacology, Fremantle Hospital, PO Box 480, Fremantle, Western Australia, 6959, Australia.
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de Oliveira Regina MC, Tambascia MA. Depression and alexithymia on weight perception in patients with metabolic syndrome and type 2 diabetes. Diabetol Metab Syndr 2017; 9:34. [PMID: 28507609 PMCID: PMC5429505 DOI: 10.1186/s13098-017-0222-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/02/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Obesity's increasing follows decreased perception of weight status in obese persons, mainly female, undergoing age-related changes. OBJECTIVE To study weight perception and psychological alterations associated to MS and T2DM. METHODS 200 patients selected from Metabolic Syndrome Outpatient Clinic of University of Campinas. Instruments: Beck Depression and Beck Anxiety Inventories', Toronto Alexithymia Scale-26s, questionnaire and data from reports. Approved by Unicamp Research Ethic Committee. RESULTS Patients aged 18-40 years perceived their weight higher than actual (A < D) (p = 0.0272), amongst untreated hypertensive (p = 0.037). ≥41 years old patient's subdivided into A = D and A > D. A = D had 4.3 more chances to be alexithymic than A < D. 35% of A < D accepted their physical appearance, contrarily A = D (66%) and A > D (69%) (p = 0.0018). 50% of A < D felt offended by social aggression due to their weight; A = D (20%) and A > D (34%) (p = 0.007). 3.6 more chances of A > D than A < D using anti-hypertensive drugs (p = 0.021) (≥41 years old) and 3.5 more chances to perceive A = D (41-60 years old) (p = 0.023). A = D presented 3.8 more chances of depression than A < D and 4.3 more chances of alexithymia than A < D (62% of 41-60 year-old patients with higher cholesterol, mainly LDL and hyper-triglycerides). A = D with alexithymia, partially linked with higher cholesterol, suggests neuroinflammation due to hypertriglycerides. Females, who declared had been anteriorly made diet as treatment to lose weight were exactly those who perceived their weight A > D (45%, p = 0.0091). CONCLUSIONS Age as a period of development, in which cultural influences occurs, was a factor in weight misperception. A < D and A > D were distinct in age, history of obesity and BMI.
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Affiliation(s)
| | - Marcos Antonio Tambascia
- Department of Internal Medicine, Endocrinology Metabolic Syndrome and Diabetes, Medical Faculty of State University of Campinas, Campinas, Brazil
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115
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Feng BY, Huang C, Cao J, Dong Z, Liu FC, Ji LN, Yang JK, Li G, Li JX, Yang XL, Xie J, Fang K, Huang JF, Gu DF. Diabetes awareness, treatment, control rates and associated risk factors among Beijing residents in 2011: A cross-sectional survey. Chronic Dis Transl Med 2016; 2:147-158. [PMID: 29063036 PMCID: PMC5643831 DOI: 10.1016/j.cdtm.2016.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Indexed: 01/19/2023] Open
Abstract
Objective To examine the awareness, treatment and control rates of diabetes and identify their associated risk factors among Beijing residents. Methods A cross-sectional survey was conducted in 2011, using a stratified multistage cluster random sampling method to select a representative sample of 20,242 residents in Beijing aged 18–79 years. Diabetes was defined as fasting blood glucose (FBG) ≥7.0 mmol/L and/or history of diabetes and/or using insulin or hypoglycemic agents. All estimates of awareness, treatment and control rates were weighted by the 2010 Beijing Population Census data and the sampling scheme. Multivariate Logistic regression was used to identify factors associated with awareness, treatment and control rates. Results A total of 2061 (10.3%) participants were diagnosed as diabetes. The overall awareness, treatment and control rate among patients were 60.9%, 51.3% and 22.4%, respectively, while overall control rate among treated patients was 33.8%. These rates differed across subgroups. Women were more likely to be aware of diabetes status, receive treatment and have better glucose controlled than men (69.5% vs. 54.7% for awareness, 61.0% vs. 44.3% for treatment, and 27.6% vs. 18.6% for control, respectively). In addition, only 22.2% of treated patients had both FBG and hemoglobin A1c (HbA1c) controlled well. Multivariate Logistic regression suggested that old age, women, higher education and family history of diabetes were associated with higher awareness, treatment and control rates (All P < 0.05). Treated individuals living in rural (OR = 0.67(95%CI: 0.47–0.96)) or with dyslipidemia (OR = 0.63 (95%CI: 0.44–0.91)) had a lower diabetic control rate. Conclusions Awareness, treatment and control rates of diabetes in Beijing were still low. A comprehensive intervention strategy on diabetes management and control is warranted.
