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Diabetes and Alzheimer's Disease: A Link not as Simple as it Seems. Neurochem Res 2018; 44:1271-1278. [PMID: 30523576 DOI: 10.1007/s11064-018-2690-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/11/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes mellitus is associated with an increased risk to develop Alzheimer disease, however, the underlying mechanisms for this association are still unclear. In this review we will provide a critical overview of the major findings coming from clinical studies and animal models.
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152
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Lacy ME, Gilsanz P, Karter AJ, Quesenberry CP, Pletcher MJ, Whitmer RA. Long-term Glycemic Control and Dementia Risk in Type 1 Diabetes. Diabetes Care 2018; 41:2339-2345. [PMID: 30181165 PMCID: PMC6196833 DOI: 10.2337/dc18-0073] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Individuals with type 1 diabetes have experienced an increase in life expectancy, yet it is unknown what level of glycemic control is ideal for maintaining late-life brain health. We investigated the association of long-term glycemic control with dementia in older individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS We followed 3,433 members of a health care system with type 1 diabetes, aged ≥50 years, from 1996 to 2015. Repeated measurements of hemoglobin A1c (HbA1c), dementia diagnoses, and comorbidities were ascertained from health records. Cox proportional hazards models were fit to evaluate the association of time-varying glycemic exposure with dementia, with adjustment for age, sex, race/ethnicity, baseline health conditions, and frequency of HbA1c measurement. RESULTS Over a mean follow-up of 6.3 years, 155 individuals (4.5%) were diagnosed with dementia. Patients with ≥50% of HbA1c measurements at 8-8.9% (64-74 mmol/mol) and ≥9% (≥75 mmol/mol) had 65% and 79% higher risk of dementia, respectively, compared with those with <50% of measurements exposed (HbA1c 8-8.9% adjusted hazard ratio [aHR] 1.65 [95% CI 1.06, 2.57] and HbA1c ≥9% aHR 1.79 [95% CI 1.11, 2.90]). By contrast, patients with ≥50% of HbA1c measurements at 6-6.9% (42-52 mmol/mol) and 7-7.9% (53-63 mmol/mol) had a 45% lower risk of dementia (HbA1c 6-6.9% aHR 0.55 [95% CI 0.34, 0.88] and HbA1c 7-7.9% aHR 0.55 [95% CI 0.37, 0.82]). CONCLUSIONS Among older patients with type 1 diabetes, those with majority exposure to HbA1c 8-8.9% and ≥9% had increased dementia risk, while those with majority exposure to HbA1c 6-6.9% and 7-7.9% had reduced risk. Currently recommended glycemic targets for older patients with type 1 diabetes are consistent with healthy brain aging.
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Affiliation(s)
- Mary E Lacy
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA .,Division of Research, Kaiser Permanente, Oakland, CA
| | - Paola Gilsanz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.,Division of Research, Kaiser Permanente, Oakland, CA
| | | | | | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Rachel A Whitmer
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.,Division of Research, Kaiser Permanente, Oakland, CA.,Division of Epidemiology, Public Health Sciences, University of California Davis School of Medicine, Davis, CA
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153
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van Duinkerken E, Steenwijk MD, Klein M, Barkhof F, Mograbi DC, Diamant M, Snoek FJ, Ijzerman RG. Accelerated executive functions decline and gray matter structural changes in middle-aged type 1 diabetes mellitus patients with proliferative retinopathy. J Diabetes 2018; 10:835-846. [PMID: 29665283 DOI: 10.1111/1753-0407.12773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/19/2018] [Accepted: 04/11/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of the present study was to determine trajectories of cognitive and cortical changes over time in middle-aged patients with type 1 diabetes mellitus (T1DM) and proliferative retinopathy. METHODS Twenty-five patients and 25 controls underwent neuropsychological assessment and neuroimaging twice in a mean (±SD) of 3.56 ± 0.65 and 3.94 ± 0.91 years, respectively (P = 0.098). Cognitive assessment included the domains of general cognitive ability, memory, information processing speed, executive functions, attention, and motor and psychomotor speed. Symmetrized percentage change in local cortical thickness, surface area, and volume was determined using the FreeSurfer 6 vertex-wise general linear model method. Analyses were performed uncorrected and corrected for baseline systolic blood pressure and depressive symptoms. RESULTS In patients versus controls, accelerated executive function decline was accompanied by, but not related to, lower left frontal and temporal surface area, left parietal and right frontal thickness, and bilateral frontal and right posterior cingulate volume (family-wise error [FWE]-corrected P < 0.05 for all). In patients, lower executive performance was related to loss of right precuneus surface area (PFWE = 0.005). Higher HbA1c during follow-up was related to executive function decline (r = -0.509, P = 0.016) and loss of left hemisphere surface area (rcorrected analysis = -0.555, P = 0.007). CONCLUSIONS After 3.5 years of follow-up, middle-aged T1DM patients with proliferative retinopathy, mild focal changes in executive functions, and cortical structure were found, which may indicate accelerated aging.
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Affiliation(s)
- Eelco van Duinkerken
- Amsterdam Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
- Center for Epilepsy, State Brain Institute Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Martijn D Steenwijk
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin Klein
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Daniel C Mograbi
- Center for Epilepsy, State Brain Institute Paulo Niemeyer, Rio de Janeiro, Brazil
- Department of Psychology, Institute of Psychiatry, Kings College, London, UK
| | - Michaela Diamant
- Amsterdam Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Richard G Ijzerman
- Amsterdam Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Type 2 diabetes and cognitive impairment in an older population with overweight or obesity and metabolic syndrome: baseline cross-sectional analysis of the PREDIMED-plus study. Sci Rep 2018; 8:16128. [PMID: 30382190 PMCID: PMC6208341 DOI: 10.1038/s41598-018-33843-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/05/2018] [Indexed: 12/12/2022] Open
Abstract
This study cross-sectionally examines in the elderly population: (a) the association of type 2 diabetes with executive function (EF); (b) the effect of BMI on both type 2 diabetes and EF; (c) the association between glycaemia control and EF in type 2 diabetes. 6823 older individuals with overweight/obesity and metabolic syndrome participating in the PREDIMED-PLUS study, were assessed with a battery of cognitive tests and a medical interview. ANOVA showed a significantly worse performance on EF in type 2 diabetes vs. non-diabetic individuals. Two complementary models were displayed: (1) in the whole sample, the presence of type 2 diabetes, depressive symptoms and BMI had a direct negative effect on EF, while apnoea had an indirect negative effect; (2) in the diabetes subsample, higher illness duration was associated with worse performance in EF. Participants with type 2 diabetes and HbA1c<53 mmol/mol displayed better cognitive performance when compared to those with HbA1c≥53 mmol/mol. Our results provide a controlled comprehensive model that integrates relevant neuropsychological and physical variables in type 2 diabetes. The model suggests that, to improve treatment adherence and quality of life once diabetes has been diagnosed, cognitive decline prevention strategies need to be implemented while monitoring depressive symptoms, BMI and glycaemia control.
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155
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Hughes TM, Sink KM, Williamson JD, Hugenschmidt CE, Wagner BC, Whitlow CT, Xu J, Smith SC, Launer LJ, Barzilay JI, Ismail-Beigi F, Bryan RN, Hsu FC, Bowden DW, Maldjian JA, Divers J, Freedman BI. Relationships between cerebral structure and cognitive function in African Americans with type 2 diabetes. J Diabetes Complications 2018; 32:916-921. [PMID: 30042057 PMCID: PMC6138531 DOI: 10.1016/j.jdiacomp.2018.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Relationships between cognitive function and brain structure remain poorly defined in African Americans with type 2 diabetes. METHODS Cognitive testing and cerebral magnetic resonance imaging in African Americans from the Diabetes Heart Study Memory IN Diabetes (n = 480) and Action to Control Cardiovascular Risk in Diabetes MIND (n = 104) studies were examined for associations. Cerebral gray matter volume (GMV), white matter volume (WMV) and white matter lesion volume (WMLV) and cognitive performance (Mini-mental State Exam [MMSE and 3MSE], Digit Symbol Coding (DSC), Stroop test, and Rey Auditory Verbal Learning Test) were recorded. Multivariable models adjusted for age, sex, BMI, scanner, intracranial volume, education, diabetes duration, HbA1c, LDL-cholesterol, smoking, hypertension and cardiovascular disease assessed associations between cognitive tests and brain volumes by study and meta-analysis. RESULTS Mean(SD) participant age was 60.1(7.9) years, diabetes duration 12.1(7.7) years, and HbA1c 8.3(1.7)%. In the fully-adjusted meta-analysis, lower GMV associated with poorer global performance on MMSE/3MSE (β̂ = 7.1 × 10-3, SE 2.4 × 10-3, p = 3.6 × 10-3), higher WMLV associated with poorer performance on DSC (β̂ = -3 × 10-2, SE 6.4 × 10-3, p = 5.2 × 10-5) and higher WMV associated with poorer MMSE/3MSE performance (β̂ = -7.1 × 10-3, SE = 2.4 × 10-3, p = 3.6 × 10-3). CONCLUSIONS In African Americans with diabetes, smaller GMV and increased WMLV associated with poorer performance on tests of global cognitive and executive function. These data suggest that WML burden and gray matter atrophy associate with cognitive performance independent of diabetes-related factors in this population.
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Affiliation(s)
- Timothy M Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Kaycee M Sink
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D Williamson
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Christina E Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Benjamin C Wagner
- Department of Radiology, Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | - Jianzhao Xu
- Departments of Biochemistry & Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - S Carrie Smith
- Departments of Biochemistry & Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Lenore J Launer
- National Institutes of Health, National Institute on Aging, Laboratory of Epidemiology, Demography, and Biometry, Bethesda, MD, USA.
| | | | - Faramarz Ismail-Beigi
- Department of Internal Medicine, Division of Endocrinology, University of Cincinnati, Veterans Administration Medical Center, Cincinnati, OH.
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - Fang-Chi Hsu
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Donald W Bowden
- Departments of Biochemistry & Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Joseph A Maldjian
- Department of Radiology, Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Jasmin Divers
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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156
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Lo RY, Chen SC, Yang YL, Wang YH, Chen HD, Li JC, Wu DA. Cognitive Impairment and Glycemic Control in Elderly Patients Under Health-Care Case Management. J Geriatr Psychiatry Neurol 2018; 31:265-270. [PMID: 30041563 DOI: 10.1177/0891988718790410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We aim to test whether the association between glucose control and cognitive function still holds true in elderly patients with diabetes mellitus (DM) and Alzheimer disease (AD) under health-care case management. We enrolled 100 patients with DM (mean age: 74.6 years; male: 49%) and 102 patients with AD (mean age: 77.9 years; male: 41.2%) consecutively from the Diabetes Shared Care Program and the memory clinic. These patients were followed up every 3 months with scheduled examinations. Most patients with AD were at early stage and DM was a common comorbidity (n = 42). In the DM group, there were 76 patients with subjective cognitive decline and 19 patients with mild cognitive impairment, but none sought further consultation. After adjusting for age, sex, education, and comorbidity, higher levels of glycated hemoglobin (HbA1C) were not associated with lower Mini-Mental State Examination (MMSE) scores in the DM group (coefficient: 0.03; 95% confidence interval [CI]: -0.44 to 0.50) and lower MMSE scores were not associated with higher HbA1C in the AD group either (coefficient: -0.05; 95% CI: -0.11 to 0.01). When additionally accounting for the variability of HbA1C in the DM group, higher standard deviation of HbA1C was associated with poor clock drawing test scores, but not MMSE. The coexistence of AD-DM was common, but the association between hyperglycemia and cognitive impairment was not seen in patients under regular health monitoring.
