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Shapiro ALB, Coughlan C, Bettcher BM, Pauley ME, Kim J, Bjornstad P, Rajic B, Truong J, Bell C, Choi YJ, Walker KA, Potter H, Liese AD, Dabelea D, Whitlow CT. Biomarkers of Neurodegeneration and Alzheimer's Disease Neuropathology in Adolescents and Young Adults with Youth-Onset Type 1 or Type 2 Diabetes: A Proof-of-Concept Study. ENDOCRINES 2024; 5:197-213. [PMID: 38764894 PMCID: PMC11101213 DOI: 10.3390/endocrines5020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024] Open
Abstract
Adult-onset diabetes increases one's risk of neurodegenerative disease including Alzheimer's disease (AD); however, the risk associated with youth-onset diabetes (Y-DM) remains underexplored. We quantified plasma biomarkers of neurodegeneration and AD in participants with Y-DM from the SEARCH cohort at adolescence and young adulthood (Type 1, n = 25; Type 2, n = 25; 59% female; adolescence, age = 15 y/o [2.6]; adulthood, age = 27.4 y/o [2.2]), comparing them with controls (adolescence, n = 25, age = 14.8 y/o [2.7]; adulthood, n = 21, age = 24.9 y/o [2.8]). Plasma biomarkers, including glial fibrillary acidic protein (GFAP), neurofilament light chain protein (NfL), phosphorylated tau-181 (pTau181), and amyloid beta (Aβ40, Aβ42), were measured via Simoa. A subset of participants (n = 7; age = 27.5 y/o [5.7]) and six controls (age = 25.1 y/o [4.5]) underwent PET scans to quantify brain amyloid and tau densities in AD sensitive brain regions. Y-DM adolescents exhibited lower plasma levels of Aβ40, Aβ42, and GFAP, and higher pTau181 compared to controls (p < 0.05), a pattern persisting into adulthood (p < 0.001). All biomarkers showed significant increases from adolescence to adulthood in Y-DM (p < 0.01), though no significant differences in brain amyloid or tau were noted between Y-DM and controls in adulthood. Preliminary evidence suggests that preclinical AD neuropathology is present in young people with Y-DM, indicating a potential increased risk of neurodegenerative diseases.
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Affiliation(s)
- Allison L. B. Shapiro
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
- Section of Endocrinology, Department of Pediatrics, School of Medicine (SOM), CU-Anschutz, Aurora, CO 80045, USA
| | - Christina Coughlan
- University of Colorado Alzheimer’s and Cognition Center, CU-Anschutz, Aurora, CO 80045, USA
- Department of Neurology, SOM, CU-Anschutz, Aurora, CO 80045, USA
| | | | - Meghan E. Pauley
- Barbara Davis Center for Diabetes, CU-Anschutz, Aurora, CO 80045, USA
| | - Jeongchul Kim
- Radiology Informatics and Image Processing Laboratory, Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Petter Bjornstad
- Section of Endocrinology, Department of Pediatrics, School of Medicine (SOM), CU-Anschutz, Aurora, CO 80045, USA
- Division of Renal Diseases and Hypertension, Department of Medicine, SOM, CU-Anschutz, Aurora, CO 80045, USA
| | - Benjamin Rajic
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
| | - Jennifer Truong
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
| | - Christopher Bell
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
| | - Ye Ji Choi
- Section of Endocrinology, Department of Pediatrics, School of Medicine (SOM), CU-Anschutz, Aurora, CO 80045, USA
| | - Keenan A. Walker
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, MD 20814, USA
| | - Huntington Potter
- University of Colorado Alzheimer’s and Cognition Center, CU-Anschutz, Aurora, CO 80045, USA
- Department of Neurology, SOM, CU-Anschutz, Aurora, CO 80045, USA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado at Anschutz (CU-Anschutz), Aurora, CO 80045, USA
| | - Christopher T. Whitlow
- Radiology Informatics and Image Processing Laboratory, Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
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Wang Y, Wang L, Yan J, Yuan X, Lou QQ. Aerobic Training Increases Hippocampal Volume and Protects Cognitive Function for Type 2 Diabetes Patients with Normal Cognition. Exp Clin Endocrinol Diabetes 2023; 131:605-614. [PMID: 37268011 DOI: 10.1055/a-2105-0799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To evaluate the effects of aerobic training on hippocampal volume and cognitive function in patients with type 2 diabetes mellitus (T2DM) with normal cognition. MATERIALS AND METHODS One hundred patients with T2DM aged 60-75 years who met inclusion criteria were randomized into the aerobic training group (n=50) and control group (n=50). The aerobic training group received 1 year of aerobic training, while the control group maintained their lifestyle without additional exercise intervention. The primary outcomes were hippocampal volume measured by MRI and Mini-mental State Examination (MMSE) score or Montreal Cognitive Assessment scale (MoCA) scores. RESULTS Eighty-two participants completed the study (aerobic training group, n=40; control group, n=42). There was no significant difference between the two groups at baseline (P>0.05). After one year of moderate aerobic training, increase in total and right hippocampal volume in the aerobic training group were significantly higher than in the control group (P=0.027, P=0.043, respectively). In the aerobic group, total hippocampal volume significantly increased after the intervention compared with baseline (P=0.034). The between-group difference in the change of MMSE and MoCA scores was statistically significant (P=0.015, P=0.027, respectively). Logistic regression showed strong correlations between aerobic training and increase in total hippocampal volume (OR:1.091, [95%CI 0.969, 1.228], P=0.002), improvement of MMSE scores (OR:1.127, [95%CI 1.005, 1.263], P=0.041) or MoCA scores (OR:2.564, [95%CI 2.098.2.973], P=0.045). CONCLUSIONS One-year moderate aerobic training increased total and right hippocampal volume and protected cognitive function for T2DM patients with normal cognition. Early intervention focusing on cognition protection should be considered for T2DM patients in clinical settings.
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Affiliation(s)
- Ying Wang
- The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan Province, China
| | - Liping Wang
- Department of Geriatrics, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Juan Yan
- Jiangsu college of nursing, Huaian, Jiangsu Province, China
| | - Xiaodan Yuan
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Qing Q Lou
- The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, Hainan Province, China
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Huang J, Huang N, Mao Q, Shi J, Qiu Y. Natural bioactive compounds in Alzheimer's disease: From the perspective of type 3 diabetes mellitus. Front Aging Neurosci 2023; 15:1130253. [PMID: 37009462 PMCID: PMC10062602 DOI: 10.3389/fnagi.2023.1130253] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
There is a close relationship between Alzheimer's disease (AD) and diabetes mellitus (DM), and the link between the two is often referred to as type 3 diabetes mellitus (T3DM). Many natural bioactive compounds have shown the potential to treat AD and diabetes. We mainly review the polyphenols represented by resveratrol (RES) and proanthocyanidins (PCs) and alkaloids represented by berberine (BBR) and Dendrobium nobile Lindl. alkaloids (DNLA) from the perspective of T3DM to review the neuroprotective effects and molecular mechanisms of natural compounds in AD.