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Affiliation(s)
- Bao-Yu Feng
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Chen Huang
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Jie Cao
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Zhong Dong
- Institute of Chronic Diseases Control and Prevention, Beijing Center for Diseases Control and Prevention, Beijing 100013, China
| | - Fang-Chao Liu
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Li-Nong Ji
- Department of Endocrinology, Peking University People's Hospital, Beijing 100044, China
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Gang Li
- Institute of Chronic Diseases Control and Prevention, Beijing Center for Diseases Control and Prevention, Beijing 100013, China
| | - Jian-Xin Li
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Xue-Li Yang
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Jin Xie
- Institute of Chronic Diseases Control and Prevention, Beijing Center for Diseases Control and Prevention, Beijing 100013, China
| | - Kai Fang
- Institute of Chronic Diseases Control and Prevention, Beijing Center for Diseases Control and Prevention, Beijing 100013, China
| | - Jian-Feng Huang
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
| | - Dong-Feng Gu
- Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
- Corresponding author. Fax: +86 10 88363812.Department of EpidemiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical SciencesPeking Union Medical College167 Beilishi RoadBeijing100037China
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Stefan N, Fritsche A, Schick F, Häring HU. Phenotypes of prediabetes and stratification of cardiometabolic risk. Lancet Diabetes Endocrinol 2016; 4:789-798. [PMID: 27185609 DOI: 10.1016/s2213-8587(16)00082-6] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 02/07/2023]
Abstract
Prediabetes is associated with increased risks of type 2 diabetes, cardiovascular disease, dementia, and cancer, and its prevalence is increasing worldwide. Lifestyle and pharmacological interventions in people with prediabetes can prevent the development of diabetes and possibly cardiovascular disease. However, prediabetes is a highly heterogeneous metabolic state, both with respect to its pathogenesis and prediction of disease. Improved understanding of these features and precise phenotyping of prediabetes could help to improve stratification of disease risk. In this Personal View, we focus on the extreme metabolic phenotypes of metabolically healthy obesity and metabolically unhealthy normal weight, insulin secretion failure, insulin resistance, visceral obesity, and non-alcoholic fatty liver disease. We present new analyses aimed at improving characterisation of phenotypes in lean, overweight, and obese people with prediabetes. We discuss evidence from lifestyle intervention studies to explore whether these phenotypes can also be used for individualised prediction and prevention of cardiometabolic diseases.
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Affiliation(s)
- Norbert Stefan
- Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany; German Centre for Diabetes Research (DZD), Tübingen, Germany.
| | - Andreas Fritsche
- Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany; German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Fritz Schick
- Section of Experimental Radiology, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany; German Centre for Diabetes Research (DZD), Tübingen, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany; German Centre for Diabetes Research (DZD), Tübingen, Germany
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117
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Does type 2 diabetes increase rate of cognitive decline in older Mexican Americans? Alzheimer Dis Assoc Disord 2016; 29:206-12. [PMID: 25650694 DOI: 10.1097/wad.0000000000000083] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Estimating effects of diabetes on cognitive change among older Mexican Americans is important, yet challenging, because diabetes and cognitive decline both predict mortality, which can induce survival bias. Older Mexican Americans in the Sacramento Area Latino Study on Aging (n=1634) completed Modified Mini-Mental State Exams (3MSE) and diabetes assessments up to 7 times (from 1998 to 2007). We examined baseline and new-onset diabetes and cognitive decline with joint longitudinal-survival models to account for death. At baseline, 32.4% of participants had diabetes and 15.8% developed diabetes during the study. During the study period, 22.8% of participants died. In joint longitudinal-survival models, those with baseline diabetes experienced faster cognitive decline (P=0.003) and higher mortality (hazards ratio=1.88; 95% confidence interval, 1.48-2.38) than those without diabetes. Cognitive decline and mortality were similar for those with new-onset diabetes and those without diabetes. For a typical person, 3MSE scores declined by 2.3 points among those without diabetes and 4.3 points among those with baseline diabetes, during the last 6 years of study. Ignoring the impact of death yielded a 17.0% smaller estimate of the effect of baseline diabetes on cognitive decline. Analyses that overlook the association between cognitive decline and mortality may underestimate the effect of diabetes on cognitive aging.
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118
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Palleria C, Leporini C, Maida F, Succurro E, De Sarro G, Arturi F, Russo E. Potential effects of current drug therapies on cognitive impairment in patients with type 2 diabetes. Front Neuroendocrinol 2016; 42:76-92. [PMID: 27521218 DOI: 10.1016/j.yfrne.2016.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/13/2016] [Accepted: 07/22/2016] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes mellitus is a complex metabolic disease that can cause serious damage to various organs. Among the best-known complications, an important role is played by cognitive impairment. Impairment of cognitive functioning has been reported both in type 1 and 2 diabetes mellitus. While this comorbidity has long been known, no major advances have been achieved in clinical research; it is clear that appropriate control of blood glucose levels represents the best current (although unsatisfactory) approach in the prevention of cognitive impairment. We have focused our attention on the possible effect on the brain of antidiabetic drugs, despite their effects on blood glucose levels, giving a brief rationale on the mechanisms (e.g. GLP-1, BDNF, ghrelin) that might be involved. Indeed, GLP-1 agonists are currently clinically studied in other neurodegenerative diseases (i.e. Parkinson's and Alzheimer's disease); furthermore, also other antidiabetic drugs have proven efficacy in preclinical studies. Overall, promising results are already available and finding new intervention strategies represents a current need in this field of research.
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Affiliation(s)
- Caterina Palleria
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Italy
| | - Christian Leporini
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Italy
| | - Francesca Maida
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, Internal Medicine Unit of "Mater Domini", University Hospital, University "Magna Graecia" of Catanzaro, Policlinico "Mater Domini", Campus Universitario, Viale Europa, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Italy
| | - Franco Arturi
- Department of Medical and Surgical Sciences, Internal Medicine Unit of "Mater Domini", University Hospital, University "Magna Graecia" of Catanzaro, Policlinico "Mater Domini", Campus Universitario, Viale Europa, 88100 Catanzaro, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Italy.