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Affiliation(s)
- Raymond Y Lo
- 1 Division of Cognitive/Geriatric Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Shu-Ching Chen
- 1 Division of Cognitive/Geriatric Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Ya-Ling Yang
- 1 Division of Cognitive/Geriatric Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Yi-Hsuan Wang
- 2 Department of Metabolism and Endocrinology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hsin-Dean Chen
- 2 Department of Metabolism and Endocrinology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Jer-Chuan Li
- 2 Department of Metabolism and Endocrinology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Du-An Wu
- 2 Department of Metabolism and Endocrinology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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157
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Altschul DM, Starr JM, Deary IJ. Cognitive function in early and later life is associated with blood glucose in older individuals: analysis of the Lothian Birth Cohort of 1936. Diabetologia 2018; 61:1946-1955. [PMID: 29860628 PMCID: PMC6096629 DOI: 10.1007/s00125-018-4645-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/30/2018] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine whether cognitive function in early and later life, and decline in cognitive function from age 70 to 79 years, are associated with high blood glucose, as measured by HbA1c, at baseline (age 70), and changes in blood glucose from age 70 to 79. METHODS Participants (n = 1091) in the Lothian Birth Cohort of 1936 were examined. Fourteen tests were used to assess cognitive functions, grouped into four domains: visuospatial ability, processing speed, memory and crystallised ability. Test results, and measurements of HbA1c and other health variables, were collected at each of four waves of assessment: at the mean age of 70, 73, 76 and 79 years. Data on cognitive function at age 11 was also available for this cohort. Latent growth curve modelling was performed and statistical controls for known risk factors were introduced. RESULTS Higher age 11 cognitive function predicted lower HbA1c level at age 70 (p < 0.001). Higher cognitive function at age 70 was related to a comparatively smaller increase in HbA1c levels from age 70 to 79 (p < 0.001). HbA1c from age 70 to 79 did not have any consistent association with change in cognitive function from age 70 to 79. These associations survived adjustments for age, sex, education, APOE*ε4, smoking history, cardiovascular disease history, hypertension history, BMI and corrections for multiple testing. CONCLUSIONS/INTERPRETATION Our results show that, among older individuals, high blood glucose is consistently predicted by lower cognitive function. Clinical care that examines and tracks cognitive function, while also taking the positive effects of maintaining cognitive function and emulating healthy behaviours associated with higher cognitive function into account, may be one approach for protecting at-risk individuals from elevated blood glucose and subsequent type 2 diabetes mellitus.
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Affiliation(s)
- Drew M Altschul
- Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK.
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK.
| | - John M Starr
- Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
- Geriatric Medicine Unit, Western General Hospital, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
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158
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Using high-dimensional machine learning methods to estimate an anatomical risk factor for Alzheimer's disease across imaging databases. Neuroimage 2018; 183:401-411. [PMID: 30130645 DOI: 10.1016/j.neuroimage.2018.08.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 08/12/2018] [Accepted: 08/16/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The main goal of this work is to investigate the feasibility of estimating an anatomical index that can be used as an Alzheimer's disease (AD) risk factor in the Women's Health Initiative Magnetic Resonance Imaging Study (WHIMS-MRI) using MRI data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), a well-characterized imaging database of AD patients and cognitively normal subjects. We called this index AD Pattern Similarity (AD-PS) scores. To demonstrate the construct validity of the scores, we investigated their associations with several AD risk factors. The ADNI and WHIMS imaging databases were collected with different goals, populations and data acquisition protocols: it is important to demonstrate that the approach to estimating AD-PS scores can bridge these differences. METHODS MRI data from both studies were processed using high-dimensional warping methods. High-dimensional classifiers were then estimated using the ADNI MRI data. Next, the classifiers were applied to baseline and follow-up WHIMS-MRI GM data to generate the GM AD-PS scores. To study the validity of the scores we investigated associations between GM AD-PS scores at baseline (Scan 1) and their longitudinal changes (Scan 2 -Scan 1) with: 1) age, cognitive scores, white matter small vessel ischemic disease (WM SVID) volume at baseline and 2) age, cognitive scores, WM SVID volume longitudinal changes respectively. In addition, we investigated their associations with time until classification of independently adjudicated status in WHIMS-MRI. RESULTS Higher GM AD-PS scores from WHIMS-MRI baseline data were associated with older age, lower cognitive scores, and higher WM SVID volume. Longitudinal changes in GM AD-PS scores (Scan 2 - Scan 1) were also associated with age and changes in WM SVID volumes and cognitive test scores. Increases in the GM AD-PS scores predicted decreases in cognitive scores and increases in WM SVID volume. GM AD-PS scores and their longitudinal changes also were associated with time until classification of cognitive impairment. Finally, receiver operating characteristic curves showed that baseline GM AD-PS scores of cognitively normal participants carried information about future cognitive status determined during follow-up. DISCUSSION We applied a high-dimensional machine learning approach to estimate a novel AD risk factor for WHIMS-MRI study participants using ADNI data. The GM AD-PS scores showed strong associations with incident cognitive impairment and cross-sectional and longitudinal associations with age, cognitive function, cognitive status and WM SVID volume lending support to the ongoing validation of the GM AD-PS score.
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159
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Zhong KL, Chen F, Hong H, Ke X, Lv YG, Tang SS, Zhu YB. New views and possibilities of antidiabetic drugs in treating and/or preventing mild cognitive impairment and Alzheimer's Disease. Metab Brain Dis 2018; 33:1009-1018. [PMID: 29626315 DOI: 10.1007/s11011-018-0227-1] [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: 08/25/2017] [Accepted: 03/28/2018] [Indexed: 12/13/2022]
Abstract
Mounting evidence suggests that diabetes mellitus (DM) is associated with mild cognitive impairment (MCI), vascular dementia and Alzheimer's disease (AD). Biological, clinical and epidemiological data support a close link between DM and AD. Increasingly, studies have found that several antidiabetic agents can promote neurogenesis, and clinically ameliorate cognitive and memory impairments in different clinical settings. Data has shown that these antidiabetic drugs positively affect mitochondrial and synaptic function, neuroinflammation, and brain metabolism. Evidence to date strongly suggests that these antidiabetic drugs could be developed as disease-modifying therapies for MCI and AD in patients with and without diabetes.
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Affiliation(s)
- Kai Long Zhong
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Fang Chen
- Department of Pharmacology, Key Laboratory of Neuropsychiatric Diseases, China Pharmaceutical University, Nanjing, 210009, China
| | - Hao Hong
- Department of Pharmacology, Key Laboratory of Neuropsychiatric Diseases, China Pharmaceutical University, Nanjing, 210009, China
| | - Xuan Ke
- Department of Pharmacology, Key Laboratory of Neuropsychiatric Diseases, China Pharmaceutical University, Nanjing, 210009, China
| | - Yang Ge Lv
- Department of Pharmacology, Key Laboratory of Neuropsychiatric Diseases, China Pharmaceutical University, Nanjing, 210009, China
| | - Su Su Tang
- Department of Pharmacology, Key Laboratory of Neuropsychiatric Diseases, China Pharmaceutical University, Nanjing, 210009, China
| | - Yu Bing Zhu
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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160
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Liu J, Rutten-Jacobs L, Liu M, Markus HS, Traylor M. Causal Impact of Type 2 Diabetes Mellitus on Cerebral Small Vessel Disease: A Mendelian Randomization Analysis. Stroke 2018; 49:1325-1331. [PMID: 29686024 PMCID: PMC5976219 DOI: 10.1161/strokeaha.117.020536] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE The relationship between type 2 diabetes mellitus (T2D) and cerebral small vessel disease (CSVD) is unclear. We aimed to examine the causal effect of T2D, fasting glucose levels, and higher insulin resistance on CSVD using Mendelian randomization. METHODS Five CSVD phenotypes were studied; 2 were clinical outcomes associated with CSVD (lacunar stroke: n=2191/27 297 and intracerebral hemorrhage [ICH]: n=2254/8195 [deep and lobar ICH]), whereas 3 were radiological markers of CSVD (white matter hyperintensities: n=8429; fractional anisotropy [FA]: n=8357; and mean diffusivity: n=8357). We applied 2 complementary analyses to evaluate the association of T2D with CSVD. First, we used summarized data from genome-wide association study to calculate the effects of T2D-related variants on CSVD with inverse-variance weighted and weighted median approaches. Second, we performed a genetic risk score approach to test the effects of T2D-associated variants on white matter hyperintensities, FA, and mean diffusivity using individual-level data in UK Biobank. RESULTS T2D was associated with higher risk of lacunar stroke (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.04-1.28; P=0.007) and lower mean FA (OR, 0.78; 95% CI, 0.66-0.92; P=0.004) but not white matter hyperintensities volume (OR, 1.01; 95% CI, 0.97-1.04; P=0.626), higher mean diffusivity (OR, 1.04; 95% CI, 0.89-1.23; P=0.612), ICH (OR, 1.07; 95% CI, 0.95-1.20; P=0.269), lobar ICH (OR, 1.07; 95% CI, 0.89-1.28; P=0.466), or deep ICH (OR, 1.16; 95% CI, 0.99-1.36; P=0.074). Weighted median and penalized median weighted analysis showed similar effect estimates of T2D on lacunar stroke and FA, but with wider CIs, meaning they were not significant. The genetic score on individual-level data was significantly associated with FA (OR, 0.63; 95% CI, 0.45-0.89; P=0.008) after adjusting for potential confounders. CONCLUSIONS Our Mendelian randomization study provides evidence to suggest that T2D may be causally associated with CSVD, in particular with lacunar stroke and FA.
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Affiliation(s)
- Junfeng Liu
- From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, P. R. China (J.L., M.L.)
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
| | - Loes Rutten-Jacobs
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (L.R.-J.)
| | - Ming Liu
- From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, P. R. China (J.L., M.L.)
| | - Hugh S Markus
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
| | - Matthew Traylor
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
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Rensma SP, van Sloten TT, Launer LJ, Stehouwer CDA. Cerebral small vessel disease and risk of incident stroke, dementia and depression, and all-cause mortality: A systematic review and meta-analysis. Neurosci Biobehav Rev 2018; 90:164-173. [PMID: 29656031 PMCID: PMC6123527 DOI: 10.1016/j.neubiorev.2018.04.003] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022]
Abstract
MRI features of cerebral small vessel disease (CSVD), i.e. white matter hyperintensities, lacunes, microbleeds, perivascular spaces, and cerebral atrophy, may be associated with clinical events, but the strength of these associations remains unclear. We conducted a systematic review and meta-analysis on the association between these features and incident ischaemic and haemorrhagic stroke, all-cause dementia and depression, and all-cause mortality. For the association with stroke, 36 studies were identified (number of individuals/events [n] = 38,432/4,136), for dementia 28 (n = 16,458/1,709), for depression nine (n = 9,538/1,746), and for mortality 28 (n = 23,031/2,558). Only two studies evaluated perivascular spaces; these results were not pooled. Pooled analyses showed that all other features were associated with all outcomes (hazard ratios ranged 1.22–2.72). Combinations of two features were more strongly associated with stroke than any individual feature. Individual features and combinations of CSVD features are strongly associated with incident ischaemic and haemorrhagic stroke, all-cause dementia and depression, and all-cause mortality. If these associations are causal, the strength of these associations suggests that a substantial burden of disease is attributable to CSVD.