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Affiliation(s)
- Juan Huang
- Department of Pharmacology and Chemical Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Lab of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou, China
- School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Nanqu Huang
- National Drug Clinical Trial Institution, Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, Guizhou, China
| | - Qianhua Mao
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Lab of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jingshan Shi
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Lab of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou, China
- Jingshan Shi
| | - Yu Qiu
- Department of Pharmacology and Chemical Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Yu Qiu
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4
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Ortiz GG, Huerta M, González-Usigli HA, Torres-Sánchez ED, Delgado-Lara DLC, Pacheco-Moisés FP, Mireles-Ramírez MA, Torres-Mendoza BMG, Moreno-Cih RI, Velázquez-Brizuela IE. Cognitive disorder and dementia in type 2 diabetes mellitus. World J Diabetes 2022; 13:319-337. [PMID: 35582669 PMCID: PMC9052006 DOI: 10.4239/wjd.v13.i4.319] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/14/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Insulin, a key pleiotropic hormone, regulates metabolism through several signaling pathways in target tissues including skeletal muscle, liver, and brain. In the brain, insulin modulates learning and memory, and impaired insulin signaling is associated with metabolic dysregulation and neurodegenerative diseases. At the receptor level, in aging and Alzheimer’s disease (AD) models, the amount of insulin receptors and their functions are decreased. Clinical and animal model studies suggest that memory improvements are due to changes in insulin levels. Furthermore, diabetes mellitus (DM) and insulin resistance are associated with age-related cognitive decline, increased levels of β-amyloid peptide, phosphorylation of tau protein; oxidative stress, pro-inflammatory cytokine production, and dyslipidemia. Recent evidence shows that deleting brain insulin receptors leads to mild obesity and insulin resistance without influencing brain size and apoptosis development. Conversely, deleting insulin-like growth factor 1 receptor (IGF-1R) affects brain size and development, and contributes to behavior changes. Insulin is synthesized locally in the brain and is released from the neurons. Here, we reviewed proposed pathophysiological hypotheses to explain increased risk of dementia in the presence of DM. Regardless of the exact sequence of events leading to neurodegeneration, there is strong evidence that mitochondrial dysfunction plays a key role in AD and DM. A triple transgenic mouse model of AD showed mitochondrial dysfunction, oxidative stress, and loss of synaptic integrity. These alterations are comparable to those induced in wild-type mice treated with sucrose, which is consistent with the proposal that mitochondrial alterations are associated with DM and contribute to AD development. Alterations in insulin/IGF-1 signaling in DM could lead to mitochondrial dysfunction and low antioxidant capacity of the cell. Thus, insulin/IGF-1 signaling is important for increased neural processing and systemic metabolism, and could be a specific target for therapeutic strategies to decrease alterations associated with age-related cognitive decline.
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Affiliation(s)
- Genaro G Ortiz
- Department of Philosophical and Methodological Disciplines, University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
- Department of Neurology, Movement Disorders Clinic, Sub-Specialty Medical Unit, National Western Medical Center, Mexican Social Security Institute (IMSS), Guadalajara 44340, Jalisco, Mexico
| | - Miguel Huerta
- University Biomedical Research Center, University of Colima, Colima 28040, Mexico
| | - Héctor A González-Usigli
- Department of Neurology, Movement Disorders Clinic, Sub-Specialty Medical Unit, National Western Medical Center, Mexican Social Security Institute (IMSS), Guadalajara 44340, Jalisco, Mexico
| | - Erandis D Torres-Sánchez
- Department of Medical and Life Sciences, University Center of ‘La Ciénega’, University of Guadalajara, Ocotlán 47810, Jalisco, Mexico
| | - Daniela LC Delgado-Lara
- Department of Philosophical and Methodological Disciplines, University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Fermín P Pacheco-Moisés
- Department of Chemistry, University Center of Exact Sciences and Engineering, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Mario A Mireles-Ramírez
- Department of Neurology, Movement Disorders Clinic, Sub-Specialty Medical Unit, National Western Medical Center, Mexican Social Security Institute (IMSS), Guadalajara 44340, Jalisco, Mexico
| | - Blanca MG Torres-Mendoza
- Department of Philosophical and Methodological Disciplines, University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
- Division of Neurosciences, Western Biomedical Research Center, Mexican Social Security Institute (IMSS), Guadalajara 44340, Jalisco, Mexico
| | - Roxana I Moreno-Cih
- Gerontology Postgraduate Program, Public Health Department, University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Irma E Velázquez-Brizuela
- Department of Philosophical and Methodological Disciplines, University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
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Ju Z, Shen L, Zhou M, Luo J, Yu Z, Qu C, Lei R, Lei M, Huang R. Helicobacter pylori and Alzheimer's Disease-Related Metabolic Dysfunction: Activation of TLR4/Myd88 Inflammation Pathway from p53 Perspective and a Case Study of Low-Dose Radiation Intervention. ACS Chem Neurosci 2022; 13:1065-1081. [PMID: 35312296 DOI: 10.1021/acschemneuro.2c00082] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Gut dysbiosis is observed in Alzheimer's disease (AD) and is frequently associated with AD-induced metabolic dysfunction. However, the extent and specific underlying molecular mechanisms triggered by alterations of gut microbiota composition and function mediating AD-induced metabolic dysfunction in AD remain incompletely uncovered. Here, we indicate that Helicobacter pylori (H. pylori) is abundant in AD patients with relative metabolic dysfunction. Fecal microbiota transplantation from the AD patients promoted metabolic dysfunction in mice and increased gut permeability. H. pylori increased gut permeability through activation of the TLR4/Myd88 inflammation pathway in a p53-dependent manner, leading to metabolic dysfunction. Moreover, p53 deficiency reduced bile acid concentration, leading to an increased abundance of H. pylori colonization. Overall, these data identify H. pylori as a key promoter of AD-induced metabolic dysfunction.
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Affiliation(s)
- Zhao Ju
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, Hunan 410078, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Meiling Zhou
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, Hunan 410078, China
| | - Jinhua Luo
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, Hunan 410078, China
| | - Zijian Yu
- The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, Hunan 421001, People’s Republic of China
| | - Can Qu
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, Hunan 410078, China
| | - Ridan Lei
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, Hunan 410078, China
| | - Mingjun Lei
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Ruixue Huang
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, Hunan 410078, China
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Athanasaki A, Melanis K, Tsantzali I, Stefanou MI, Ntymenou S, Paraskevas SG, Kalamatianos T, Boutati E, Lambadiari V, Voumvourakis KI, Stranjalis G, Giannopoulos S, Tsivgoulis G, Paraskevas GP. Type 2 Diabetes Mellitus as a Risk Factor for Alzheimer’s Disease: Review and Meta-Analysis. Biomedicines 2022; 10:biomedicines10040778. [PMID: 35453527 PMCID: PMC9029855 DOI: 10.3390/biomedicines10040778] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 01/16/2023] Open
Abstract
Alzheimer’s disease is the most common type of dementia, reaching 60–80% of case totals, and is one of the major global causes of the elderly population’s decline in functionality concerning daily life activities. Epidemiological research has already indicated that, in addition to several others metabolic factors, diabetes mellitus type 2 is a risk factor of Alzheimer’s disease. Many molecular pathways have been described, and at the same time, there are clues that suggest the connection between type 2 diabetes mellitus and Alzheimer’s disease, through specific genes, autophagy, and even inflammatory pathways. A systematic review with meta-analysis was conducted, and its main goal was to reveal the multilevel connection between these diseases.
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Affiliation(s)
- Athanasia Athanasaki
- Department of Neurology, Evangelismos Hospital, 10676 Athens, Greece; (A.A.); (S.N.)
| | - Konstantinos Melanis
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Ioanna Tsantzali
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Maria Ioanna Stefanou
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Sofia Ntymenou
- Department of Neurology, Evangelismos Hospital, 10676 Athens, Greece; (A.A.); (S.N.)
| | - Sotirios G. Paraskevas
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Theodosis Kalamatianos
- 1st Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (T.K.); (G.S.)
| | - Eleni Boutati
- 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (E.B.); (V.L.)
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (E.B.); (V.L.)
| | - Konstantinos I. Voumvourakis
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - George Stranjalis
- 1st Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (T.K.); (G.S.)
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - Georgios Tsivgoulis
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
| | - George P. Paraskevas
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12462 Athens, Greece; (K.M.); (I.T.); (M.I.S.); (S.G.P.); (K.I.V.); (S.G.); (G.T.)