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119
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Therapeutic Potential of Antidiabetic Medications in the Treatment of Cognitive Dysfunction and Dementia. Drugs Aging 2016; 33:399-409. [DOI: 10.1007/s40266-016-0375-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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120
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Zietemann V, Wollenweber FA, Bayer-Karpinska A, Biessels GJ, Dichgans M. Peripheral glucose levels and cognitive outcome after ischemic stroke-Results from the Munich Stroke Cohort. Eur Stroke J 2016; 1:51-60. [PMID: 31008267 DOI: 10.1177/2396987316631674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/19/2016] [Indexed: 01/04/2023] Open
Abstract
Introduction The relationship between glucose metabolism and stroke outcome is likely to be complex. We examined whether there is a linear or non-linear relationship between glucose measures in the acute phase of stroke and post-stroke cognition, and whether altered glucose metabolism at different time intervals (long- and short-term before stroke, acute phase) is associated with cognitive outcome. Patients and methods In all, 664 consecutively recruited patients with acute ischemic stroke and without pre-stroke dementia were included in this prospective observational study. Blood samples were taken at admission and fasting on the first morning after stroke. Duration of diabetes was assessed by interview. Cognitive outcome was assessed by the Telephone Interview for Cognitive Status 3 months post-stroke. Dose-response analyses were used to investigate non-linearity. Regression analyses were stratified by diabetes status and adjusted for relevant confounders. Results Cognitive status was testable in 422 patients (81 with diabetes). There was a non-linear relationship between both admission and fasting glucose levels and cognitive outcome. Lower glucose values were significantly associated with lower Telephone Interview for Cognitive Status scores 3 months post-stroke in patients without diabetes with a similar trend in diabetic patients. There was an inverse association between duration of diabetes and Telephone Interview for Cognitive Status scores (linear regression: -0.10 (95% confidence interval: -0.17 to -0.02) per year increase of diabetes duration), whereas HbA1c was not related to cognitive outcome. Results were supported by sensitivity analyses accounting for attrition. Conclusion Lower glucose levels in the acute phase of stroke are associated with worse cognitive outcome but the relationship is non-linear. Long-term abnormalities in glucose metabolism are also related to poor outcome but this is not the case for shorter term abnormalities. Altered glucose levels at different stages of stroke may affect stroke outcome through different pathways.
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Affiliation(s)
- Vera Zietemann
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Frank Arne Wollenweber
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Abstract
The Framingham Heart Study (FHS), initiated in 1948, is the longest running prospective cohort study in the USA. Through >65 years of discovery, the FHS has contributed to our understanding of obesity, type 2 diabetes mellitus and prediabetes mellitus, the metabolic syndrome and nonalcoholic fatty liver disease (NAFLD), and to how these conditions relate to our overall and cardiovascular-related mortality. This Timeline gives an overview of the substantial role the FHS has played in advancing the understanding of obesity, diabetes mellitus and NAFLD, and considers the direction the FHS will take in the years to come.
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Affiliation(s)
- Michelle T Long
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, 7th Floor, 85 East Concord Street, Boston, Massachusetts 02118, USA
| | - Caroline S Fox
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts 01702-5827, USA
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122
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Pearson-Stuttard J, Blundell S, Harris T, Cook DG, Critchley J. Diabetes and infection: assessing the association with glycaemic control in population-based studies. Lancet Diabetes Endocrinol 2016; 4:148-58. [PMID: 26656292 DOI: 10.1016/s2213-8587(15)00379-4] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/24/2015] [Accepted: 09/25/2015] [Indexed: 02/08/2023]
Abstract
Diabetes is a leading cause of morbidity and mortality. The global burden of diabetes is rising because of increased obesity and population ageing. Although preventive and treatment measures are well documented for macrovascular and microvascular complications, little such guidance exists for infections in people with diabetes, despite evidence suggesting greater susceptibility to infections, and worse outcomes. In particular, few studies have characterised the relation between glycaemic control and infectious disease, which we discuss in this Review. Some large population-based observational studies have reported strong associations between higher HbA1c and infection risks for both type 1 and type 2 diabetes. However, studies are contradictory, underpowered, or do not control for confounders. Evidence suggests that better glycaemic control might reduce infection risk, but further longitudinal studies with more frequent measures of HbA1c are needed. Older people (aged 70 years or older) with diabetes are at increased risk of complications, including infectious diseases. There is more uncertainty about appropriate glycaemic control targets in this age group, and evidence suggests that glycaemic control is often neglected. Robust evidence from cohorts with sufficient numbers of older people would help to develop clinically relevant guidelines and targets to reduce mortality, morbidity, and antibiotic use, and to improve quality of life.