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Affiliation(s)
- Sytze P Rensma
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Thomas T van Sloten
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Lenore J Launer
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Avenue, Bethesda, MD, USA.
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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162
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Zheng F, Yan L, Yang Z, Zhong B, Xie W. HbA 1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing. Diabetologia 2018; 61:839-848. [PMID: 29368156 PMCID: PMC6448974 DOI: 10.1007/s00125-017-4541-7] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/08/2017] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS The aim of the study was to evaluate longitudinal associations between HbA1c levels, diabetes status and subsequent cognitive decline over a 10 year follow-up period. METHODS Data from wave 2 (2004-2005) to wave 7 (2014-2015) of the English Longitudinal Study of Ageing (ELSA) were analysed. Cognitive function was assessed at baseline (wave 2) and reassessed every 2 years at waves 3-7. Linear mixed models were used to evaluate longitudinal associations. RESULTS The study comprised 5189 participants (55.1% women, mean age 65.6 ± 9.4 years) with baseline HbA1c levels ranging from 15.9 to 126.3 mmol/mol (3.6-13.7%). The mean follow-up duration was 8.1 ± 2.8 years and the mean number of cognitive assessments was 4.9 ± 1.5. A 1 mmol/mol increment in HbA1c was significantly associated with an increased rate of decline in global cognitive z scores (-0.0009 SD/year, 95% CI -0.0014, -0.0003), memory z scores (-0.0005 SD/year, 95% CI -0.0009, -0.0001) and executive function z scores (-0.0008 SD/year, 95% CI -0.0013, -0.0004) after adjustment for baseline age, sex, total cholesterol, HDL-cholesterol, triacylglycerol, high-sensitivity C-reactive protein, BMI, education, marital status, depressive symptoms, current smoking, alcohol consumption, hypertension, CHD, stroke, chronic lung disease and cancer. Compared with participants with normoglycaemia, the multivariable-adjusted rate of global cognitive decline associated with prediabetes and diabetes was increased by -0.012 SD/year (95% CI -0.022, -0.002) and -0.031 SD/year (95% CI -0.046, -0.015), respectively (p for trend <0.001). Similarly, memory, executive function and orientation z scores showed an increased rate of cognitive decline with diabetes. CONCLUSIONS/INTERPRETATION Significant longitudinal associations between HbA1c levels, diabetes status and long-term cognitive decline were observed in this study. Future studies are required to determine the effects of maintaining optimal glucose control on the rate of cognitive decline in people with diabetes.
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Affiliation(s)
- Fanfan Zheng
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, People's Republic of China
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Li Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Zhenchun Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Baoliang Zhong
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wuxiang Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
- Peking University Clinical Research Institute, Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, 100191, Beijing, People's Republic of China.
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163
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Haneda M, Noda M, Origasa H, Noto H, Yabe D, Fujita Y, Goto A, Kondo T, Araki E. Japanese Clinical Practice Guideline for Diabetes 2016. J Diabetes Investig 2018; 9:657-697. [PMID: 29582574 PMCID: PMC5934251 DOI: 10.1111/jdi.12810] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
| | | | | | | | - Daisuke Yabe
- Department of Diabetes, Endocrinology and NutritionKyoto University Graduate School of MedicineKyotoJapan
| | | | - Atsushi Goto
- Center for Public Health SciencesNational Cancer CenterTokyoJapan
| | - Tatsuya Kondo
- Department of Metabolic MedicineKumamoto UniversityKumamotoJapan
| | - Eiichi Araki
- Department of Metabolic MedicineKumamoto UniversityKumamotoJapan
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164
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Umegaki H. Diabetes-related cognitive dysfunction: Hyperglycemia in the early stage might be a key? J Diabetes Investig 2018; 9:1019-1021. [PMID: 29377593 PMCID: PMC6123037 DOI: 10.1111/jdi.12808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 01/01/2023] Open
Affiliation(s)
- Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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165
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Alford S, Patel D, Perakakis N, Mantzoros CS. Obesity as a risk factor for Alzheimer's disease: weighing the evidence. Obes Rev 2018; 19:269-280. [PMID: 29024348 DOI: 10.1111/obr.12629] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/03/2017] [Accepted: 09/04/2017] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) is the sixth leading cause of death in the USA today; therefore, it is imperative that public health initiatives and clinical strategies are developed to prevent and effectively treat AD. Despite the enormous impact that AD has on individuals, families, society, and the health care system, there are no biomarkers to clearly identify those at risk for AD, public health prevention strategies in place, or treatments to address the underlying pathology or stop the progression of AD. There is ample scientific as well as empirical evidence that obesity and its metabolic and vascular comorbidities are related to AD and likely in the causative pathway. Obesity prevention and treatment could prove to be an efficacious and safe approach to preventing AD, a serious and daunting epidemic disease. In this review, we present the current pathophysiological and clinical evidence linking obesity and obesity-related comorbidities (eg, insulin resistance, hyperglycaemia, and type 2 diabetes) with AD. Additionally, we discuss which population to target and when to consider treatment for AD. Finally, we summarize the current evidence regarding the efficacy of anti-obesity and anti-diabetic pharmacotherapeutic agents for the treatment of AD.
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Affiliation(s)
| | - D Patel
- MCPHS University, Boston, MA, USA.,VA Boston Healthcare System, Boston, MA, USA
| | - N Perakakis
- Mantzoros Lab, Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - C S Mantzoros
- Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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166
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Haneda M, Noda M, Origasa H, Noto H, Yabe D, Fujita Y, Goto A, Kondo T, Araki E. Japanese Clinical Practice Guideline for Diabetes 2016. Diabetol Int 2018; 9:1-45. [PMID: 30603347 PMCID: PMC6224875 DOI: 10.1007/s13340-018-0345-3] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | | | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Atsushi Goto
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Tatsuya Kondo
- Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan
| | - Eiichi Araki
- Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan
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167
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Biessels GJ, Janssen J, van den Berg E, Zinman B, Espeland MA, Mattheus M, Johansen OE. Rationale and design of the CAROLINA® - cognition substudy: a randomised controlled trial on cognitive outcomes of linagliptin versus glimepiride in patients with type 2 diabetes mellitus. BMC Neurol 2018; 18:7. [PMID: 29334906 PMCID: PMC5769408 DOI: 10.1186/s12883-018-1014-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 01/03/2018] [Indexed: 01/16/2023] Open
Abstract
Background Type 2 diabetes mellitus is associated with cognitive dysfunction and an increased risk of dementia. Linagliptin is a glucose-lowering agent of the dipeptidyl peptidase-IV (DPP-IV) inhibitor class that is of particular interest for the prevention of accelerated cognitive decline, because it may potentially benefit the brain through pleiotropic effects, beyond glucose lowering. This paper presents the design of a study that aims to establish if linagliptin is superior to the sulfonylurea glimepiride in the prevention of accelerated cognitive decline in patients with type 2 diabetes mellitus. Methods The cognition substudy is an integral part of the ongoing event-driven, randomised, double blind CARdiOvascular safety of LINAgliptin (CAROLINA®) trial, which evaluates the effect of treatment with linagliptin versus glimepiride on cardiovascular outcomes. CAROLINA® includes patients with type 2 diabetes mellitus with sub-optimal glycaemic control at elevated cardiovascular risk. The substudy will evaluate patients randomised and treated who have a baseline Mini Mental State Examination (MMSE) score ≥ 24, documented years of formal education with at least one valid cognitive assessment at baseline and during follow-up. The primary cognitive outcome is the occurrence of accelerated cognitive decline at the end of follow-up. The two treatment groups will be compared by using a logistic regression. Accelerated cognitive decline is defined as a rate of cognitive decline that falls at or below the 16th percentile of decline for the whole cohort on either the MMSE or a combined score of the trail making and verbal fluency test. Potential confounders are taken into account at an individual patient level, using a regression based index. Discussion Between December 2010 and December 2012, 6042 patients were randomised and treated with either linagliptin (5 mg) or glimepiride (1-4 mg) once daily in CAROLINA®. Cognitive tests were conducted in nearly 4500 participants at baseline and are scheduled for two subsequent assessments, after 160 weeks of follow-up and end of follow-up. This substudy of the ongoing CAROLINA® trial will establish if linagliptin is superior to glimepiride in the prevention of accelerated cognitive decline in patients with type 2 diabetes mellitus. Final results are expected in 2019. Trial registration ClinicalTrials.gov Identifier: NCT 01243424. Electronic supplementary material The online version of this article (10.1186/s12883-018-1014-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Geert Jan Biessels
- Department of Neurology, G03.232 Brain Center Rudolf Magnus, University Medical Center, PO Box 85500, 3508, GA, Utrecht, the Netherlands.
| | - Jolien Janssen
- Department of Neurology, G03.232 Brain Center Rudolf Magnus, University Medical Center, PO Box 85500, 3508, GA, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Esther van den Berg
- Department of Neurology, G03.232 Brain Center Rudolf Magnus, University Medical Center, PO Box 85500, 3508, GA, Utrecht, the Netherlands.,Department of Neurology, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada, Division of Endocrinology, University of Toronto, Toronto, Canada
| | - Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michaela Mattheus
- Global biometrics and datamanagement, Boehringer Ingelheim, Ingelheim, Germany
| | - Odd Erik Johansen
- Clinical development, Therapeutic Area Metabolism, Boehringer Ingelheim, Asker, Norway
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168
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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169
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3. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018; 41:S28-S37. [PMID: 29222374 DOI: 10.2337/dc18-s003] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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170
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Shahi N, Tobe SW. Thresholds and Targets for Hypertension Management in Adults With Type 2 Diabetes Should Remain at 130/80 mmHg: What's the Evidence? Can J Diabetes 2017; 42:166-172. [PMID: 29273294 DOI: 10.1016/j.jcjd.2017.10.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
Hypertension and diabetes are common comorbidities and are both modifiable risk factors for cardiovascular disease and death. Lowering blood pressure reduces target organ damage and prevents cardiovascular disease outcomes. The harmonized Canadian clinical practice guidelines for managing hypertension in people with diabetes provides health-behaviour advice and medical therapy recommendations for a threshold blood pressure of 130/80 mmHg and above and to target blood pressure to below 130/80 mmHg. We have reviewed the studies supporting these recommendations and others, and they appear to be at odds with the guidelines, including those for elderly people and patients with pre-existing cardiovascular disease.