- Correspondence: ; Tel.: +30-2105832466
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7
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López-Rubio C, Koponen M, Lampela P, Taipale H, Tanskanen A, Bell JS, Tolppanen AM, Hartikainen S. Changes in the use of diabetes drugs among community-dwelling people with Alzheimer's disease. BMC Geriatr 2021; 21:701. [PMID: 34911481 PMCID: PMC8672592 DOI: 10.1186/s12877-021-02694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Type 2 diabetes is common in persons with Alzheimer’s disease (AD). Management of diabetes in persons with AD is challenging due to changing goals of care and susceptibility to adverse drug events including hypoglycemia. The aim of this study was to investigate the prevalence of diabetes drug use from 5 years before to 5 years after the time of AD diagnosis among persons with and without AD. Methods This was a nationwide register-based study of persons with and without AD and diabetes in Finland. We analyzed data from the Medication Use and Alzheimer’s disease (MEDALZ) study that included 70,718 community-dwelling people diagnosed with AD from 2005 to 2011. The study population included 8418 persons with AD and 6666 matched persons without AD who were diagnosed with diabetes 5 years before AD diagnosis (index date). We defined the prevalence of diabetes drug use in three-month evaluation periods from 5 years before until 5 years after the index date. Results Nearly all people with diabetes (94% in both cohorts) used one or more diabetes drugs on the index date. The most prevalent drug metformin was used by 60.9% of people with AD and 59.1% of people without AD. The next most prevalent drugs were sulfonylureas and insulin. The prevalence of diabetes drug use was similar in people with and without AD but began to decline 1 year after AD diagnosis in the AD cohort compared to non-AD cohort. Conclusions The decline in diabetes drug use after AD diagnosis may be attributed to clinicians and patients seeking to avoid serious adverse drug events including hypoglycemia. In addition, the findings may reflect personalized glycemic control and unintentional weight loss in persons with AD reducing the need for diabetes drugs. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02694-w.
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Affiliation(s)
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Pasi Lampela
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - J Simon Bell
- School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. .,School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland.
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8
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Liu XY, Zhang N, Zhang SX, Xu P. Potential new therapeutic target for Alzheimer's disease: Glucagon-like peptide-1. Eur J Neurosci 2021; 54:7749-7769. [PMID: 34676939 DOI: 10.1111/ejn.15502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/13/2022]
Abstract
Increasing evidence shows a close relationship between Alzheimer's disease (AD) and type 2 diabetes mellitus (T2DM). Recently, glucagon-like peptide-1 (GLP-1), a gut incretin hormone, has become a well-established treatment for T2DM and is likely to be involved in treating cognitive impairment. In this mini review, the similarities between AD and T2DM are summarised with the main focus on GLP-1-based therapeutics in AD.
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Affiliation(s)
- Xiao-Yu Liu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ni Zhang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Sheng-Xiao Zhang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China.,Key laboratory of Cellular Physiology, Shanxi Medical University, Ministry of Education, Shanxi, China
| | - Ping Xu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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9
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Wang R, Yan W, Du M, Tao L, Liu J. The effect of physical activity interventions on cognition function in patients with diabetes: A systematic review and meta-analysis. Diabetes Metab Res Rev 2021; 37:e3443. [PMID: 33616310 PMCID: PMC8519002 DOI: 10.1002/dmrr.3443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND In recent years, studies have revealed that cognition may be impaired by glucose metabolism disorder. Meanwhile, physical activity has been demonstrated to maintain blood glucose. This meta-analysis was conducted to assess the effect of physical activity on cognition in patients with diabetes and provide evidence for the treatment of cognition impairment among them. METHODS We searched studies published in five databases from 1 January 1984 to 29 August 2020. A random-effect or fixed-effect meta-analysis was used to estimate the pooled effect of physical activity on the change of cognition throughout intervention duration and post-intervention cognition scores by standardized mean difference (SMD) and its 95% confidence interval (CI). We used funnel plots to evaluate the publication bias, I2 statistic to evaluate the heterogeneity and did subgroup analysis stratified by sample size and follow-up time. RESULTS Five eligible studies involving 2581 patients with diabetes were included. The pooled effect of physical activity on cognition improvement in patients with diabetes was significant (SMD = 0.98, 95% CI: 0.34-1.62), while the effect on post-intervention cognition scores was not significant (SMD = 0.35, 95% CI: -0.04-0.73). In the subgroup analysis, the pooled effect was significantly higher in studies of follow-up time less than 1 year (SMD = 2.14, 95% CI: 1.63-2.64), while observing no significant effect in studies of follow-up time over 1 year (SMD = 0.10, 95% CI: -0.11-0.32). CONCLUSIONS Physical activity is beneficial to improving cognition in patients with diabetes. However, the long-term effect needs to be explored in future studies.
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Affiliation(s)
- Ruitong Wang
- School of Public HealthPeking UniversityBeijingChina
| | - Wenxin Yan
- School of Public HealthPeking UniversityBeijingChina
| | - Min Du
- School of Public HealthPeking UniversityBeijingChina
| | - Liyuan Tao
- Research Center of Clinical EpidemiologyPeking University Third HospitalBeijingChina
| | - Jue Liu
- School of Public HealthPeking UniversityBeijingChina
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Peng X, Shi X, Huang J, Zhang S, Yan Y, Ma D, Xu W, Xu W, Dong K, Tao J, Li M, Yang Y. Exendin-4 Improves Cognitive Function of Diabetic Mice via Increasing Brain Insulin Synthesis. Curr Alzheimer Res 2021; 18:546-557. [PMID: 34587885 DOI: 10.2174/1567205018666210929150004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/16/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Type 2 diabetes(T2D) patients are more prone to develop Alzheimer's disease (AD). We have previously shown that Glucagon-like peptide-1 receptor agon- ist exendin-4 (Ex-4) reduces tau hyperphosphorylation in T2D animals through upregulating in- sulin signaling, and peripheral injected Ex-4 increases insulin levels in the T2D brain. This study aims to further clarify whether the elevated insulin in the brain is produced by nerve cells under the action of Ex-4. METHODS The neuronal cell line-HT22 was treated with Ex-4 under high glucose or normal cultiva- tion, and the number of insulin-positive cells as well as the expression levels of insulin synthesis-re- lated genes were examined. The db/db mice were treated with a peripheral injection of Ex-4 and/or intracerebroventricular (ICV) injection of siRNA to inhibit the expression of insulin synthesis-relat- ed genes and the behavior tests were carried on. Finally, plasma glucose, cerebrospinal fluid (CSF) glucose, CSF insulin, phosphorylation of tau, phosphorylation of AKT and GSK-3β of db/db mice were detected. RESULTS We found that Ex-4 promoted the expression of insulin synthesis-related genes and in- duced an obvious increase of insulin-positive HT-22 neuronal cells in a high glucose environment. Peripheral injection of Ex-4 improved the cognitive function of db/db mice and increased brain in- sulin levels which activated brain insulin signaling and subsequently alleviated tau hyperphosphory- lation. However, when siRNA-neurod1 was injected to block insulin synthesis, the cognitive func- tion of db/db mice was not improved under the action of Ex-4 anymore. Moreover, the brain in- sulin levels dropped to an extremely low level, and the phosphorylation level of tau increased signi- ficantly. CONCLUSION This study demonstrated that Ex-4 improved cognition function by promoting brain in- sulin synthesis followed by the activation of brain insulin signaling and alleviation of tau hyper- phosphorylation.