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Affiliation(s)
| | | | - Tess Harris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Julia Critchley
- Population Health Research Institute, St George's, University of London, London, UK
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Anstey KJ, Sargent-Cox K, Eramudugolla R, Magliano DJ, Shaw JE. Association of cognitive function with glucose tolerance and trajectories of glucose tolerance over 12 years in the AusDiab study. ALZHEIMERS RESEARCH & THERAPY 2015; 7:48. [PMID: 26167206 PMCID: PMC4499451 DOI: 10.1186/s13195-015-0131-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/22/2015] [Indexed: 01/19/2023]
Abstract
Introduction We investigated the association between glucose tolerance status and trajectories of change in blood glucose, and cognitive function in adults aged 25 to 85. Methods The sample (n = 4547) was drawn from a national, population-based cohort study in Australia (AusDiab). Fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) and general health were assessed at 0, 5 and 12 years. Covariates included age, education, body mass index, blood pressure and physical activity. At 12 years, participants completed assessments of memory, processing speed and verbal ability. Results Known diabetes at baseline was associated with slower processing speed at 12 years in both younger (25–59 years) and older (>60 years) age-groups. After 12 years of follow-up, adults aged < 60 with diabetes at baseline had a mean speed score of 49.17 (SE = 1.09) compared with 52.39 (SE = 0.20) in normals. Among younger males without diagnosed diabetes, reduced memory at 12 years was associated with higher HbA1c at 5 years (β = −0.91, SE = 0.26, p < 0.001). No effects were apparent for females or older males. Adjusting for insulin sensitivity (HOMA-%S) and hs-C reactive protein attenuated these associations, but depression and CVD risk did not. Latent class analysis was used to analyse the associations between trajectories of HbA1C and glucose over 12 years, and cognition. Identified classes were described as 1) normal and stable blood glucose over time (reference), 2) high intercept but stable blood glucose over time, and 3) increasing blood glucose over time. In both young males and females, high stable glucose measures were associated with poorer cognitive function after 12 years. Conclusion Those with type 2 diabetes, younger males with high non-diabetic HbA1c, and adults with high stable blood glucose are at increased risk of poorer cognition. The findings reinforce the need for management of diabetes risk factors in midlife. Electronic supplementary material The online version of this article (doi:10.1186/s13195-015-0131-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kaarin J Anstey
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, 54 Mills Road, Canberra, ACT 0200 Australia
| | - Kerry Sargent-Cox
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, 54 Mills Road, Canberra, ACT 0200 Australia
| | - Ranmalee Eramudugolla
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, 54 Mills Road, Canberra, ACT 0200 Australia
| | - Dianna J Magliano
- Baker IDI Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria 3004 Australia
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria 3004 Australia
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Roy S, Kim N, Desai A, Komaragiri M, Baxi N, Jassil N, Blessinger M, Khan M, Cole R, Desai N, Terrigno R, Hunter K. Cognitive Function and Control of Type 2 Diabetes Mellitus in Young Adults. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:220-6. [PMID: 26110134 PMCID: PMC4462818 DOI: 10.4103/1947-2714.157627] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Type 2 diabetes mellitus (T2DM) has been associated with impairment of cognitive function. Studies show a strong negative correlation between the levels of glycosylated hemoglobin and cognitive function in adult patients above the mean age of 60 years. In healthy adults, age-related cognitive impairment is mostly reported after the age of 60 years, hence the decline in cognitive function can be a part of normal aging without diabetes. Since the majority of patients with diabetes are between the ages of 40 and 59 years, it is crucial to ascertain whether the levels of glycosylated hemoglobin negatively correlate with the levels of cognitive function scores in adult patients of age 60 years or younger, similar to the way it correlates in patients older than 60 years of age, or not. Aims: We observed the relationship between the levels of glycosylated hemoglobin and the levels of cognitive function in patients of age 60 years or younger with T2DM. Materials and Methods: Eighty-two patients with T2DM underwent cognitive assessment testing by using a Modified Mini-Mental State Examination (3MS), and their cognitive function scores were correlated with their glycosylated hemoglobin levels, durations of diabetes, and levels of education. Results: Cognitive impairment was observed in 19.5% of the studied patients. We found a weakly negative relationship between the glycosylated hemoglobin level and cognitive function score (r = -0.292), a moderately negative relationship between the duration of diabetes and cognitive function score (r = -0.303), and a weakly positive relationship between the level of education and cognitive function score (r = 0.277). Conclusion: Cognitive impairment affects one-fifth of the patients of age 60 years or younger with T2DM. It is weakly negatively related to the glycosylated hemoglobin level, moderately negatively related to the duration of diabetes, and weakly positively related to the level of education.
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Affiliation(s)
- Satyajeet Roy
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Nami Kim
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Anjali Desai
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Mahathi Komaragiri
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Namrata Baxi
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Navinder Jassil
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Megan Blessinger
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Maliha Khan
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Robert Cole
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Nayan Desai
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Rocco Terrigno
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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125
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Du N, Xu D, Hou X, Song X, Liu C, Chen Y, Wang Y, Li X. Inverse Association Between Serum Uric Acid Levels and Alzheimer's Disease Risk. Mol Neurobiol 2015; 53:2594-9. [PMID: 26084440 DOI: 10.1007/s12035-015-9271-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
The association between Alzheimer's disease and uric acid levels had gained great interest in recent years, but there was still lack of definite evidence. A systematic review and meta-analysis of relevant studies was performed to comprehensively estimate the association. Relevant studies published before October 26, 2014, were searched in PubMed, Embase, and China Biology Medicine (CBM) databases. Study-specific data were combined using random-effects or fixed-effects models of meta-analysis according to between-study heterogeneity. Twenty-four studies (21 case-control and 3 cohort studies) were finally included into the meta-analysis. Those 21 case-control studies included a total of 1128 cases of Alzheimer's disease and 2498 controls without Alzheimer's disease. Those 3 cohort studies included a total of 7327 participants. Meta-analysis showed that patients with Alzheimer's disease had lower levels of uric acid than healthy controls (weighted mean difference (WMD) = -0.77 mg/dl, 95% CI -2.28 to -0.36, P = 0.0002). High serum uric acid levels were significantly associated with decreased risk of Alzheimer's disease (risk ratio (RR) = 0.66, 95% CI 0.52-0.85, P = 0.001). There was low risk of publication bias in the meta-analysis. There is an inverse association between serum uric acid levels and Alzheimer's disease. High serum uric acid level is a protective factor of Alzheimer's disease.