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Affiliation(s)
- Niharika Shahi
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Sheldon W Tobe
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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171
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Barrett EJ, Liu Z, Khamaisi M, King GL, Klein R, Klein BEK, Hughes TM, Craft S, Freedman BI, Bowden DW, Vinik AI, Casellini CM. Diabetic Microvascular Disease: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2017; 102:4343-4410. [PMID: 29126250 PMCID: PMC5718697 DOI: 10.1210/jc.2017-01922] [Citation(s) in RCA: 287] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 01/18/2023]
Abstract
Both type 1 and type 2 diabetes adversely affect the microvasculature in multiple organs. Our understanding of the genesis of this injury and of potential interventions to prevent, limit, or reverse injury/dysfunction is continuously evolving. This statement reviews biochemical/cellular pathways involved in facilitating and abrogating microvascular injury. The statement summarizes the types of injury/dysfunction that occur in the three classical diabetes microvascular target tissues, the eye, the kidney, and the peripheral nervous system; the statement also reviews information on the effects of diabetes and insulin resistance on the microvasculature of skin, brain, adipose tissue, and cardiac and skeletal muscle. Despite extensive and intensive research, it is disappointing that microvascular complications of diabetes continue to compromise the quantity and quality of life for patients with diabetes. Hopefully, by understanding and building on current research findings, we will discover new approaches for prevention and treatment that will be effective for future generations.
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Affiliation(s)
- Eugene J. Barrett
- Division of Endocrinology, Department of Medicine, University of Virginia, Charlottesville, Virginia 22908
| | - Zhenqi Liu
- Division of Endocrinology, Department of Medicine, University of Virginia, Charlottesville, Virginia 22908
| | - Mogher Khamaisi
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - George L. King
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705
| | - Barbara E. K. Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705
| | - Timothy M. Hughes
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Suzanne Craft
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Barry I. Freedman
- Divisions of Nephrology and Endocrinology, Department of Internal Medicine, Centers for Diabetes Research, and Center for Human Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Donald W. Bowden
- Divisions of Nephrology and Endocrinology, Department of Internal Medicine, Centers for Diabetes Research, and Center for Human Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Aaron I. Vinik
- EVMS Strelitz Diabetes Center, Eastern Virginia Medical Center, Norfolk, Virginia 23510
| | - Carolina M. Casellini
- EVMS Strelitz Diabetes Center, Eastern Virginia Medical Center, Norfolk, Virginia 23510
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172
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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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173
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Freedman BI, Sink KM, Hugenschmidt CE, Hughes TM, Williamson JD, Whitlow CT, Palmer ND, Miller ME, Lovato LC, Xu J, Smith SC, Launer LJ, Barzilay JI, Cohen RM, Sullivan MD, Bryan RN, Wagner BC, Bowden DW, Maldjian JA, Divers J. Associations of Early Kidney Disease With Brain Magnetic Resonance Imaging and Cognitive Function in African Americans With Type 2 Diabetes Mellitus. Am J Kidney Dis 2017; 70:627-637. [PMID: 28648301 PMCID: PMC5651190 DOI: 10.1053/j.ajkd.2017.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/04/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Relationships between early kidney disease, neurocognitive function, and brain anatomy are poorly defined in African Americans with type 2 diabetes mellitus (T2DM). STUDY DESIGN Cross-sectional associations were assessed between cerebral anatomy and cognitive performance with estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) in African Americans with T2DM. SETTING & PARTICIPANTS African Americans with cognitive testing and cerebral magnetic resonance imaging (MRI) in the African American-Diabetes Heart Study Memory in Diabetes (AA-DHS MIND; n=512; 480 with MRI) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) MIND (n=484; 104 with MRI) studies. PREDICTORS eGFR (CKD-EPI creatinine equation), spot UACR. MEASUREMENTS MRI-based cerebral white matter volume (WMV), gray matter volume (GMV), and white matter lesion volume; cognitive performance (Mini-Mental State Examination, Digit Symbol Coding, Stroop Test, and Rey Auditory Verbal Learning Test). Multivariable models adjusted for age, sex, body mass index, scanner, intracranial volume, education, diabetes duration, hemoglobin A1c concentration, low-density lipoprotein cholesterol concentration, smoking, hypertension, and cardiovascular disease were used to test for associations between kidney phenotypes and the brain in each study; a meta-analysis was performed. RESULTS Mean participant age was 60.1±7.9 (SD) years; diabetes duration, 12.1±7.7 years; hemoglobin A1c concentration, 8.3%±1.7%; eGFR, 88.7±21.6mL/min/1.73m2; and UACR, 119.2±336.4mg/g. In the fully adjusted meta-analysis, higher GMV associated with lower UACR (P<0.05), with a trend toward association with higher eGFR. Higher white matter lesion volume was associated with higher UACR (P<0.05) and lower eGFR (P<0.001). WMV was not associated with either kidney parameter. Higher UACR was associated with lower Digit Symbol Coding performance (P<0.001) and a trend toward association with higher Stroop interference; eGFR was not associated with cognitive tests. LIMITATIONS Cross-sectional; single UACR measurement. CONCLUSIONS In African Americans with T2DM, mildly high UACR and mildly low eGFR were associated with smaller GMV and increased white matter lesion volume. UACR was associated with poorer processing speed and working memory.
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Affiliation(s)
- Barry I Freedman
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
| | - Kaycee M Sink
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christina E Hugenschmidt
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Timothy M Hughes
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Nicholette D Palmer
- Department of Biochemistry and Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael E Miller
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Laura C Lovato
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jianzhao Xu
- Department of Biochemistry and Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - S Carrie Smith
- Department of Biochemistry and Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lenore J Launer
- National Institute on Aging, Laboratory of Epidemiology, Demography, and Biometry, National Institutes of Health, Bethesda, MD
| | | | - Robert M Cohen
- Division of Endocrinology, Department of Internal Medicine, University of Cincinnati, Veterans Administration Medical Center, Cincinnati, OH
| | - Mark D Sullivan
- Department of Psychiatry, University of Washington, Seattle, WA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Benjamin C Wagner
- Advanced Neuroscience Imaging Research (ANSIR) Laboratory, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Donald W Bowden
- Department of Biochemistry and Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joseph A Maldjian
- Advanced Neuroscience Imaging Research (ANSIR) Laboratory, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jasmin Divers
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Hayden KM, Baker LD, Bray G, Carvajal R, Demos-McDermott K, Hergenroeder AL, Hill JO, Horton E, Jakicic JM, Johnson KC, Neiberg RH, Rapp SR, Wadden TA, Miller ME. Long-term impact of intensive lifestyle intervention on cognitive function assessed with the National Institutes of Health Toolbox: The Look AHEAD study. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 10:41-48. [PMID: 29159267 PMCID: PMC5675717 DOI: 10.1016/j.dadm.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction This study sought to determine whether 10 years of assignment to intensive lifestyle intervention (ILI) relative to diabetes support and education leads to better cognition. We examine intervention effects overall and among clinical subgroups, and report correlations between computer-administered and interviewer-administered cognitive batteries. Methods The Action for Health in Diabetes (Look AHEAD) was a 16-site randomized controlled trial with overweight/obese individuals (aged 45-76) who had type 2 diabetes. The NIH Toolbox Cognition Battery tests developed to measure cognition across the lifespan were used to evaluate cognition. Results were compared with standard paper-and-pencil tests. The Toolbox and paper-and-pencil tests were administered an average of 10.9 years after randomization to 1002 participants. Results Toolbox measures significantly correlated with interviewer-administered measures, with the strongest correlations between the Toolbox Fluid Cognition Composite and Trails B (r = -0.64, P < .0001) and Digit Symbol Coding (r = 0.63, P < .0001), and between the Toolbox Dimensional Change Card Sort (r = 0.55, P < .0001) and the Digit Symbol Coding test. Overall, ILI and diabetes support and education groups had similar adjusted mean cognitive outcomes (P > .05 for all). Subgroup analyses identified different intervention effects within baseline body mass index groups for Picture Sequence Memory (P = .01), within baseline cardiovascular disease groups for Picture Vocabulary (P = .01) and Fluid Cognition Composite (P = .02) measures, and within baseline age groups for Picture Vocabulary (P = .02). Discussion Correlations between Toolbox and interviewer-administered outcomes provide a measure of internal validity. Findings suggest no overall effect of the intervention on cognition and that an ILI resulting in weight loss may have negative implications for cognition in individuals aged ≥60, with previous history of cardiovascular disease, and those with body mass index ≥40.
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Affiliation(s)
- Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laura D Baker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - George Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Raymond Carvajal
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Andrea L Hergenroeder
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - James O Hill
- Anschultz Health and Wellness Center, Aurora, CO, USA
| | | | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca H Neiberg
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen R Rapp
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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175
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Schimming C, Luo X, Zhang C, Sano M. Cognitive performance of older adults in a specialized diabetes clinic. J Diabetes 2017; 9:929-935. [PMID: 27807922 PMCID: PMC6478382 DOI: 10.1111/1753-0407.12503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/30/2016] [Accepted: 10/29/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a risk factor for cognitive changes, but assessment for cognitive disorders in this population is performed infrequently. The present study examined the frequency of cognitive disorders and patterns of deficit in patients enrolled in a specialized clinic for diabetes. METHODS A cross-sectional study was conducted to assess cognition in Mount Sinai Diabetes Center patients. Thirty eligible subjects aged ≥50 years were assessed and compared with non-diabetic cognitively normal control subjects, as well as non-diabetic subjects with mild cognitive impairment (MCI). The main outcome(s) and measure(s) were obtained through cognitive assessment and diagnosis using the Alzheimer's Disease Centers' uniform data set. RESULTS Forty percent of subjects were newly diagnosed with a cognitive disorder: 10% were diagnosed with dementia and 30% with MCI. Diabetic subjects performed worse on the Mini-Mental State Examination (27.2 vs 28.4; P = 0.0132), list generation (9.5 vs 12.2; P = 0.0190), Trail Making Test, Parts A (70.1 vs 43.0; P < 0.0001) and B (197.2 vs 123.6; P < 0.0001), and the Digit Symbol test (12.7 vs 40.1; P < 0.0001) than cognitively normal individuals. Compared with subjects with MCI (amnestic type), diabetic subjects performed better on tasks of immediate and delayed recall (11.2 vs 7.3 [P = 0.0048] and 8.4 vs. 4.1 [P = 0.0003], respectively). CONCLUSIONS Undiagnosed cognitive disorders are common and underappreciated in patients being treated in a specialized diabetes clinic. It may be important to make cognitive assessment a standard part of patient assessments.