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Affiliation(s)
- Xuemin Peng
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Xiaoli Shi
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Jiaojiao Huang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Shujun Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Yongli Yan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Delin Ma
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Weijie Xu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Weijie Xu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Kun Dong
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Jing Tao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Mengni Li
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei. China
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11
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Jia Y, Liu R, Tang S, Zhang D, Wang Y, Cong L, Hou T, Ren J, Du Y. Associations of the Glycaemic Control of Diabetes with Dementia and Physical Function in Rural-Dwelling Older Chinese Adults: A Population-Based Study. Clin Interv Aging 2021; 16:1503-1513. [PMID: 34413638 PMCID: PMC8370580 DOI: 10.2147/cia.s319633] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose To examine the associations of impaired fasting glucose (IFG) and glycaemic control of diabetes with dementia, global cognitive function and physical function among rural-dwelling Chinese older adults. Patients and Methods This population-based cross-sectional study included 4583 participants (age ≥65 years, 57.3% women) living in Yanlou Town, Yanggu County, western Shandong Province, China. In 2018, data were collected through interviews, clinical examinations, neuropsychological tests, and laboratory tests. Diabetes status was defined by self-reported physician-diagnosed diabetes, current use of antidiabetic agents, and fasting blood glucose tests. Global cognitive function was assessed using the Mini-Mental State Examination. Dementia was diagnosed following DSM-IV criteria, and Alzheimer's disease (AD) was diagnosed following the National Institute on Aging-Alzheimer's Association criteria. Physical function was assessed by the Short Physical Performance Battery. Data were analysed using multiple logistic and general linear regression models. Results IFG was found in 267 participants, and diabetes was diagnosed in 658 participants (257 with well-controlled diabetes, 401 with poorly controlled diabetes). Dementia was diagnosed in 166 participants (116 with AD), and physical functional impairment was found in 1973 participants. The multi-adjusted odds ratio (OR) of dementia associated with poorly controlled diabetes (vs without IFG or diabetes) was 2.41 (95% CI 1.52-3.84), and the OR of AD associated with poorly controlled diabetes was 2.32 (1.34-4.04). In addition, the adjusted OR of physical functional impairment was 1.40 (1.06-1.85) for well-controlled diabetes and 1.69 (1.35-2.12) for poorly controlled diabetes. However, IFG was not associated with cognitive or physical function. Conclusion The glycaemic control status of diabetes patients was associated with cognitive impairment and physical functional impairment.
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Affiliation(s)
- Yanhong Jia
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China
| | - Rui Liu
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Dongming Zhang
- Department of General Surgery, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Juan Ren
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
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12
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Hong J, Liu WY, Hu X, Jiang FF, Xu ZR, Li F, Shen FX, Zhu H. Association between heart rate-corrected QT interval and severe peripheral arterial disease in patients with type 2 diabetes and foot ulcers. Endocr Connect 2021; 10:845-851. [PMID: 34223825 PMCID: PMC8346192 DOI: 10.1530/ec-21-0140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A prolonged heart rate-corrected QT interval (QTc) has been associated with peripheral artery disease (PAD) in the general population. However, no study to date has identified a link between prolonged QTc and the severity of PAD in patients with diabetes mellitus and foot ulcers (DFUs). This study aimed to investigate this relationship. METHODS This multicenter study enrolled 281 patients with DFUs. The severity of PAD was classified into no severe PAD group (without stenosis or occlusion) and severe PAD group (with stenosis or occlusion) based on duplex ultrasonography. The association of prolonged QTc with severe PAD was evaluated in a multivariable mixed-effect logistic regression model, with the hospital as a random effect. Directed acyclic graphs were used to drive the selection of variables to fit the regression model. RESULTS Patients with severe PAD had longer QTc than those without. Based on the multivariable mixed-effect logistic regression model, a prolonged QTc was positively associated with severe PAD (odds ratio (OR) = 2.61; 95% CI: 1.07-6.35) and severe DFUs (Wagner grade score ≥ 3) (OR = 2.87; 95% CI: 1.42-5.81). CONCLUSIONS A prolonged QTc was associated with severe PAD in patients with DFUs. Further research is required to ascertain whether the association is causal.
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Affiliation(s)
- Jing Hong
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wen-Yue Liu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang Hu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fei-Fei Jiang
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ze-Ru Xu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fang Li
- Department of Endocrinology, Ruian Traditional Chinese Medicine Hospital, Wenzhou, China
| | - Fei-Xia Shen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Zhu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Correspondence should be addressed to H Zhu:
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Abstract
OBJECTIVE To examine the association between sleep duration in different stages of life and amnestic mild cognitive impairment (aMCI). DESIGN, SETTING, AND PARTICIPANTS A total of 2472 healthy elderly and 505 patients with aMCI in China were included in this study. The study analyzed the association between aMCI and sleep duration in different stages of life. MEASUREMENTS We compared sleep duration in different stages of life and analyzed the association between Montreal Cognitive Assessment scores and sleep duration by curve estimation. Logistic regression was used to evaluate the association between aMCI and sleep duration. RESULTS In the analysis, there were no results proving that sleep duration in youth (P = 0.719, sleep duration < 10 hours; P = 0.999, sleep duration ≥ 10 hours) or midlife (P = 0.898, sleep duration < 9 hours; P = 0.504, sleep duration ≥ 9 hours) had a significant association with aMCI. In the group sleeping less than 7 hours in late life, each hour more of sleep duration was associated with approximately 0.80 of the original risk of aMCI (P = 0.011, odds ratio = 0.80, 95% confidence interval = 0.68-0.95). CONCLUSIONS Among the elderly sleeping less than 7 hours, there is a decreased risk of aMCI for every additional hour of sleep.
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14
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Johansen MC, Gottesman RF. Cerebrovascular Disease and Cognitive Outcome in Patients with Cardiac Disease. Semin Neurol 2021; 41:463-472. [PMID: 33851395 DOI: 10.1055/s-0041-1726330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The pace of understanding cognitive decline and dementia has rapidly accelerated over the past decade, with constantly evolving insights into the vascular contributions to cognitive impairment and dementia (VCID). Notably, more overlap has been discovered in the pathophysiology between what was previously understood to be Alzheimer's disease and VCID, leading to a heightened emphasis on disease prevention through early and aggressive control of vascular risk factors. One particularly vulnerable population may be those with cardiac disease, as they are at risk for cerebrovascular disease, which itself can lead to dementia, and increasing evidence supports cognitive impairment in disease processes such as heart failure and atrial fibrillation, independent of ischemic stroke, suggesting other potential mechanisms. In this article, we review the evidence supporting the relationship between cardiac disease, cerebrovascular disease, and cognitive decline and discuss the ongoing and future research efforts aimed at defining the important relationship between these entities.
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Affiliation(s)
- Michelle C Johansen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca F Gottesman
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Cholerton B, Omidpanah A, Verney SP, Nelson LA, Baker LD, Suchy-Dicey A, Longstreth WT, Howard BV, Henderson JA, Montine TJ, Buchwald D. Type 2 diabetes and later cognitive function in older American Indians: The Strong Heart Study. Int J Geriatr Psychiatry 2019; 34:1050-1057. [PMID: 30924200 PMCID: PMC6579638 DOI: 10.1002/gps.5108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/29/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Insulin resistance is a substantial health issue for American Indians, with type 2 diabetes overrepresented in this population as compared with non-Hispanic whites. Insulin resistance and its related conditions in turn increase risk for dementia and cognitive impairment. The aim of the current study was to determine whether type 2 diabetes and insulin resistance at midlife was associated with later-life cognitive testing in a large sample of older American Indians, aged 65 and older. METHODS American Indian participants who underwent both fasting blood draw as part of the Strong Heart Study and had subsequent cognitive testing as part of the later adjunct Cerebrovascular Disease and its Consequences in American Indians study were included (n = 790). Regression models examined type 2 diabetes and impaired fasting glucose and subsequent cognitive test performance as part of a longitudinal study design. The relationship between a continuous measure of insulin resistance and later cognitive test performance was assessed using generalized estimating equations. RESULTS Controlling for demographic and clinical factors, verbal fluency and processing speed/working memory were significantly negatively associated with having type 2 diabetes and with insulin resistance, but not with impaired fasting glucose. CONCLUSION In this sample of American Indians, type 2 diabetes at midlife was associated with subsequent lower performance on measures of executive function. These results may have important implications for future implementation of diagnostic and intervention services in this population.