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Affiliation(s)
- Na Du
- Department of Endocrinology, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Donghua Xu
- Department of Rheumatology, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Xu Hou
- Department of Endocrinology, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Xuejia Song
- Department of Endocrinology, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Cancan Liu
- Department of Endocrinology, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Ying Chen
- Department of Endocrinology, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Yangang Wang
- Department of Endocrinology, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China.
| | - Xin Li
- Department of Physiology, Functional Laboratory of Weifang Medical University, Weifang, 261031, China.
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126
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Tuligenga RH. Intensive glycaemic control and cognitive decline in patients with type 2 diabetes: a meta-analysis. Endocr Connect 2015; 4:R16-24. [PMID: 25712899 PMCID: PMC4419843 DOI: 10.1530/ec-15-0004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/23/2015] [Indexed: 12/30/2022]
Abstract
The aim of this meta-analysis was to compare the effect of intensive vs standard glycaemic control on cognitive decline in type 2 diabetic patients. A systematic search of PubMed and ALOIS was conducted from inception up to October 30, 2014. Randomised controlled trials (RCTs) of type 2 diabetic patients comparing the rate of change in cognitive function among participants assigned to intensive vs standard glycaemic control were included. An inverse-variance-weighted random effects model was used to calculate standardised mean differences (SMDs) and 95% CIs. A total of 24 297 patients from five RCTs were included in the meta-analysis. Follow-up ranged from 3.3 to 6.2 years. The result from the pooled analysis showed that intensive glycaemic control was not associated with a slower rate of cognitive decline in patients with type 2 diabetes, compared with standard glycaemic control (SMD=0.02; 95% CI=-0.03 to 0.08) although there was some heterogeneity across individual studies (I(2)=68%, P for heterogeneity=0.01). There are few diabetes control trials including cognitive endpoints and a small number of trials comparing intensive and standard treatment strategies. Currently, intensive glycaemic control should not be recommended for prevention of cognitive decline in patients with type 2 diabetes because there is no evidence of its effectiveness. Moreover, the use of intensive diabetes treatment results in an increase of risk of hypoglycaemia, which is linked to a greater risk of poor cognition.
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Affiliation(s)
- Richard H Tuligenga
- INSERM U1018Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Paris, Villejuif Cedex, FranceUniversité Paris SudUMRS 1018 Paris, Villejuif, France INSERM U1018Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Paris, Villejuif Cedex, FranceUniversité Paris SudUMRS 1018 Paris, Villejuif, France
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127
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Singh-Manoux A, Schmidt R. Diabetes: A risk factor for cognitive impairment and dementia? Neurology 2015; 84:2300-1. [PMID: 25948721 DOI: 10.1212/wnl.0000000000001671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Archana Singh-Manoux
- From INSERM (A.S.-M.), Epidemiology of Ageing and Age-related Diseases, Hôpital Paul Brousse, Villejuif Cedex, France; the Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and the Department of Neurology (R.S.), Clinical Division of Neurogeriatrics, Medical University Graz, Austria.
| | - Reinhold Schmidt
- From INSERM (A.S.-M.), Epidemiology of Ageing and Age-related Diseases, Hôpital Paul Brousse, Villejuif Cedex, France; the Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and the Department of Neurology (R.S.), Clinical Division of Neurogeriatrics, Medical University Graz, Austria
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128
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Kern W. [How poor blood glucose values damage the brain]. MMW Fortschr Med 2015; 157:63-66. [PMID: 25743987 DOI: 10.1007/s15006-015-2776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Werner Kern
- Endokrinologikum Ulm, Keltergasse 1, D-89073, Ulm, Deutschland,
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129
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Buysschaert M, Medina JL, Bergman M, Shah A, Lonier J. Prediabetes and associated disorders. Endocrine 2015; 48:371-93. [PMID: 25294012 DOI: 10.1007/s12020-014-0436-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/20/2014] [Indexed: 12/14/2022]
Abstract
Prediabetes represents an elevation of plasma glucose above the normal range but below that of clinical diabetes. Prediabetes includes individuals with IFG, IGT, IFG with IGT and elevated HbA1c levels. Insulin resistance and β-cell dysfunction are characteristic of this disorder. The diagnosis of prediabetesis is vital as both IFG and IGT are indeed well-known risk factors for type 2 diabetes with a greater risk in the presence of combined IFG and IGT. Furthermore, as will be illustrated in this review, prediabetes is associated with associated disorders typically only considered in with established diabetes. These include cardiovascular disease, periodontal disease, cognitive dysfunction, microvascular disease, blood pressure abnormalities, obstructive sleep apnea, low testosterone, metabolic syndrome, various biomarkers, fatty liver disease, and cancer. As the vast majority of individuals with prediabetes are unaware of their diagnosis, it is therefore vital that the associated conditions are identified, particularly in the presence of mild hyperglycemia, so they may benefit from early intervention.
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Affiliation(s)
- Martin Buysschaert
- Department of Endocrinology and Diabetology, University Clinic Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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130
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Xu X, Du N, Wang R, Wang Y, Cai S. Hyperuricemia is independently associated with increased risk of atrial fibrillation: A meta-analysis of cohort studies. Int J Cardiol 2015; 184:699-702. [PMID: 25777070 DOI: 10.1016/j.ijcard.2015.02.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/21/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Xiang Xu
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Na Du
- Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Robin Wang
- Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Yangang Wang
- Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao 266003, China.
| | - Shanglang Cai
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao 266003, China.