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Affiliation(s)
- Corbett Schimming
- Department of Psychiatry, Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, New York, New York, USA
| | - Xiaodong Luo
- Department of Psychiatry, Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, New York, New York, USA
| | - Cen Zhang
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Sano
- Department of Psychiatry, Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, New York, New York, USA
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176
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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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177
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Chen JC, Wang X, Serre M, Cen S, Franklin M, Espeland M. Particulate Air Pollutants, Brain Structure, and Neurocognitive Disorders in Older Women. Res Rep Health Eff Inst 2017; 2017:1-65. [PMID: 31898881 PMCID: PMC7266369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Introduction An increasing number of studies have suggested that exposure to particulate matter (PM) may represent a novel - and potentially amendable - environmental determinant of brain aging. The current longitudinal environmental epidemiological study addressed some important knowledge gaps in this emerging field, which combines the study of air pollution and neuroepidemiology. The investigators hypothesized that long-term PM exposure adversely influences global brain volume and brain regions (e.g., frontal lobe or hippocampus) that are critical to memory and complex cognitive processing or that are affected by neuropathological changes in dementia. It was also hypothesized that long-term PM exposure results in neurovascular damage and may increase the risk of mild cognitive impairment (MCI) and -dementia. Methods The investigators selected a well-characterized and geographically diverse population of older women (N = 7,479; average age = 71.0 ± 3.8 years at baseline) in the Women's Health Initiative (WHI) Memory Study (WHIMS) cohort (1996-2007), which included a subcohort (n = 1,403) enrolled in the WHIMS-Magnetic Resonance Imaging (WHIMS-MRI) study (2005-2006). Residence-specific yearly exposures to PM ≤ 2.5 µm in aerodynamic diameter (PM₂.₅) were estimated using a Bayesian maximum entropy spatiotemporal model of annual monitoring data (1999-2007) recorded in the U.S. Environmental Protection Agency (U.S. EPA) Air Quality System (AQS). Annual exposures (1996-2005) to diesel PM (DPM) were assigned to each residential census tract in a nationwide spatiotemporal mapping, based on a generalized additive model (GAM), to conduct census tract-specific temporal interpolation of DPM on-road estimates given by the U.S. EPA National-Scale Air Toxics Assessment Program. Multiple linear regression and multicovariate-adjusted Cox models were used to examine the associations, with statistical adjustment for multiple potential confounders. Results The investigators found that participants had smaller brain volumes, especially in the normal-appearing white matter (WM), if they lived in locations with higher levels of cumulative exposure (1999-2006) to PM ₂.₅ before the brain MRI scans were performed. The associations were not explained by sociodemographic factors, socioeconomic status, lifestyle factors, or other clinical characteristics. Analyses showed that the adverse effect on brain structure in the participants was driven primarily by the smaller WM volumes associated with cumulative PM₂.₅ exposures, which were present in the WM divisions of the association brain area (frontal, parietal, and temporal lobes) and corpus callosum. Increased DPM exposures were associated with larger ventricular volume, suggesting an overall atrophic effect on the aging brains. The participants tended to have smaller gray matter (GM) volumes if they lived in areas with the highest (i.e., fourth quartile) estimated cumulative DPM exposure in the 10 years before the brain MRI scans, compared with women in the first to third quartiles. This observed association was present in the total brain GM and in the association brain cortices. The associations with normal-appearing WM varied by DPM exposure range. For women with estimated cumulative exposure below that of the fourth quartile, increased DPM estimates were associated with smaller WM volumes. However, for women with increased cumulative DPM exposures estimates in the fourth quartile, WM volumes were larger. This pattern of association was found consistently in the association brain area; no measurable difference was found in the volume of the corpus callosum. These observed adverse effects of cumulative exposure to PM₂.₅ (linking exposure with smaller WM volumes) and to DPM (linking exposure in the highest quartile with smaller GM volumes) were not significantly modified by existing cardiovascular diseases, diabetes mellitus, obesity, or measured white blood cell (WBC) count. MRI measurements of the structural brain showed no differences in small-vessel ischemic diseases (SVID) in participants with varying levels of cumulative exposure to PM₂.₅ (1999-2006) or DPM (1996-2005), and no associations between PM exposures and SVID volumes were noted for total brain, association brain area, GM, or WM. For neurocognitive outcomes followed until 2007, the investigators found no evidence for increased risk of MCI/dementia associated with long-term PM exposures. Although exploratory secondary analyses showed different patterns of associations linking PM exposures separately with MCI and dementia, none of the -results was statistically significant. A similar lack of associations between PM exposures and MCI/dementia was found across the subgroups, with no strong indications for effect modification by cardiovascular diseases, diabetes mellitus, obesity, or WBC count. Conclusions The investigators concluded that their study findings support the hypothesized brain-structure neurotoxicity associated with PM exposures, a result that is in line with emerging neurotoxicological data. However, the investigators found no evidence of increased risk of MCI/dementia associated with long-term PM exposures. To better test the neurovascular effect hypothesis in PM-associated neurotoxic effects on the aging brain, the investigators recommend that future studies pay greater attention to selecting optimal populations with repeated measurements of cerebrovascular damage and address the possibility of selection biases accordingly. To further investigate the long-term consequence of brain-structure neurotoxicity on pathological brain aging, future researchers should take the pathobiologically heterogeneous neurocognitive outcomes into account and design adequately powered prospective cohort studies with improved exposure estimation and valid outcome ascertainment to assess whether PM-associated neurotoxicity increases the risks of pathological brain aging, including MCI and dementia.
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Affiliation(s)
- J-C Chen
- Keck School of Medicine, University of Southern California, Los Angeles
| | - X Wang
- Keck School of Medicine, University of Southern California, Los Angeles
| | - M Serre
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - S Cen
- Keck School of Medicine, University of Southern California, Los Angeles
| | - M Franklin
- Keck School of Medicine, University of Southern California, Los Angeles
| | - M Espeland
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
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178
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Dao E, Hsiung GYR, Liu-Ambrose T. The role of exercise in mitigating subcortical ischemic vascular cognitive impairment. J Neurochem 2017; 144:582-594. [PMID: 28833160 DOI: 10.1111/jnc.14153] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 12/14/2022]
Abstract
Subcortical ischemic vascular cognitive impairment (SIVCI) is the most preventable form of cognitive dysfunction. There is converging evidence from animal and human studies that indicate vascular injury as the primary cause of SIVCI. Currently, there are no curative pharmaceutical treatments for vascular dementia; however, exercise may be a promising strategy to combat SIVCI. This review will focus on the role of exercise as a strategy to prevent or slow the progression of SIVCI, with particular emphasis on the mechanisms by which exercise may improve cerebrovascular function. We propose that exercise may be an effective strategy to combat SIVCI by improving cognitive function, increasing the bioavailability of neurotrophins, stimulating endothelial function, and controlling vascular risk factors. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Elizabeth Dao
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada
| | - Ging-Yuek Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Department of Medicine, Division of Neurology, UBC, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
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179
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Mehta HB, Mehta V, Goodwin JS. Association of Hypoglycemia With Subsequent Dementia in Older Patients With Type 2 Diabetes Mellitus. J Gerontol A Biol Sci Med Sci 2017; 72:1110-1116. [PMID: 27784724 DOI: 10.1093/gerona/glw217] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 10/12/2016] [Indexed: 12/18/2022] Open
Abstract
Background Studies have found conflicting evidence regarding the association of hypoglycemia with dementia. We evaluated an association of hypoglycemia with subsequent dementia in patients with type 2 diabetes. Methods This retrospective longitudinal cohort study used the Clinical Practice Research Datalink, an electronic medical records data from the United Kingdom, from 2003 to 2012. We included patients aged >65 years diagnosed with type 2 diabetes, with no prior diagnosis of dementia. Dementia was defined using diagnosis codes from medical records. All patients were followed from the date of initial diabetes diagnosis. To account for competing risk of death, we used Fine and Gray's competing risk model to determine the association of hypoglycemia with dementia while adjusting for potential confounders. Hypoglycemia was modeled as a time-dependent covariate. Results Of 53,055 patients, 5.7% (n = 3,018) had at least one hypoglycemia episodes. The overall incidence rate of dementia was 12.7 per 1,000 person-years. In the fully adjusted model that controlled for all confounders, the occurrence of at least one hypoglycemia episode was associated with 27% higher odds of subsequent dementia (hazard ratio = 1.27; 95% confidence interval = 1.06-1.51). The risk increased with the number of hypoglycemia episodes: one episode (hazard ratio = 1.26; 95% confidence interval = 1.03-1.54); two or more episodes (hazard ratio = 1.50; 95% confidence interval = 1.09-2.08). Conclusions Hypoglycemia is associated with a higher risk of dementia and may be responsible in part for the higher risk of dementia in patients with diabetes. Alternatively, hypoglycemia may be a marker for undiagnosed cognitive impairment, and we cannot rule out the possibility of reverse causation between hypoglycemia and dementia.
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Affiliation(s)
| | | | - James S Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
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180
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Bidirectional interactions between diabetes and Alzheimer's disease. Neurochem Int 2017; 108:296-302. [DOI: 10.1016/j.neuint.2017.04.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 01/21/2023]
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181
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Quartuccio M, Buta B, Kalyani RR. Comparative Effectiveness for Glycemic Control in Older Adults with Diabetes. CURRENT GERIATRICS REPORTS 2017; 6:175-186. [PMID: 28920012 PMCID: PMC5585298 DOI: 10.1007/s13670-017-0215-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To review and summarize the current data for comparative effectiveness of glycemic control in older adults. RECENT FINDINGS In the last several years, professional societies have released guidelines for glycemic control in older adults, generally recommending individualized HbA1c goals. However, recent observational studies demonstrate that many older adults remain aggressively managed and are at increased risk of hypoglycemia. Large randomized trials of older adults with diabetes have failed to show cardiovascular benefit from intensive glycemic control and show only minimal microvascular benefit. Additionally, a few studies suggest that suboptimal glycemic control can increase the risk for geriatric syndromes. Emerging research suggests similar safety and efficacy of glucose-lowering therapies in older versus younger adults. SUMMARY Overall, there is a paucity of data supporting the benefit of intensive glycemic control in older adults. More research is needed in this vulnerable population.
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Affiliation(s)
- Michael Quartuccio
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287 USA
| | - Brian Buta
- Department of Medicine, Johns Hopkins University, Baltimore, MD USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD USA
| | - Rita Rastogi Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287 USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD USA
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182
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Cukierman-Yaffe T, Gerstein HC, Miller ME, Launer LJ, Williamson JD, Horowitz KR, Ismail-Beigi F, Lazar RM. The Relationship Between the Score on a Simple Measure of Cognitive Function and Incident CVD in People With Diabetes: A Post Hoc Epidemiological Analysis From the ACCORD-MIND Study. J Clin Endocrinol Metab 2017; 102:3218-3225. [PMID: 28575229 PMCID: PMC5587069 DOI: 10.1210/jc.2016-3480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/25/2017] [Indexed: 12/30/2022]
Abstract
CONTEXT AND OBJECTIVE Diabetes is associated with a greater risk for incident cardiovascular disease and cognitive dysfunction. This study aimed to investigate, in people with type 2 diabetes, the association of a simple measure of cognitive function to cardiovascular disease events and mortality. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS, AND OUTCOMES The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial included persons with longstanding type 2 diabetes. A substudy of 2977 (Memory in Diabetes) participants aged 55 years or older aimed to test the effect of the interventions on brain structure and function. At baseline, participants were administered a cognitive battery that included the digit symbol substitution test (DSST). The associations of the DSST and the ACCORD primary outcome (the first occurrence of nonfatal myocardial infarction or nonfatal stroke or death from cardiovascular causes) and all-cause mortality were investigated with Cox proportional hazard models adjusting for several demographic and clinical variables. RESULTS Median follow-up time was 4.27 years. An inverse relationship between the incidence of the ACCORD primary outcome and baseline cognitive score was demonstrated. A 1-point higher DSST score was associated with a lower incidence of the primary outcome (hazard ratio, 0.987; 95% confidence interval, 0.977 to 0.998; P = 0.019), after adjustment for demographic and clinical trial factors, additional baseline cardiovascular risk factors, and self-reported need for assistance to follow the protocol. CONCLUSION Lower scores on the DSST, a simple, sensitive neuropsychological instrument, are associated with a higher incidence of cardiovascular events in persons >55 years old with longstanding diabetes.