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Affiliation(s)
- Brenna Cholerton
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Adam Omidpanah
- Department of Community Health, Washington State University, Seattle, Washington, USA
| | - Steven P. Verney
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Lonnie A. Nelson
- Department of Community Health, Washington State University, Seattle, Washington, USA
| | - Laura D. Baker
- Department of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Astrid Suchy-Dicey
- Department of Community Health, Washington State University, Seattle, Washington, USA
| | - William T. Longstreth
- Department of Neurology, School of Medicine, University of Washington, Seattle, Washington, USA,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | | | | | - Thomas J. Montine
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Dedra Buchwald
- Department of Community Health, Washington State University, Seattle, Washington, USA
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16
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Lin CE, Chung CH, Chen LF, Chi MJ. Increased risk of dementia in patients with Schizophrenia: A population-based cohort study in Taiwan. Eur Psychiatry 2018; 53:7-16. [DOI: 10.1016/j.eurpsy.2018.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/10/2018] [Accepted: 05/15/2018] [Indexed: 11/15/2022] Open
Abstract
AbstractBackground:The extent to which schizophrenia is associated with the risk of all-cause dementia is controversial. This study investigated the risk of dementia by type in patients with schizophrenia.Methods:Data were collected from the Taiwanese National Health Insurance Database 2005 and analyzed using multivariate Cox proportional hazard regression models to determine the effect of schizophrenia on the dementia risk after adjusting for demographic characteristics, comorbidities, and medications. Fine and Gray's competing risk analysis was used to determine the risk of dementia, as death can act as a competing risk factor for dementia.Results:We assessed 6040 schizophrenia patients and 24,160 propensity scale-matched control patients. Schizophrenia patients exhibited a 1.80-fold risk of dementia compared to controls (adjusted hazard ratio [aHR] = 1.80, 95% confidence interval [CI] = 1.36 ∼ 2.21,p <0.001) after adjusting for covariates. Cardiovascular disease (aHR = 5.26; 95% CI = 4.50 ∼ 6.72;p <0.001), hypertension (aHR = 1.83; 95% CI = 1.77 ∼ 2.04;p= 0.002), traumatic head injury (aHR = 1.35; 95% CI = 1.24 ∼ 1.78;p <0.001), chronic lung diseases (aHR = 1.64; 95% CI = 1.13 ∼ 2.56;p <0.001), alcohol-related disorders (aHR = 3.67; 95% CI = 2.68 ∼ 4.92;p <0.001), and Parkinson’s disease (aHR = 1.72; 95% CI = 1.25 ∼ 2.40;p <0.001) were significantly associated with dementia risk. Notably, first-generation antipsychotics (aHR = 0.80; 95% CI = 0.56 ∼ 0.95;p=0.044) and second-generation antipsychotics (aHR = 0.24; 95% CI = 0.11 ∼ 0.60;p <0.001) were associated with a lower dementia risk. Sensitivity tests yielded consistent findings after excluding the first year and first 3 years of observation. Patients with schizophrenia had the highest risk of developing Alzheimer’s [dementia/disease?] among dementia subtypes (aHR = 2.10; 95% CI = 1.88 ∼ 3.86;p< 0.001), followed by vascular dementia (aHR = 1.67; 95% CI = 1.27 ∼ 2.12;p< 0.001) and unspecified dementia (aHR = 1.30; 95% CI = 1.04 ∼ 2.01;p< 0.001).Conclusions:Schizophrenia was significantly associated with the risk of all-cause dementia. Data are scarce on the mechanisms through which antipsychotic agents protect persons with schizophrenia from developing dementia. Further research is recommended to elucidate the neurobiological mechanisms underlying the association between schizophrenia and dementia, and whether antipsychotics protect against the development of dementia in schizophrenia.
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The Role of Glucagon-Like Peptide 1 (GLP1) in Type 3 Diabetes: GLP-1 Controls Insulin Resistance, Neuroinflammation and Neurogenesis in the Brain. Int J Mol Sci 2017; 18:ijms18112493. [PMID: 29165354 PMCID: PMC5713459 DOI: 10.3390/ijms18112493] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 12/25/2022] Open
Abstract
Alzheimer's disease (AD), characterized by the aggregation of amyloid-β (Aβ) protein and neuroinflammation, is the most common neurodegenerative disease globally. Previous studies have reported that some AD patients show impaired glucose utilization in brain, leading to cognitive decline. Recently, diabetes-induced dementia has been called "type 3 diabetes", based on features in common with those of type 2 diabetes and the progression of AD. Impaired glucose uptake and insulin resistance in the brain are important issues in type 3 diabetes, because these problems ultimately aggravate memory dysfunction in the brain. Glucagon-like peptide 1 (GLP-1) has been known to act as a critical controller of the glucose metabolism. Several studies have demonstrated that GLP-1 alleviates learning and memory dysfunction by enhancing the regulation of glucose in the AD brain. However, the specific actions of GLP-1 in the AD brain are not fully understood. Here, we review evidences related to the role of GLP-1 in type 3 diabetes.
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18
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Notarianni E. Cortisol: Mediator of association between Alzheimer's disease and diabetes mellitus? Psychoneuroendocrinology 2017; 81:129-137. [PMID: 28458232 DOI: 10.1016/j.psyneuen.2017.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/17/2017] [Accepted: 04/17/2017] [Indexed: 01/21/2023]
Abstract
Numerous epidemiologic studies have identified an independent association between Alzheimer's disease (AD) and diabetes mellitus (DM), which remains unexplained. This review contends that the association is mediated by mild hypercortisolemia that is manifested in AD by early stages, as empirical evidence indicates that hypercortisolemia is diabetogenic even at subclinical levels. Subclinical Cushing's syndrome is discussed as the paradigm. It is proposed that hypercortisolemia increases the risk of pre-diabetes and DM during early AD and the preceding decades. That hypercortisolemia is exhibited during the AD prodromal stage has yet to be determined, but may be inferred from concurrent metabolic parameters as documented in the literature. Studies refuting association between AD and DM also are evaluated, and the relationship between AD and DM is deduced to be more complex than directly causal, with DM of longstanding duration having a protective role. Association between DM and AD may require reappraisal by APOE ε4 carrier status, in view of newly identified roles of APOE ε4 in pre-diabetes. That association of APOE ε4 with DM in AD may have been underestimated in epidemiologic studies also is highlighted. At the core of arguments and mechanisms presented in this review is the circadian rhythm of cortisol secretion, which is the main determinant of glycemic control in humans. Alterations to that rhythm and to the hypothalamic-pituitary-adrenal axis occurring in AD are examined. Consequently the cause of hypercortisolemia in AD, and therefore of association between AD and DM, is proposed to be adrenal hyper-responsiveness to adrenocorticotropic hormone.
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Affiliation(s)
- Elena Notarianni
- St Hilda's College, University of Oxford, Cowley Place, Oxford OX4 1DY, UK; Department of Biosciences, Durham University, South Road, Durham DH1 3LE, UK.
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Simó R, Ciudin A, Simó-Servat O, Hernández C. Cognitive impairment and dementia: a new emerging complication of type 2 diabetes-The diabetologist's perspective. Acta Diabetol 2017; 54:417-424. [PMID: 28210868 DOI: 10.1007/s00592-017-0970-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/30/2017] [Indexed: 12/24/2022]
Abstract
Type 2 diabetes mellitus (T2D) and Alzheimer's disease (AD) are two of the most common diseases of aging around the world. Given the frequency with which T2D and AD occur, the notion that people with T2D may be at increased risk for AD has large societal consequences, and understanding the mechanistic links between these diseases is imperative for the development of effective AD prevention and treatment strategies. Apart from being an accelerator of AD, T2D is associated with a progressive cognitive decline. Impaired insulin signaling, inflammation, the accumulation of advanced glycation end-products and oxidative stress all play an essential role in the pathogenesis of both AD and diabetic complications. Therefore, it is reasonable to postulate that these pathways are involved in the increased risk of dementia that occurs in the T2D population. The early diagnosis of cognitive impairment and the identification of the subset of patients at a higher risk of developing AD is a challenge for healthcare providers, and meeting it will permit us to implement a personalized medicine, which is an essential issue in diabetes care with significant therapeutic implications. The main gaps that should be filled to achieve this objective are examined.