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131
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Abstract
Dementia is a major cause of disability and death among older adults. Those with type 2 diabetes (T2D) are 50-100% more likely to develop dementia than those without T2D, but it is unknown whether this association reflects a causal relationship. Proposed mechanisms through which T2D could cause dementia include the effects of insulin dysregulation and chronic hyperglycemia on features of Alzheimer's disease and macrovascular and microvascular disorders in the brain. More research is needed to elucidate the link between T2D and dementia and identify strategies to maintain cognitive function among people with T2D.
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Affiliation(s)
- Elizabeth Rose Mayeda
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107, Phone: 415-514-8018
| | - Rachel A. Whitmer
- Epidemiology, Etiology & Prevention, Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, Phone: 510-891-3400
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco VA Medical Center, Box VAMC – 181, San Francisco, CA. 94143, Phone: 415-221-4810
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132
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Wang M, Li Y, Lin L, Song G, Deng T. GSTM1 Null Genotype and GSTP1 Ile105Val Polymorphism Are Associated with Alzheimer's Disease: a Meta-Analysis. Mol Neurobiol 2015; 53:1355-1364. [PMID: 25633095 DOI: 10.1007/s12035-015-9092-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/12/2015] [Indexed: 01/09/2023]
Abstract
Published studies on the associations between glutathione S-transferase (GST) polymorphisms and Alzheimer's disease reported controversial findings. A meta-analysis of published studies was performed to assess the associations between polymorphisms of GSTM1, GSTT1 and GSTP1, and Alzheimer's disease. PubMed, Embase, and other databases were searched for case-control on the associations between polymorphisms of GSTM1, GSTT1 and GSTP1, and Alzheimer's disease. The odds ratio (OR) and 95% confidence interval (95% CI) were used to assess the associations. Eleven articles were finally included into the meta-analysis, including eight studies on GSTM1 null genotype, six studies on GSTT1 null genotype, and six studies on GSTP1 Ile105Val polymorphism. Overall, GSTM1 null genotype was associated with increased risk of Alzheimer's disease (fixed effect OR = 1.34, 95% CI 1.10-1.64, P = 0.004). GSTT1 null genotype was not associated with risk of Alzheimer's disease (random effect OR = 1.15, 95% CI 0.68-1.92, P = 0.60). Besides, GSTP1 Ile105Val polymorphism was significantly associated with increased risk of Alzheimer's disease (Val vs Ile: OR = 1.45, 95% CI 1.05-1.99, P = 0.023; ValVal vs IleIle: OR = 1.87, 95% CI 1.30-2.69, P = 0.001; ValVal vs IleIle + IleVal: OR = 1.76, 95% CI 1.24-2.51, P = 0.002). No obvious risk of publication bias was observed in the meta-analysis. GSTM1 null genotype and GSTP1 Ile105Val polymorphism are associated with increased risk of Alzheimer's disease. More studies with large sample size are needed to validate the findings in the meta-analysis.
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Affiliation(s)
- Mo Wang
- Neurology Department No.1, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Yu Li
- Neurology Department No.1, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Lulu Lin
- Neurology Department No.1, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Guijun Song
- Neurology Department No.1, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China.
| | - Teng Deng
- Capital Medical University, Beijing, 100068, China
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133
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Korol SV, Jin Z, Babateen O, Birnir B. GLP-1 and exendin-4 transiently enhance GABAA receptor-mediated synaptic and tonic currents in rat hippocampal CA3 pyramidal neurons. Diabetes 2015; 64:79-89. [PMID: 25114295 DOI: 10.2337/db14-0668] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Glucagon-like peptide-1 (GLP-1) is a hormone that stimulates insulin secretion. Receptors for GLP-1 are also found in the brain, including the hippocampus, the center for memory and learning. Diabetes is a risk factor for decreased memory functions. We studied effects of GLP-1 and exendin-4, a GLP-1 receptor agonist, on γ-aminobutyric acid (GABA) signaling in hippocampal CA3 pyramidal neurons. GABA is the main inhibitory neurotransmitter and decreases neuronal excitability. GLP-1 (0.01-1 nmol/L) transiently enhanced synaptic and tonic currents, and the effects were blocked by exendin (9-39). Ten pmol/L GLP-1 increased both the spontaneous inhibitory postsynaptic current (sIPSC) amplitudes and frequency by a factor of 1.8. In 0.1, 1 nmol/L GLP-1 or 10, 50, or 100 nmol/L exendin-4, only the sIPSC frequency increased. The tonic current was enhanced by 0.01-1 nmol/L GLP-1 and by 0.5-100 nmol/L exendin-4. When action potentials were inhibited by tetrodotoxin (TTX), inhibitory postsynaptic currents decreased and currents were no longer potentiated by GLP-1 or exendin-4. In contrast, although the tonic current decreased in TTX, it was still enhanced by GLP-1 or exendin-4. The results demonstrate GLP-1 receptor regulation of hippocampal function and are consistent with GLP-1 receptor agonists enhancing GABAA signaling by pre- and postsynaptic mechanisms.