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Affiliation(s)
- Tali Cukierman-Yaffe
- Endocrinology Institute, Gertner Institute Sheba Medical Center, Ramat-Gan, 52621, Israel
- Epidemiology Department, Sackler School of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario L8S4K1, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario L8S4K1, Canada
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Lenore J Launer
- Intramural Research Program, National Institute on Aging, Bethesda, Maryland 20016
| | - Jeff D Williamson
- Department of Internal Medicine and the Kulynych Center for Memory and Cognition Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Karen R Horowitz
- Division of General Internal Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio 44106
- Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
| | - Faramarz Ismail-Beigi
- Division of General Internal Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio 44106
- Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
| | - Ronald M Lazar
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, Alabama 35294
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183
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Ben Assayag E, Eldor R, Korczyn AD, Kliper E, Shenhar-Tsarfaty S, Tene O, Molad J, Shapira I, Berliner S, Volfson V, Shopin L, Strauss Y, Hallevi H, Bornstein NM, Auriel E. Type 2 Diabetes Mellitus and Impaired Renal Function Are Associated With Brain Alterations and Poststroke Cognitive Decline. Stroke 2017; 48:2368-2374. [PMID: 28801477 DOI: 10.1161/strokeaha.117.017709] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Type 2 diabetes mellitus (T2DM) is associated with diseases of the brain, kidney, and vasculature. However, the relationship between T2DM, chronic kidney disease, brain alterations, and cognitive function after stroke is unknown. We aimed to evaluate the inter-relationship between T2DM, impaired renal function, brain pathology on imaging, and cognitive decline in a longitudinal poststroke cohort. METHODS The TABASCO (Tel Aviv brain acute stroke cohort) is a prospective cohort of stroke/transient ischemic attack survivors. The volume and white matter integrity, ischemic lesions, and brain and hippocampal volumes were measured at baseline using 3-T MRI. Cognitive tests were performed on 507 patients, who were diagnosed as having mild cognitive impairment, dementia, or being cognitively intact after 24 months. RESULTS At baseline, T2DM and impaired renal function (estimated creatinine clearance [eCCl] <60 mL/min) were associated with smaller brain and hippocampal volumes, reduced cortical thickness, and worse white matter microstructural integrity. Two years later, both T2DM and eCCl <60 mL/min were associated with poorer cognitive scores, and 19.7% of the participants developed cognitive decline (mild cognitive impairment or dementia). Multiple analysis, controlling for age, sex, education, and apolipoprotein E4, showed a significant association of both T2DM and eCCl <60 mL/min with cognitive decline. Having both conditions doubled the risk compared with patients with T2DM or eCCl <60 mL/min alone and almost quadrupled the risk compared with patients without either abnormality. CONCLUSIONS T2DM and impaired renal function are independently associated with abnormal brain structure, as well as poorer performance in cognitive tests, 2 years after stroke. The presence of both conditions quadruples the risk for cognitive decline. T2DM and lower eCCl have an independent and additive effect on brain atrophy and the risk of cognitive decline. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01926691.
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Affiliation(s)
- Einor Ben Assayag
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.).
| | - Roy Eldor
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Amos D Korczyn
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Efrat Kliper
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Shani Shenhar-Tsarfaty
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Oren Tene
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Jeremy Molad
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Itzhak Shapira
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Shlomo Berliner
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Viki Volfson
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Ludmila Shopin
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Yehuda Strauss
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Hen Hallevi
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Natan M Bornstein
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
| | - Eitan Auriel
- From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.)
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184
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Ciudin A, Espinosa A, Simó-Servat O, Ruiz A, Alegret M, Hernández C, Boada M, Simó R. Type 2 diabetes is an independent risk factor for dementia conversion in patients with mild cognitive impairment. J Diabetes Complications 2017; 31:1272-1274. [PMID: 28545893 DOI: 10.1016/j.jdiacomp.2017.04.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/12/2017] [Accepted: 04/16/2017] [Indexed: 02/06/2023]
Abstract
AIMS To explore whether type 2 diabetes (T2D) is a risk factor for dementia conversion in patients with mild cognitive impairment (MCI). METHODS A longitudinal nested case-control study in which 101 T2D patients and 101 non-diabetic patients with MCI matched by age and gender were included. RESULTS The dementia conversion rate was 57.4% in T2D patients vs. 42.6% in non-diabetic subjects (p=0.02). T2D and APOE ε4 allele were independent risk factors for developing dementia. CONCLUSION T2D is an independent risk factor for dementia conversion in MCI patients. This finding has significant clinical implications.
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Affiliation(s)
- Andreea Ciudin
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Ana Espinosa
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Olga Simó-Servat
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Agustín Ruiz
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Montserrat Alegret
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Cristina Hernández
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Mercè Boada
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Rafael Simó
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.
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185
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Mukai N, Ohara T, Hata J, Hirakawa Y, Yoshida D, Kishimoto H, Koga M, Nakamura U, Kitazono T, Kiyohara Y, Ninomiya T. Alternative Measures of Hyperglycemia and Risk of Alzheimer's Disease in the Community: The Hisayama Study. J Clin Endocrinol Metab 2017; 102:3002-3010. [PMID: 28605542 DOI: 10.1210/jc.2017-00439] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/05/2017] [Indexed: 02/05/2023]
Abstract
CONTEXT AND OBJECTIVE We investigated the associations of hemoglobin A1c (HbA1c), glycated albumin (GA), GA/HbA1c ratio, and 1,5-anhydroglucitol (1,5-AG) with the development of Alzheimer's disease (AD). DESIGN AND PARTICIPANTS A total of 1187 community-dwelling Japanese subjects aged ≥65 years without dementia were followed up for an average of 4.8 years. RESULTS The age- and sex-adjusted incidence of AD increased significantly with higher quartiles of GA/HbA1c ratio, and a similar tendency was seen for GA, whereas no such association was observed for HbA1c and 1,5-AG. After adjusting for potential confounding factors, positive association of GA/HbA1c ratio with the risk of AD remained significant: the multivariable-adjusted hazard ratio (HR) was significantly higher in the third [HR = 2.11, 95% confidence interval (CI) = 1.16 to 3.82] and fourth (HR = 2.01, 95% CI = 1.09 to 3.68) quartile than in the first quartile. Among subjects with normal glucose tolerance, those with high GA/HbA1c ratio had a higher risk of AD than those with low GA/HbA1c ratio (HR = 1.82, 95% CI = 1.05 to 3.16), and a similar tendency was found in those with glucose intolerance (HR = 1.73, 95% CI = 0.96 to 3.13). No such associations were observed for HbA1c, GA, and 1,5-AG, regardless of glucose tolerance status. CONCLUSIONS Our findings suggest that elevated GA/HbA1c ratio-but not HbA1c, GA, or 1,5-AG level-is significantly associated with the risk of AD in subjects both with and without glucose intolerance. GA/HbA1c ratio may be a useful biomarker for predicting incident AD.
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Affiliation(s)
- Naoko Mukai
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Tomoyuki Ohara
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Jun Hata
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoichiro Hirakawa
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Daigo Yoshida
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hiro Kishimoto
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masafumi Koga
- Department of Internal Medicine, Hakuhokai Central Hospital, Hyogo 661-0953, Japan
| | - Udai Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takanari Kitazono
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yutaka Kiyohara
- Hisayama Research Institute for Lifestyle Diseases, Fukuoka 812-8582, Japan
| | - Toshiharu Ninomiya
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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186
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Luchsinger JA, Ma Y, Christophi CA, Florez H, Golden SH, Hazuda H, Crandall J, Venditti E, Watson K, Jeffries S, Manly JJ, Pi-Sunyer FX. Metformin, Lifestyle Intervention, and Cognition in the Diabetes Prevention Program Outcomes Study. Diabetes Care 2017; 40:958-965. [PMID: 28500216 PMCID: PMC5481986 DOI: 10.2337/dc16-2376] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/03/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the association of the Diabetes Prevention Program (DPP) intervention arms (lifestyle intervention, metformin, and placebo) with cognition in the Diabetes Prevention Program Outcomes Study (DPPOS). We also examined metformin use, incident type 2 diabetes, and glycemia as exposures. RESEARCH DESIGN AND METHODS The DPP lasted 2.8 years, followed by a 13-month bridge to DPPOS. Cognition was assessed in DPPOS years 8 and 10 (12 and 14 years after randomization) with the Spanish English Verbal Learning Test (SEVLT), letter fluency and animal fluency tests, Digit Symbol Substitution Test (DSST), and a composite cognitive score. RESULTS A total of 2,280 participants (749 lifestyle, 776 metformin, and 755 placebo) aged 63.1 ± 10.7 years underwent cognitive assessments; 67.7% women, 54.6% non-Hispanic white, 20.7% non-Hispanic black, 14.6% Hispanic, 5.5% American Indian, and 4.6% Asian; 26.6% were homozygous or heterozygous for APOE-ε4. At the time of cognitive assessment, type 2 diabetes was higher in the placebo group (57.9%; P < 0.001) compared with lifestyle (47.0%) and metformin (50.4%). Metformin exposure was higher in the metformin group (8.72 years; P < 0.001) compared with placebo (1.43 years) and lifestyle (0.96 years). There were no differences in cognition across intervention arms. Type 2 diabetes was not related to cognition, but higher glycated hemoglobin at year 8 was related to worse cognition after confounder adjustment. Cumulative metformin exposure was not related to cognition. CONCLUSIONS Exposure to intensive lifestyle intervention or metformin was not related to cognition among DPPOS participants. Higher glycemia was related to worse cognitive performance. Metformin seemed cognitively safe among DPPOS participants.