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Affiliation(s)
- Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Andreea Ciudin
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Olga Simó-Servat
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Metabolic parameters and cognitive function in a cohort of older diabetic patients. Aging Clin Exp Res 2016; 28:1105-1112. [PMID: 26727913 DOI: 10.1007/s40520-015-0515-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 12/06/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Dementia is one of the most disabling conditions associated with old age. With increasing life expectancy, prevalence of both dementia and diabetes is rising. The complex pathological relationship between diabetes mellitus (DM) and dementia has been studied, but is not yet fully understood. AIMS The main objective of this study was to investigate the relationship between metabolic parameters and the cognitive function in older diabetics. METHODS A total number of 360 diabetic subjects, age 65 years and over, and 300 older people controls were included. Clinical and biological parameters, together with the cognitive function, were assessed every 6 months over a 18-month period, for each study participant. RESULTS By employing a multivariate linear regression analysis, several significant relationships have been identified: between Clock Drawing Test (CDT) scores and HbA1c (R 2 = 0.68); between CDT scores (R 2 = 0.51) and overall MMSE scores (R 2 = 0.43) on one hand, and DM duration in years, on the other hand; also between CDT scores and BMI (R 2 = 0.59). There was no significant association between fasting serum glucose (FSG), total serum cholesterol, LDL cholesterol or triglycerides levels and cognitive function scores (p > 0.05). CONCLUSIONS The close detailed monitoring of the cognitive function and a rigorous metabolic control are important, especially in the very early stages of DM. Addressing factors such as weight control in older diabetic patients could contribute to better cognitive outcomes.
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Tramutola A, Arena A, Cini C, Butterfield DA, Barone E. Modulation of GLP-1 signaling as a novel therapeutic approach in the treatment of Alzheimer’s disease pathology. Expert Rev Neurother 2016; 17:59-75. [DOI: 10.1080/14737175.2017.1246183] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Antonella Tramutola
- Department of Biochemical Sciences ‘A. Rossi-Fanelli’, Sapienza University of Rome, Roma, Italy
| | - Andrea Arena
- Department of Biochemical Sciences ‘A. Rossi-Fanelli’, Sapienza University of Rome, Roma, Italy
| | - Chiara Cini
- Department of Biochemical Sciences ‘A. Rossi-Fanelli’, Sapienza University of Rome, Roma, Italy
| | - D. Allan Butterfield
- Department of Chemistry and Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Eugenio Barone
- Department of Biochemical Sciences ‘A. Rossi-Fanelli’, Sapienza University of Rome, Roma, Italy
- Universidad Autónoma de Chile, Instituto de Ciencias Biomédicas, Facultad de Salud, Santiago, Chile
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Tolppanen AM, Taipale H, Koponen M, Lavikainen P, Tanskanen A, Tiihonen J, Hartikainen S. Cohort profile: the Finnish Medication and Alzheimer's disease (MEDALZ) study. BMJ Open 2016; 6:e012100. [PMID: 27412109 PMCID: PMC4947779 DOI: 10.1136/bmjopen-2016-012100] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The aim of the Medicine use and Alzheimer's disease (MEDALZ) study is to investigate the changes in medication and healthcare service use among persons with Alzheimer's disease (AD) and to evaluate the safety and effectiveness of medications in this group. This is important, because the number of persons with AD is rapidly growing and even though they are a particularly vulnerable patient group, the number of representative, large-scale studies with adequate follow-up time is limited. PARTICIPANTS MEDALZ contains all residents of Finland who received a clinically verified diagnosis of AD between 2005 and 2011 and were community-dwelling at the time of diagnosis (N=70 719). The diagnosis is based on the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCS-ADRDA) and Diagnostic and Statistical Manual Fourth Edition (DSM-IV) criteria for Alzheimer's disease. The cohort contains socioeconomic data (education, occupational status and taxable income, 1972-2012) and causes of death (2005-2012), data from the prescription register (1995-2012), the special reimbursement register (1972-2012) and the hospital discharge register (1972-2012). Future updates are planned.The average age was 80.1 years (range 34.5-104.6 years). The majority of cohort (65.2%) was women. Currently, the average length of follow-up after AD diagnosis is 3.1 years and altogether 26 045 (36.8%) persons have died during the follow-up. FINDINGS Altogether 53% of the cohort had used psychotropic drugs within 1 year after AD diagnoses. The initiation rate of for example, benzodiazepines and related drugs and antidepressants began to increase already before AD diagnosis. FUTURE PLANS We are currently assessing if these, and other commonly used medications are related to adverse events such as death, hip fractures, head injuries and pneumonia.
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Affiliation(s)
- Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Research Center for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjaana Koponen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
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Papachristou E, Ramsay SE, Papacosta O, Lennon LT, Iliffe S, Whincup PH, Goya Wannamethee S. The Test Your Memory cognitive screening tool: sociodemographic and cardiometabolic risk correlates in a population-based study of older British men. Int J Geriatr Psychiatry 2016; 31:666-75. [PMID: 26489874 PMCID: PMC4855642 DOI: 10.1002/gps.4377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/11/2015] [Accepted: 09/23/2015] [Indexed: 12/04/2022]
Abstract
OBJECTIVE This study aimed to examine the association of Test Your Memory (TYM)-defined cognitive impairment groups with known sociodemographic and cardiometabolic correlates of cognitive impairment in a population-based study of older adults. METHODS Participants were members of the British Regional Heart Study, a cohort across 24 British towns initiated in 1978-1980. Data stemmed from 1570 British men examined in 2010-2012, aged 71-92 years. Sociodemographic and cardiometabolic factors were compared between participants defined as having TYM scores in the normal cognitive ageing, mild cognitive impairment (MCI) and severe cognitive impairment (SCI) groups, defined as ≥46 (45 if ≥80 years of age), ≥33 and <33, respectively. RESULTS Among 1570 men, 636 (41%) were classified in the MCI and 133 (8%) in the SCI groups. Compared with participants in the normal cognitive ageing category, individuals with SCI were characterized primarily by lower socio-economic position (odds ratio (OR) = 6.15, 95% confidence interval (CI) 4.00-9.46), slower average walking speed (OR = 3.36, 95% CI 2.21-5.10), mobility problems (OR = 4.61, 95% CI 3.04-6.97), poorer self-reported overall health (OR = 2.63, 95% CI 1.79-3.87), obesity (OR = 2.59, 95% CI 1.72-3.91) and impaired lung function (OR = 2.25, 95% CI 1.47-3.45). A similar albeit slightly weaker pattern was observed for participants with MCI. CONCLUSION Sociodemographic and lifestyle factors as well as adiposity measures, lung function and poor overall health are associated with cognitive impairments in late life. The correlates of cognitive abilities in the MCI and SCI groups, as defined by the TYM, resemble the risk profile for MCI and Alzheimer's disease outlined in current epidemiological models.