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Affiliation(s)
- Sergiy V Korol
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Zhe Jin
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Omar Babateen
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Bryndis Birnir
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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134
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Glycemia and cognitive function in metabolic syndrome and coronary heart disease. Am J Med 2015; 128:46-55. [PMID: 25220612 PMCID: PMC4306431 DOI: 10.1016/j.amjmed.2014.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Higher hemoglobin A1c (HbA1c) is associated with lower cognitive function in type 2 diabetes. To determine whether associations persist at lower levels of dysglycemia in patients who have established cardiovascular disease, cognitive performance was assessed in the Targeting INflammation Using SALsalate in CardioVascular Disease (TINSAL-CVD) trial. METHODS The age-adjusted relationships between HbA1c and cognitive performance measured by the Mini-Mental State Examination, Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Trail Making Test, and Categorical Verbal Fluency were assessed in 226 men with metabolic syndrome and established stable coronary artery disease. RESULTS Of the participants, 61.5% had normoglycemia, 20.8% had impaired fasting glucose, and 17.7% had type 2 diabetes. HbA1c was associated with cognitive function tests of Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Trail Making Test, and Categorical Verbal Fluency (all P < .02), but not the Mini-Mental State Examination. In an age-adjusted model, a 1% (11 mmol/mol) higher HbA1c value was associated with a 5.9 lower Digit Symbol Substitution Test score (95% confidence interval [CI], -9.58 to -2.21; P < .0001); a 2.44 lower Rey Auditory Verbal Learning Test score (95% CI, -4.00 to -0.87; P < .0001); a 15.6 higher Trail Making Test score (95% CI, 5.73 to 25.6; P < .0001); and a 3.71 lower Categorical Verbal Fluency score (95% CI, -6.41 to -1.01; P < .02). In a multivariate model adjusting for age, education, and cardiovascular covariates, HbA1c remained associated with cognitive function tests of Rey Auditory Verbal Learning Test (R(2) = 0.27, P < .0001), Trail Making Test (R(2) = 0.18, P < .0001), and Categorical Verbal Fluency (R(2) = 0.20, P < .0001), although association with the Digit Symbol Substitution Test was reduced. CONCLUSIONS Higher HbA1c is associated with lower cognitive function performance scores across multiple domain tests in men with metabolic syndrome and coronary artery disease. Future studies may demonstrate whether glucose lowering within the normative range improves cognitive health.
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135
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Geijselaers SLC, Sep SJS, Stehouwer CDA, Biessels GJ. Glucose regulation, cognition, and brain MRI in type 2 diabetes: a systematic review. Lancet Diabetes Endocrinol 2015; 3:75-89. [PMID: 25163604 DOI: 10.1016/s2213-8587(14)70148-2] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Type 2 diabetes is associated with cognitive dysfunction and structural brain changes. Abnormalities in glucose regulation are involved in several complications related to type 2 diabetes, but their role in these cerebral complications is unclear. We systematically reviewed studies of the association between glucose regulation (glycaemia, hypoglycaemic events, insulin concentration, insulin resistance, and glucose-lowering treatment) and cognitive function and brain abnormalities on MRI in people with type 2 diabetes. The 86 papers included showed that glycaemia, particularly high HbA1c concentration and glucose variability, are negatively associated with cognitive function in people with type 2 diabetes without dementia. However, the strength of this association is weak, and HbA1c generally accounted for less than 10% of the variance in cognition. Importantly, few studies have measured long-term cerebral outcomes, such as dementia and structural brain changes on MRI, and the effect of glucose-lowering treatment on these outcomes. More randomised controlled trials are needed to establish the effect of glucose-lowering treatment on long-term cognitive function in people with type 2 diabetes.
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Affiliation(s)
- Stefan L C Geijselaers
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Simone J S Sep
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
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136
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Rawlings AM, Sharrett AR, Schneider ALC, Coresh J, Albert M, Couper D, Griswold M, Gottesman RF, Wagenknecht LE, Windham BG, Selvin E. Diabetes in midlife and cognitive change over 20 years: a cohort study. Ann Intern Med 2014; 161:785-93. [PMID: 25437406 PMCID: PMC4432464 DOI: 10.7326/m14-0737] [Citation(s) in RCA: 267] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Type 2 diabetes is associated with dementia risk, but evidence is limited for possible associations of diabetes and prediabetes with cognitive decline. OBJECTIVE To determine whether diabetes in midlife is associated with 20-year cognitive decline and to characterize long-term cognitive decline across clinical categories of hemoglobin A1c (HbA1c) levels. DESIGN Prospective cohort study. SETTING The community-based ARIC (Atherosclerosis Risk in Communities) study. PARTICIPANTS 13,351 black and white adults aged 48 to 67 years at baseline (1990 to 1992). MEASUREMENTS Diabetes was defined by self-reported physician diagnosis or medication use or HbA1c level of 6.5% or greater. Undiagnosed diabetes, prediabetes, and glucose control in persons with diagnosed diabetes were defined by clinical categories of HbA1c level. Delayed word recall, digit symbol substitution, and word fluency tests were used to assess cognitive performance and were summarized with a global Z score. RESULTS Diabetes in midlife was associated with a 19% greater cognitive decline over 20 years (adjusted global Z-score difference, -0.15 [;95% CI, -0.22 to -0.08];) compared with no diabetes. Cognitive decline was significantly greater among persons with prediabetes (HbA1c level of 5.7% to 6.4%) than among those with an HbA1c level less than 5.7%. Participants with poorly controlled diabetes (HbA1c level ≥ 7.0%) had greater decline than those whose diabetes was controlled (adjusted global Z-score difference, -0.16; P = 0.071). Longer-duration diabetes was also associated with greater late-life cognitive decline (P for trend < 0.001). Rates of decline did not differ significantly between white and black persons (P for interaction = 0.44). LIMITATION Single HbA1c measurement at baseline, 1 test per cognitive domain, and potential geographic confounding of race comparisons. CONCLUSION Diabetes prevention and glucose control in midlife may protect against late-life cognitive decline. PRIMARY FUNDING SOURCE National Institutes of Health.