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Affiliation(s)
| | - Yong Ma
- Biostatistics Center, The George Washington University, Washington, DC
| | | | | | | | - Helen Hazuda
- University of Texas Health Science Center, San Antonio, TX
| | | | | | - Karol Watson
- University of California, Los Angeles, Los Angeles, CA
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188
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Areosa Sastre A, Vernooij RWM, González‐Colaço Harmand M, Martínez G. Effect of the treatment of Type 2 diabetes mellitus on the development of cognitive impairment and dementia. Cochrane Database Syst Rev 2017; 6:CD003804. [PMID: 28617932 PMCID: PMC6481422 DOI: 10.1002/14651858.cd003804.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prevention of cognitive impairment and dementia is an important public health goal. Epidemiological evidence shows a relationship between cognitive impairment and Type 2 diabetes mellitus. The risk of dementia increases with duration of disease. This updated systematic review investigated the effect on cognitive function of the type of treatment and level of metabolic control in people with Type 2 diabetes. OBJECTIVES To assess the effects of different strategies for managing Type 2 diabetes mellitus on cognitive function and the incidence of dementia. SEARCH METHODS We searched ALOIS (the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG)), the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL and LILACS on 15 October 2016. ALOIS contains records from all major health care databases, (CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS), as well as from many trials' registers and grey literature sources. SELECTION CRITERIA We included randomised controlled trials (RCTs) which compared two or more different treatments for Type 2 diabetes mellitus and in which cognitive function was measured at baseline and after treatment. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the quality of the included RCTs. We pooled data for comparable trials and estimated the effects of treatment by using risk ratios (RRs) and mean differences (MDs), according to the nature of the outcome. We assessed the quality of the evidence using GRADE methods. MAIN RESULTS We identified seven eligible studies but only four provided data we could include in efficacy analyses. Two of these studies compared intensive versus standard glycaemic control and two compared different pharmacological treatments. All studies were at unclear risk of bias in at least two domains and one large study was at high risk of performance and detection bias.(a) Two studies with 13,934 participants at high cardiovascular risk provided efficacy data on intensive versus standard glycaemic control. A third study with 1791 participants provided additional data on hypoglycaemic episodes and mortality. There is probably no difference between treatment groups in the number of participants who decline by at least 3 points on the Mini-Mental State Examination (MMSE) over five years (RR 0.98, 95% CI 0.88 to 1.08; 1 study; n = 11,140; moderate-quality evidence); and there may also be little or no difference in the incidence of dementia (RR 1.27, 95% CI 0.87 to 1.85; 1 study; n = 11,140; low-quality evidence). From another study, there was probably little or no difference in MMSE score after 40 months (MD -0.01, 95% CI -0.18 to 0.16; 1 study; n = 2794; moderate quality evidence). Participants exposed to the intensive glycaemic control strategy probably experience more episodes of severe hypoglycaemia than those who have standard treatment (RR 2.18, 95% CI 1.52 to 3.14; 2 studies; n = 12,827; moderate-quality evidence). The evidence from these trials suggests that the intensity of glycaemic control may have little or no effect on all-cause mortality (RR 0.99, 95% CI 0.87 to 1.13; 3 studies; n = 15,888; low-quality evidence).(b) One study with 156 participants compared glibenclamide (glyburide) with repaglinide. There may be a small advantage of glibenclamide on global cognitive function measured with the MMSE after 12 months (MD -0.90, 95% CI -1.68 to -0.12; low-quality evidence). No data were reported on the incidence of dementia, hypoglycaemic events or all-cause mortality.(c) One study with 145 participants compared rosiglitazone plus metformin to glibenclamide (glyburide) plus metformin over 24 weeks. It reported only on cognitive subdomains and not on global cognitive function, incidence of MCI or dementia, hypoglycaemic events or all causes of mortality. AUTHORS' CONCLUSIONS We found no good evidence that any specific treatment or treatment strategy for Type 2 diabetes can prevent or delay cognitive impairment. The best available evidence related to the comparison of intensive with standard glycaemic control strategies. Here there was moderate-quality evidence that the strategies do not differ in their effect on global cognitive functioning over 40 to 60 months.
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Affiliation(s)
- Almudena Areosa Sastre
- Hospital Universitario de GetafeGeriatric UnitCarretera de Toledo (Km 12,500)MadridSpain28905 Getafe (Madrid)
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaBarcelonaSpain08025
| | | | - Gabriel Martínez
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaBarcelonaSpain08025
- Universidad de AntofagastaFaculty of Medicine and DentistryAntofagastaChile
- Servicio de Salud AntofagastaAntofagastaChile
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Panduru NM, Nistor I, Groop PH, Van Biesen W, Farrington K, Covic A. Considerations on glycaemic control in older and/or frail individuals with diabetes and advanced kidney disease. Nephrol Dial Transplant 2017; 32:591-597. [PMID: 28340246 DOI: 10.1093/ndt/gfx021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/24/2017] [Indexed: 12/15/2022] Open
Abstract
The increasing prevalence of chronic kidney disease (CKD) and diabetes over the last decade has resulted in increasing numbers of frail older patients with a combination of these conditions. Current treatment guidelines may not necessarily be relevant for such patients, who are mostly excluded from the trials upon which these recommendations are based. There is a paucity of data upon which to base the management of older patients with CKD. Nearly all current guidelines recommend less-tight glycaemic control for the older population, citing the lack of proven medium-term benefits and concerns about the high short-term risk of hypoglycaemia. However, reports from large landmark trials have shown potential benefits for both microvascular and macrovascular complications, though the relevance of these findings to this specific population is uncertain. The trials have also highlighted potential alternative explanations for the hazards of intensive glycaemic control. These include depression, low endogenous insulin reserve, low body mass index and side effects of the medication. Over the last few years, newer classes of hypoglycaemic drugs with a lower risk of hypoglycaemia have emerged. This article aims to present a balanced view of advantages and disadvantages of intense glycaemic control in this group of patients, which we hope will help the clinician and patient to come to an individualized management approach.
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Affiliation(s)
- Nicolae Mircea Panduru
- 2nd Clinical Department, Diabetes, Nutrition and Metabolic Diseases Chair, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Ionut Nistor
- ERBP, Ghent University Hospital, Ghent, Belgium.,Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, UK.,Centre for Clinical and Health Services Research, University of Herts, Hatfield, UK
| | - Adrian Covic
- Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
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190
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Chronic Use of Aspirin and Total White Matter Lesion Volume: Results from the Women's Health Initiative Memory Study of Magnetic Resonance Imaging Study. J Stroke Cerebrovasc Dis 2017; 26:2128-2136. [PMID: 28551293 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/29/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the relationship between aspirin and subclinical cerebrovascular heath, we evaluated the effect of chronic aspirin use on white matter lesions (WML) volume among women. METHODS Chronic aspirin use was assessed in 1365 women who participated in the Women's Health Initiative Memory Study of Magnetic Resonance Imaging. Differences in WML volumes between aspirin users and nonusers were assessed with linear mixed models. A number of secondary analyses were performed, including lobe-specific analyses, subgroup analyses based on participants' overall risk of cerebrovascular disease, and a dose-response relationship analysis. RESULTS The mean age of the women at magnetic resonance imaging examination was 77.6 years. Sixty-one percent of participants were chronic aspirin users. After adjusting for demographic variables and comorbidities, chronic aspirin use was nonsignificantly associated with 4.8% (95% CI: -6.8%, 17.9%) larger WML volumes. These null findings were confirmed in secondary and sensitivity analyses, including an active comparator evaluation where aspirin users were compared to users of nonaspirin nonsteroidal anti-inflammatory drugs or acetaminophen. CONCLUSIONS There was a nonsignificant difference in WML volumes between aspirin users and nonusers. Further, our results suggest that chronic aspirin use may not have a clinically significant effect on WML volumes in women.
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191
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Smith EE, Cieslak A, Barber P, Chen J, Chen YW, Donnini I, Edwards JD, Frayne R, Field TS, Hegedus J, Hanganu V, Ismail Z, Kanji J, Nakajima M, Noor R, Peca S, Sahlas D, Sharma M, Sposato LA, Swartz RH, Zerna C, Black SE, Hachinski V. Therapeutic Strategies and Drug Development for Vascular Cognitive Impairment. J Am Heart Assoc 2017; 6:e005568. [PMID: 28476873 PMCID: PMC5524100 DOI: 10.1161/jaha.117.005568] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | - Yu-Wei Chen
- National Taiwan University Hospital, Taipei, Taiwan
- Taiwan Landseed Hospital, Taoyuan, Taiwan
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192
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Sedentary behavior as a risk factor for cognitive decline? A focus on the influence of glycemic control in brain health. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2017; 3:291-300. [PMID: 29067335 PMCID: PMC5651418 DOI: 10.1016/j.trci.2017.04.001] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cognitive decline leading to dementia represents a global health burden. In the absence of targeted pharmacotherapy, lifestyle approaches remain the best option for slowing the onset of dementia. However, older adults spend very little time doing moderate to vigorous exercise and spend a majority of time in sedentary behavior. Sedentary behavior has been linked to poor glycemic control and increased risk of all-cause mortality. Here, we explore a potential link between sedentary behavior and brain health. We highlight the role of glycemic control in maintaining brain function and suggest that reducing and replacing sedentary behavior with intermittent light-intensity physical activity may protect against cognitive decline by reducing glycemic variability. Given that older adults find it difficult to achieve current exercise recommendations, this may be an additional practical strategy. However, more research is needed to understand the impact of poor glycemic control on brain function and whether practical interventions aimed at reducing and replacing sedentary behavior with intermittent light intensity physical activity can help slow cognitive decline.
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193
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Rapp SR, Luchsinger JA, Baker LD, Blackburn GL, Hazuda HP, Demos-McDermott KE, Jeffery RW, Keller JN, McCaffery JM, Pajewski NM, Evans M, Wadden TA, Arnold SE, Espeland MA. Effect of a Long-Term Intensive Lifestyle Intervention on Cognitive Function: Action for Health in Diabetes Study. J Am Geriatr Soc 2017; 65:966-972. [PMID: 28067945 PMCID: PMC5435531 DOI: 10.1111/jgs.14692] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess whether randomization to 10 years of lifestyle intervention to induce and maintain weight loss improves cognitive function. DESIGN Randomized controlled clinical trial. SETTING Data obtained as part of the Action for Health in Diabetes (Look AHEAD) trial (NCT00017953) and Look AHEAD Continuation study (U01 DK057136-15). PARTICIPANTS Overweight and obese individuals with type 2 diabetes mellitus aged 45 to 76 (N = 3,751). INTERVENTION Intensive lifestyle intervention (ILI) for weight loss through reduced caloric intake and increased physical activity compared with a control condition of diabetes support and education (DSE). MEASUREMENTS Certified examiners who were masked to intervention assignment administered a standard battery of cognitive function tests (Modified Mini-Mental State Examination, Rey Auditory Verbal Learning Test, Digit Symbol Coding, Trail-Making Test, Modified Stroop Color-Word Test) to participants 10 to 13 years after enrollment. RESULTS Assignment to lifestyle intervention was not associated with significantly different overall (P = .10) or domain-specific (all P > .10) cognitive function than assignment to diabetes support and education. Results were fairly consistent across prespecified groups, but there was some evidence of trends for differential intervention effects showing modest harm in ILI in participants with greater body mass index and in individuals with a history of cardiovascular disease. Cognitive function was not associated with changes in weight or fitness (all P > .05). CONCLUSION A long-term behavioral weight loss intervention for overweight and obese adults with diabetes mellitus was not associated with cognitive benefit. Trial Registration clinicaltrials.gov Identifier: NCT00017953.
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Affiliation(s)
- Stephen R. Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Jose A. Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY 10032
| | - Laura D. Baker
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - George L. Blackburn
- Center for the Study of Nutrition Medicine, Beth Israel Deaconess Medical Center, Division of Nutrition, Harvard Medical School, Boston, MA, 02215
| | - Helen P. Hazuda
- Department of Medicine, University of Texas Health Sciences Center, San Antonio, TX 78229
| | - Kathryn E. Demos-McDermott
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert School of Medicine at Brown University, Providence, RI 02903
| | - Robert W. Jeffery
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454
| | | | - Jeanne M. McCaffery
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert School of Medicine at Brown University, Providence, RI 02903
| | - Nicholas M. Pajewski
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Mary Evans
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892
| | - Thomas A. Wadden
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104
| | - Steven E. Arnold
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Charleston, MA 02129
| | - Mark A. Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
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Patel SK, Restrepo C, Werden E, Churilov L, Ekinci EI, Srivastava PM, Ramchand J, Wai B, Chambers B, O’Callaghan CJ, Darby D, Hachinski V, Cumming T, Donnan G, Burrell LM, Brodtmann A. Does left ventricular hypertrophy affect cognition and brain structural integrity in type 2 diabetes? Study design and rationale of the Diabetes and Dementia (D2) study. BMC Endocr Disord 2017; 17:24. [PMID: 28388897 PMCID: PMC5384138 DOI: 10.1186/s12902-017-0173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive impairment is common in type 2 diabetes mellitus, and there is a strong association between type 2 diabetes and Alzheimer's disease. However, we do not know which type 2 diabetes patients will dement or which biomarkers predict cognitive decline. Left ventricular hypertrophy (LVH) is potentially such a marker. LVH is highly prevalent in type 2 diabetes and is a strong, independent predictor of cardiovascular events. To date, no studies have investigated the association between LVH and cognitive decline in type 2 diabetes. The Diabetes and Dementia (D2) study is designed to establish whether patients with type 2 diabetes and LVH have increased rates of brain atrophy and cognitive decline. METHODS The D2 study is a single centre, observational, longitudinal case control study that will follow 168 adult patients aged >50 years with type 2 diabetes: 50% with LVH (case) and 50% without LVH (control). It will assess change in cardiovascular risk, brain imaging and neuropsychological testing between two time-points, baseline (0 months) and 24 months. The primary outcome is brain volume change at 24 months. The co-primary outcome is the presence of cognitive decline at 24 months. The secondary outcome is change in left ventricular mass associated with brain atrophy and cognitive decline at 24 months. DISCUSSION The D2 study will test the hypothesis that patients with type 2 diabetes and LVH will exhibit greater brain atrophy than those without LVH. An understanding of whether LVH contributes to cognitive decline, and in which patients, will allow us to identify patients at particular risk. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN12616000546459 ), date registered, 28/04/2016.