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Affiliation(s)
| | - Sheena E Ramsay
- Department of Primary Care and Population Health, UCL, London, UK
| | - Olia Papacosta
- Department of Primary Care and Population Health, UCL, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, UCL, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, UCL, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
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Lehtisalo J, Lindström J, Ngandu T, Kivipelto M, Ahtiluoto S, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Eriksson JG, Uusitupa M, Tuomilehto J, Luchsinger JA. Diabetes, glycaemia, and cognition-a secondary analysis of the Finnish Diabetes Prevention Study. Diabetes Metab Res Rev 2016; 32:102-10. [PMID: 26172529 DOI: 10.1002/dmrr.2679] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 06/28/2015] [Accepted: 06/30/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Type 2 diabetes is linked with cognitive dysfunction and dementia in epidemiological studies, but these observations are limited by lack of data on the exact timing of diabetes onset. We investigated diabetes, dysglycaemia, and cognition in the Finnish Diabetes Prevention Study, in which the timing and duration of diabetes are well documented. METHODS The Finnish Diabetes Prevention Study comprised middle-aged, overweight participants with impaired glucose tolerance but no diabetes at baseline (n = 522), randomized to lifestyle intervention or a control group. After an intervention period (mean duration 4 years) and follow-up (additional 9 years), cognitive assessment with the CERAD test battery and Trail Making Test A (TMT) was executed twice within a 2-year interval. Of the 364 (70%) participants with cognitive assessments, 171 (47%) had developed diabetes. RESULTS Cognitive function did not differ between those who developed diabetes and those who did not. Lower mean 2-h glucose at an oral glucose tolerance test (OGTT) and HbA1C during the intervention period predicted better performance in the TMT (p = 0.012 and 0.024, respectively). Those without diabetes or with short duration of diabetes improved in CERAD total score between the two assessments (p = 0.001) whereas those with long duration of diabetes did not (p = 0.844). CONCLUSIONS Better glycemic control among persons with baseline impaired glucose tolerance predicted better cognitive performance 9 years later in this secondary analysis of the Finnish Diabetes Prevention Study population. In addition, learning effects in cognitive testing were not evident in people with long diabetes duration. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jenni Lehtisalo
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Finland
| | - Jaana Lindström
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tiia Ngandu
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Miia Kivipelto
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Satu Ahtiluoto
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Espoo City Hospital, Espoo, Finland
| | - Pirjo Ilanne-Parikka
- Science Center, Tampere University Hospital, Tampere, Finland
- The Diabetes Center, Finnish Diabetes Association, Tampere, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Institute of Health Sciences (General Practice), University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital and Health Centre of Oulu, Oulu, Finland
| | - Johan G Eriksson
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Research Unit, Kuopio University Hospital, Kuopio, Finland
| | - Jaakko Tuomilehto
- Center for Vascular Prevention, Danube University Krems, Krems, Austria
- Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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25
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Yang Y, Ma D, Xu W, Chen F, Du T, Yue W, Shao S, Yuan G. Exendin-4 reduces tau hyperphosphorylation in type 2 diabetic rats via increasing brain insulin level. Mol Cell Neurosci 2015; 70:68-75. [PMID: 26640240 DOI: 10.1016/j.mcn.2015.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/30/2015] [Accepted: 10/15/2015] [Indexed: 12/19/2022] Open
Abstract
Type 2 diabetes (T2D) is a high risk factor for Alzheimer's disease (AD). Our previous study identified that hyperphosphorylation of tau protein, which is one of the pathophysiologic hallmarks of AD, also occurred in T2D rats' brain; while glucagon-like peptide-1 (GLP-1) mimetics, a type of drug used in T2D, could decrease the phosphorylation of tau, probably via augmenting insulin signaling pathway. The purpose of this study was to further explore the mechanisms that underlie the effect of exendin-4 (ex-4, a GLP-1 receptor agonist) in reducing tau phosphorylation. We found that peripheral ex-4 injection in T2D rats reduced hyperphosphorylation of tau protein in rat hippocampus, probably via increasing hippocampal insulin which activated insulin signaling. Furthermore, we found that ex-4 could neither activate insulin signaling, nor reduce tau phosphorylation in HT22 neuronal cells in the absence of insulin. These results suggested that insulin is required in reduction of tau hyperphosphorylation by ex-4 in brain rats with T2D.
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Affiliation(s)
- Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030. PR China
| | - Delin Ma
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030. PR China
| | - Weijie Xu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030. PR China
| | - Fuqiong Chen
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030. PR China
| | - Tingting Du
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030. PR China
| | - Wenzhu Yue
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030. PR China
| | - Shiying Shao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030. PR China.
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030. PR China.
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26
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Ma DL, Chen FQ, Xu WJ, Yue WZ, Yuan G, Yang Y. Early intervention with glucagon-like peptide 1 analog liraglutide prevents tau hyperphosphorylation in diabetic db/db mice. J Neurochem 2015; 135:301-8. [PMID: 26183127 DOI: 10.1111/jnc.13248] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 01/23/2023]
Abstract
Increasing evidence has shown that type 2 diabetes (T2D) is a risk factor for Alzheimer's disease. Neurofibrillary tangles, which consist of hyperphosphorylated tau and misfolded microtubules, is one of the neuropathological hallmarks of Alzheimer's disease. Db/db mice, a rodent model of T2D, also exhibited age-dependent tau hyperphosphorylation. Glucagon-like peptide-1 (GLP-1) mimetics, a type of drug used in T2D, has been found to have neuroprotective effects. The aim of this study was to explore the potential effects of liraglutide (a GLP-1 analog), or insulin, on tau phosphorylation in T2D animals. Male db/db mice (3-3.5 weeks) were daily injected subcutaneously with liraglutide (n = 27), insulin (n = 27), or saline (n = 26), and five to seven mice were killed every 2 weeks for analysis of plasma and cerebrospinal (CSF) insulin levels by ELISA, and protein levels in the hippocampal formation by western blot. We found that db/db mice treated with saline exhibited an age-dependent decrease in CSF insulin and an increase in hippocampal tau phosphorylation. Liraglutide injection reversed the CSF insulin to ~1 mIU/L by the end of 8 weeks treatment, and prevented the hyperphosphorylation of tau protein in the hippocampal formation. By contrast, insulin injection had no effects on CSF insulin or phosphorylation of tau protein. In summary, this study indicates that early GLP-1 analog intervention prevented the age-dependent tau hyperphosphorylation in T2D mice brain, probably by facilitating sequential activation in an insulin signaling pathway reflected in increased basal activation of Akt and basal suppression of glycogen synthase kinase-3 beta.
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Affiliation(s)
- De-Lin Ma
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fu-Qiong Chen
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei-Jie Xu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Zhu Yue
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Lista S, Dubois B, Hampel H. Paths to Alzheimer's disease prevention: from modifiable risk factors to biomarker enrichment strategies. J Nutr Health Aging 2015; 19:154-63. [PMID: 25651440 DOI: 10.1007/s12603-014-0515-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Alzheimer's disease (AD) represents an increasing worldwide healthcare epidemic. Secondary preventive disease-modifying treatments under clinical development are considered most effective when initiated as early as possible in the pathophysiological course and progression of the disease. Major targets are to enhance clearance and to reduce cerebral accumulation of amyloid, decrease hyperphosphorylation of tau and the generation of neurofibrillary tangles, reduce inflammation, and finally progressive neurodegeneration. Comprehensive sets of biological markers are needed to characterize the pathophysiological mechanisms, indicate effects of treatment and to facilitate early characterisation and detection of AD during the prodromal or even at asymptomatic stages. No primary or secondary preventive treatments for AD have been approved. Epidemiological research, however, has provided evidence of specifically modifiable risk and protective factors. Among them are vascular, lifestyle and psychological risk factors that may act both independently and by potentiating each other. These factors may be substantially impacted by single or multi-domain strategies to prevent or postpone the onset of AD-related pathophysiology. Researchers have recently started the European Dementia Prevention Initiative (EDPI), an international consortium to improve strategies for preventing dementia. EDPI, in particular, includes the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) which aims at optimizing the early identification of subjects at increased risk of late-life cognitive deterioration, and at the evaluation of multi-domain intervention strategies. The ongoing discussion on new diagnostic criteria provided by the International Working Group (IWG), as well as by the recommendations summoned by the National Institute on Aging and Alzheimer's Association (NIA-AA) initiative, has inspired the creation of novel study designs and the definition of earlier target populations for trials in pre- and asymptomatic at-risk and prodromal stages of AD. As a result, a number of promising international prevention trials are currently ongoing. In this review, we critically discuss the main paths to AD prevention through control of modifiable risk factors and lifestyle changes. We will also review the role of biomarkers to identify subgroups of patients who would most likely benefit from secondary prevention strategies, and to evaluate the benefit of treatment in such patients.
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Affiliation(s)
- S Lista
- S. Lista, Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) and Institut du Cerveau et de la Moelle épinière (ICM), Département de Neurologie, Hôpital de la Pitié-Salpétrière, Paris, France,
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28
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Khowal S, Mustufa MMA, Chaudhary NK, Naqvi SH, Parvez S, Jain SK, Wajid S. Assessment of the therapeutic potential of hesperidin and proteomic resolution of diabetes-mediated neuronal fluctuations expediting Alzheimer’s disease. RSC Adv 2015. [DOI: 10.1039/c5ra01977j] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Alzheimer’s disease (AD) has been proposed as type III diabetes mellitus. Prognosis and early stage diagnosis of AD is essentially required in diabetes to avoid extensive irreversible neuronal damage.