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137
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Mayeda ER, Haan MN, Neuhaus J, Yaffe K, Knopman DS, Sharrett AR, Griswold ME, Mosley TH. Type 2 diabetes and cognitive decline over 14 years in middle-aged African Americans and whites: the ARIC Brain MRI Study. Neuroepidemiology 2014; 43:220-7. [PMID: 25402639 PMCID: PMC4370220 DOI: 10.1159/000366506] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/05/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Diabetes predicts late-life dementia, but the association with rate of cognitive decline is inconsistent and has rarely been examined in non-white populations, despite the high prevalence of diabetes in African Americans. We evaluated the effect of diabetes on cognitive decline in middle-aged African Americans and whites. METHODS Atherosclerosis Risk in Communities (ARIC) Brain MRI Study participants (n = 1,886, mean age = 60, 49% African American) underwent assessments of verbal memory, processing speed, and verbal fluency four times over 14 years. Using race-stratified mixed linear effects models, we examined cognitive change for participants with prevalent (baseline) diabetes and incident (diagnosed after baseline) diabetes versus those without diabetes. RESULTS African Americans had more advanced diabetes, as indicated by fasting blood glucose levels, anti-diabetes medication use, and cardiovascular risk profiles. African Americans with prevalent diabetes experienced 41% greater annual decline in processing speed scores (p = 0.048) and 50% greater annual decline in verbal fluency scores (p = 0.042) than those without diabetes; incident diabetes was not associated with cognitive decline. Among whites, diabetes was not associated with cognitive decline. CONCLUSIONS Prevalent diabetes was associated with greater cognitive decline in middle-aged African Americans, possibly reflecting adverse effects of longer duration and more advanced diabetes.
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Affiliation(s)
- Elizabeth R. Mayeda
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Mary N. Haan
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Psychiatry, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
| | | | | | - Michael E. Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center
| | - Thomas H. Mosley
- Department of Medicine, University of Mississippi Medical Center
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Meusel LAC, Kansal N, Tchistiakova E, Yuen W, MacIntosh BJ, Greenwood CE, Anderson ND. A systematic review of type 2 diabetes mellitus and hypertension in imaging studies of cognitive aging: time to establish new norms. Front Aging Neurosci 2014; 6:148. [PMID: 25071557 PMCID: PMC4085499 DOI: 10.3389/fnagi.2014.00148] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 06/17/2014] [Indexed: 12/19/2022] Open
Abstract
The rising prevalence of type 2 diabetes (T2DM) and hypertension in older adults, and the deleterious effect of these conditions on cerebrovascular and brain health, is creating a growing discrepancy between the "typical" cognitive aging trajectory and a "healthy" cognitive aging trajectory. These changing health demographics make T2DM and hypertension important topics of study in their own right, and warrant attention from the perspective of cognitive aging neuroimaging research. Specifically, interpretation of individual or group differences in blood oxygenation level dependent magnetic resonance imaging (BOLD MRI) or positron emission tomography (PET H2O(15)) signals as reflective of differences in neural activation underlying a cognitive operation of interest requires assumptions of intact vascular health amongst the study participants. Without adequate screening, inclusion of individuals with T2DM or hypertension in "healthy" samples may introduce unwanted variability and bias to brain and/or cognitive measures, and increase potential for error. We conducted a systematic review of the cognitive aging neuroimaging literature to document the extent to which researchers account for these conditions. Of the 232 studies selected for review, few explicitly excluded individuals with T2DM (9%) or hypertension (13%). A large portion had exclusion criteria that made it difficult to determine whether T2DM or hypertension were excluded (44 and 37%), and many did not mention any selection criteria related to T2DM or hypertension (34 and 22%). Of all the surveyed studies, only 29% acknowledged or addressed the potential influence of intersubject vascular variability on the measured BOLD or PET signals. To reinforce the notion that individuals with T2DM and hypertension should not be overlooked as a potential source of bias, we also provide an overview of metabolic and vascular changes associated with T2DM and hypertension, as they relate to cerebrovascular and brain health.
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Affiliation(s)
| | - Nisha Kansal
- Baycrest Centre, Rotman Research Institute Toronto, ON, Canada
| | - Ekaterina Tchistiakova
- Sunnybrook Research Institute, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery Toronto, ON, Canada ; Department of Medical Biophysics, Faculty of Medicine, University of Toronto Toronto, ON, Canada
| | - William Yuen
- Baycrest Centre, Rotman Research Institute Toronto, ON, Canada ; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto Toronto, ON, Canada
| | - Bradley J MacIntosh
- Sunnybrook Research Institute, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery Toronto, ON, Canada ; Department of Medical Biophysics, Faculty of Medicine, University of Toronto Toronto, ON, Canada
| | - Carol E Greenwood
- Baycrest Centre, Rotman Research Institute Toronto, ON, Canada ; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto Toronto, ON, Canada
| | - Nicole D Anderson
- Baycrest Centre, Rotman Research Institute Toronto, ON, Canada ; Departments of Psychology and Psychiatry, University of Toronto Toronto, ON, Canada
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