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Affiliation(s)
- Sheila K. Patel
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Health, 245 Burgundy Street, Heidelberg, VIC 3084 Australia
- Department of Medicine, University of Melbourne, Austin Health, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, VIC 3084 Australia
| | - Carolina Restrepo
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Health, 245 Burgundy Street, Heidelberg, VIC 3084 Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Health, 245 Burgundy Street, Heidelberg, VIC 3084 Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Health, 245 Burgundy Street, Heidelberg, VIC 3084 Australia
| | - Elif I. Ekinci
- Department of Medicine, University of Melbourne, Austin Health, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, VIC 3084 Australia
- Austin Health Endocrine Centre, Heidelberg, VIC Australia
| | - Piyush M. Srivastava
- Department of Medicine, University of Melbourne, Austin Health, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, VIC 3084 Australia
- Department of Cardiology, Austin Health, Heidelberg, VIC Australia
| | - Jay Ramchand
- Department of Medicine, University of Melbourne, Austin Health, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, VIC 3084 Australia
- Department of Cardiology, Austin Health, Heidelberg, VIC Australia
| | - Bryan Wai
- Department of Medicine, University of Melbourne, Austin Health, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, VIC 3084 Australia
- Department of Cardiology, Austin Health, Heidelberg, VIC Australia
| | - Brian Chambers
- Department of Medicine, University of Melbourne, Austin Health, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, VIC 3084 Australia
- Department of Neurology, Austin Health, Heidelberg, VIC Australia
| | - Christopher J. O’Callaghan
- Department of Medicine, University of Melbourne, Austin Health, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, VIC 3084 Australia
- Department of Clinical Pharmacology, Austin Health, Heidelberg, VIC Australia
| | - David Darby
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Health, 245 Burgundy Street, Heidelberg, VIC 3084 Australia
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Canada
| | - Toby Cumming
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Health, 245 Burgundy Street, Heidelberg, VIC 3084 Australia
| | - Geoff Donnan
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Health, 245 Burgundy Street, Heidelberg, VIC 3084 Australia
| | - Louise M. Burrell
- Department of Medicine, University of Melbourne, Austin Health, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, VIC 3084 Australia
- Department of Cardiology, Austin Health, Heidelberg, VIC Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Health, 245 Burgundy Street, Heidelberg, VIC 3084 Australia
- Department of Medicine, University of Melbourne, Austin Health, Level 7, Lance Townsend Building, 145 Studley Road, Heidelberg, VIC 3084 Australia
- Department of Neurology, Austin Health, Heidelberg, VIC Australia
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195
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Munshi MN. Cognitive Dysfunction in Older Adults With Diabetes: What a Clinician Needs to Know. Diabetes Care 2017; 40:461-467. [PMID: 28325796 DOI: 10.2337/dc16-1229] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/31/2016] [Indexed: 02/06/2023]
Abstract
One of the challenges of managing older adults with diabetes is the individualization of care in people with multiple comorbid conditions. Although macrovascular and microvascular complications of diabetes are well recognized, there is a lack of awareness regarding other conditions such as cognitive dysfunction, depression, and physical disabilities. Cognitive dysfunction is of particular importance because of its impact on self-care and quality of life. In this Perspective, I discuss common and practical questions faced by clinicians managing diabetes in older adults who also have cognitive dysfunction.
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Affiliation(s)
- Medha N Munshi
- Beth Israel Deaconess Medical Center, Joslin Diabetes Center, Harvard Medical School, Boston, MA
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196
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Hughes TM, Craft S, Baker LD, Espeland MA, Rapp SR, Sink KM, Bertoni AG, Burke GL, Gottesman RF, Michos ED, Luchsinger JA, Fitzpatrick AL, Hayden KM. Changes in metabolic risk factors over 10 years and their associations with late-life cognitive performance: The Multi-Ethnic Study of Atherosclerosis. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 8:18-25. [PMID: 28435852 PMCID: PMC5390661 DOI: 10.1016/j.dadm.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background We examined whether changes in metabolic factors over 10 years were associated with cognitive performance. Methods Participants from the Multi-Ethnic Study of Atherosclerosis were followed since baseline (2000–2002) with five clinical examinations. At exam 5 (2010–2012), they received a short cognitive battery (Cognitive Abilities Screening Instrument [CASI], Digit Symbol Coding [DSC], and Digit Span [DS]). We examined associations between baseline metabolic factors and their changes over time before cognitive testing. Results Among 4392 participants, baseline metabolic disorders (fasting glucose, systolic and diastolic blood pressures) were significantly associated with poorer CASI, DSC, and DS scores measured 10 years later. Increases in blood pressure were associated with lower cognitive performance. Results did not differ by race/ethnicity and were stronger among those without the APOE ε4 allele. Conclusions Cognitive performance was associated with antecedent abnormalities in glucose metabolism and blood pressure increases. Findings appeared stronger among APOE ε4-negative participants.
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Affiliation(s)
- Timothy M. Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Suzanne Craft
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laura D. Baker
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark A. Espeland
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen R. Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kaycee M. Sink
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gregory L. Burke
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D. Michos
- The Ciccarone Preventive Cardiology Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - José A. Luchsinger
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Annette L. Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kathleen M. Hayden
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Corresponding author. Tel.: +1-336-716-2918; Fax: +1-336-716-7554.
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197
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Hu X, Bai T, Xu Z, Liu Q, Zheng Y, Cai L. Pathophysiological Fundamentals of Diabetic Cardiomyopathy. Compr Physiol 2017; 7:693-711. [PMID: 28333387 DOI: 10.1002/cphy.c160021] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diabetic cardiomyopathy (DCM) was first recognized more than four decades ago and occurred independent of cardiovascular diseases or hypertension in both type 1 and type 2 diabetic patients. The exact mechanisms underlying this disease remain incompletely understood. Several pathophysiological bases responsible for DCM have been proposed, including the presence of hyperglycemia, nonenzymatic glycosylation of large molecules (e.g., proteins), energy metabolic disturbance, mitochondrial damage and dysfunction, impaired calcium handling, reactive oxygen species formation, inflammation, cardiac cell death, and cardiac hypertrophy and fibrosis, leading to impairment of cardiac contractile functions. Increasing evidence also indicates the phenomenon called "metabolic memory" for diabetes-induced cardiovascular complications, for which epigenetic modulation seemed to play an important role, suggesting that the aforementioned pathogenic bases may be regulated by epigenetic modification. Therefore, this review aims at briefly summarizing the current understanding of the pathophysiological bases for DCM. Although how epigenetic mechanisms play a role remains incompletely understood now, extensive clinical and experimental studies have implicated its importance in regulating the cardiac responses to diabetes, which are believed to shed insight into understanding of the pathophysiological and epigenetic mechanisms for the development of DCM and its possible prevention and/or therapy. © 2017 American Physiological Society. Compr Physiol 7:693-711, 2017.
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Affiliation(s)
- Xinyue Hu
- Center of Cardiovascular Diseases, the First Hospital of Jilin University, Changchun, China.,Pediatric Research Institute at the Department of Pediatrics of the University of Louisville, Louisville, Kentucky, USA
| | - Tao Bai
- Center of Cardiovascular Diseases, the First Hospital of Jilin University, Changchun, China.,Pediatric Research Institute at the Department of Pediatrics of the University of Louisville, Louisville, Kentucky, USA
| | - Zheng Xu
- Center of Cardiovascular Diseases, the First Hospital of Jilin University, Changchun, China.,Pediatric Research Institute at the Department of Pediatrics of the University of Louisville, Louisville, Kentucky, USA
| | - Qiuju Liu
- Department of Hematological Disorders the First Hospital of Jilin University, Changchun, China
| | - Yang Zheng
- Center of Cardiovascular Diseases, the First Hospital of Jilin University, Changchun, China
| | - Lu Cai
- Pediatric Research Institute at the Department of Pediatrics of the University of Louisville, Louisville, Kentucky, USA.,Wendy Novak Diabetes Care Center, University of Louisville, Louisville, Kentucky, USA
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198
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Zhang Y, Song W. Islet amyloid polypeptide: Another key molecule in Alzheimer's pathogenesis? Prog Neurobiol 2017; 153:100-120. [PMID: 28274676 DOI: 10.1016/j.pneurobio.2017.03.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 12/14/2022]
Abstract
Recent epidemiological evidence reveals that patients suffering from type 2 diabetes mellitus (T2DM) often experience a significant decline in cognitive function, and approximately 70% of those cases eventually develop Alzheimer's disease (AD). Although several pathological processes are shared by AD and T2DM, the exact molecular mechanisms connecting these two diseases are poorly understood. Aggregation of human islet amyloid polypeptide (hIAPP), the pathological hallmark of T2DM, has also been detected in brain tissue and is associated with cognitive decline and AD development. In addition, hIAPP and amyloid β protein (Aβ) share many biophysical and physiological properties as well as exert similar cytotoxic mechanisms. Therefore, it is important to examine the possible role of hIAPP in the pathogenesis of AD. In this article, we introduce the basics on this amyloidogenic protein. More importantly, we discuss the potential mechanisms of hIAPP-induced AD development, which will be beneficial for proposing novel and feasible strategies to optimize AD prevention and/or treatment in diabetics.
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Affiliation(s)
- Yun Zhang
- Townsend Family Laboratories, Department of Psychiatry, The University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | - Weihong Song
- Townsend Family Laboratories, Department of Psychiatry, The University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
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FitzGerald JD, Neogi T, Choi HK. Editorial: Do Not Let Gout Apathy Lead to Gouty Arthropathy. Arthritis Rheumatol 2017; 69:479-482. [DOI: 10.1002/art.40031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/14/2016] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Hyon K. Choi
- Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
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200
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Higher Fasting Plasma Glucose is Associated with Increased Cortical Thinning Over 12 Years: The PATH Through Life Study. Brain Topogr 2017; 30:408-416. [DOI: 10.1007/s10548-017-0544-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/04/2017] [Indexed: 01/27/2023]
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