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Affiliation(s)
- Sapna Khowal
- Department of Biotechnology
- Faculty of Science
- Hamdard University (Jamia Hamdard)
- India
| | - Malik M. A. Mustufa
- Department of Biotechnology
- Faculty of Science
- Hamdard University (Jamia Hamdard)
- India
| | - Naveen K. Chaudhary
- Department of Biotechnology
- Faculty of Science
- Hamdard University (Jamia Hamdard)
- India
| | | | - Suhel Parvez
- Department of Medical Elementology and Toxicology
- Faculty of Science
- Hamdard University (Jamia Hamdard)
- India
| | - Swatantra K. Jain
- Department of Biochemistry
- Hamdard Institute of Medical Sciences and Research
- Hamdard University (Jamia Hamdard)
- India
| | - Saima Wajid
- Department of Biotechnology
- Faculty of Science
- Hamdard University (Jamia Hamdard)
- India
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29
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Yang Y, Moghadam AA, Cordner ZA, Liang NC, Moran TH. Long term exendin-4 treatment reduces food intake and body weight and alters expression of brain homeostatic and reward markers. Endocrinology 2014; 155:3473-83. [PMID: 24949661 PMCID: PMC4138563 DOI: 10.1210/en.2014-1052] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Repeated administration of the long-acting glucagon-like peptide 1 receptor agonist exendin-4 (EX-4) has been shown to reduce food intake and body weight and do so without a rebound increase in food intake after treatment termination. The current study examines the neural mechanisms underlying these actions. After 6 weeks of maintenance on a standard chow or a high-fat (HF) diet, male Sprague Dawley rats were treated with EX-4 (3.2 μg/kg, i.p., twice a day) or vehicle for 9 consecutive days. Food intake and body weight (BW) were monitored daily. Expression of the genes for the hypothalamic arcuate nucleus (ARC) peptides proopiomelanocortin (POMC), neuropeptide Y (NPY), and agouti gene-related protein was determined. Expression of the dopamine precursor tyrosine hydroxylase (TH) gene in the ventral tegmental area and genes for dopamine receptors 1 (D1R) and dopamine receptor 2 in the nucleus accumbens were also determined. Pair-fed groups were included to control for the effects of reduced food intake and BW. Treatment with EX-4 significantly decreased food intake and BW over the 9-day period in both the standard chow and HF groups. HF feeding decreased POMC without changing NPY/agouti gene-related protein gene expression in the ARC. Treatment with EX-4 increased POMC and decreased NPY expression independent of the reduction of food intake and BW. Mesolimbic TH and D1R gene expression were decreased significantly in chronic HF diet-fed rats, and these changes were reversed in both EX-4 and pair-fed conditions. These results suggest a role for increased POMC and decreased NPY expression in the ARC in the effects of EX-4 on food intake and BW. Our findings also suggest that EX-4 induced the recovery of mesolimbic TH and D1R expression in HF diet-fed rats may be secondary to HF intake reduction and/or weight loss.
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Affiliation(s)
- Yan Yang
- Department of Endocrinology (Y.Y.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Department of Psychiatry and Behavioral Sciences (Y.Y., A.A.M., Z.A.C., T.H.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; and Department of Psychology (N.C.L.), University of Illinois-Urbana Champaign, Champaign, Illinois 61820
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Marr RA, Hafez DM. Amyloid-beta and Alzheimer's disease: the role of neprilysin-2 in amyloid-beta clearance. Front Aging Neurosci 2014; 6:187. [PMID: 25165447 PMCID: PMC4131500 DOI: 10.3389/fnagi.2014.00187] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/09/2014] [Indexed: 12/14/2022] Open
Abstract
Accumulation of the amyloid-beta (Aβ) peptide is a central factor in Alzheimer's disease (AD) pathogenesis as supported by continuing evidence. This review concisely summarizes this evidence supporting a critical role for Aβ in AD before discussing the clearance of this peptide. Mechanisms of clearance of Aβ are critical for preventing pathological elevations in Aβ concentration. Direct degradation of Aβ by endopeptidases has emerged as one important pathway for clearance. Of particular interest are endopeptidases that are sensitive to the neprilysin (NEP) inhibitors thiorphan and phosphoramidon (i.e., are "NEP-like") as these inhibitors induce a dramatic increase in Aβ levels in rodents. This review will focus on neprilysin-2 (NEP2), a NEP-like endopeptidase which cooperates with NEP to control Aβ levels in the brain. The evidence for the involvement of NEP2 in AD is discussed as well as the therapeutic relevance with regards to gene therapy and the development of molecular markers for the disease.
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Affiliation(s)
- Robert A Marr
- Department of Neuroscience, Rosalind Franklin University of Medicine and Science North Chicago, IL, USA
| | - Daniel M Hafez
- Department of Neuroscience, Rosalind Franklin University of Medicine and Science North Chicago, IL, USA
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31
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Imtiaz B, Tolppanen AM, Kivipelto M, Soininen H. Future directions in Alzheimer's disease from risk factors to prevention. Biochem Pharmacol 2014; 88:661-70. [PMID: 24418410 DOI: 10.1016/j.bcp.2014.01.003] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/30/2013] [Accepted: 01/03/2014] [Indexed: 12/21/2022]
Abstract
The increase in life expectancy has resulted in a high occurrence of dementia and Alzheimer's disease (AD). Research on AD has undergone a paradigm shift from viewing it as a disease of old age to taking a life course perspective. Several vascular, lifestyle, psychological and genetic risk factors influencing this latent period have been recognized and they may act both independently and by potentiating each other. These risk factors have consequently been used to derive risk scores for predicting the likelihood of dementia. Despite population differences, age, low education and vascular risk factors were identified as key factors in all scoring systems. Risk scores can help to identify high-risk individuals who might benefit from different interventions. The European Dementia Prevention Initiative (EDPI), an international collaboration, encourages data sharing between different randomized controlled trials. At the moment, it includes three large ongoing European trials: Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), Prevention of Dementia by Intensive Vascular Care (preDIVA), and Multidomain Alzheimer Prevention study (MAPT). Recently EDPI has developed a "Healthy Aging through Internet Counseling in Elderly" (HATICE) program, which intends to manage modifiable risk factors in an aged population through an easily accessible Internet platform. Thus, the focus of dementia research has shifted from identification of potential risk factors to using this information for developing interventions to prevent or delay the onset of dementia as well as identifying special high-risk populations who could be targeted in intervention trials.
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Affiliation(s)
- Bushra Imtiaz
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Miia Kivipelto
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland; Aging Research Center (ARC), Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - Hilkka Soininen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland; Neurocenter Neurology, Kuopio University Hospital, Kuopio, Finland.
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Blázquez E, Velázquez E, Hurtado-Carneiro V, Ruiz-Albusac JM. Insulin in the brain: its pathophysiological implications for States related with central insulin resistance, type 2 diabetes and Alzheimer's disease. Front Endocrinol (Lausanne) 2014; 5:161. [PMID: 25346723 PMCID: PMC4191295 DOI: 10.3389/fendo.2014.00161] [Citation(s) in RCA: 304] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/21/2014] [Indexed: 12/21/2022] Open
Abstract
Although the brain has been considered an insulin-insensitive organ, recent reports on the location of insulin and its receptors in the brain have introduced new ways of considering this hormone responsible for several functions. The origin of insulin in the brain has been explained from peripheral or central sources, or both. Regardless of whether insulin is of peripheral origin or produced in the brain, this hormone may act through its own receptors present in the brain. The molecular events through which insulin functions in the brain are the same as those operating in the periphery. However, certain insulin actions are different in the central nervous system, such as hormone-induced glucose uptake due to a low insulin-sensitive GLUT-4 activity, and because of the predominant presence of GLUT-1 and GLUT-3. In addition, insulin in the brain contributes to the control of nutrient homeostasis, reproduction, cognition, and memory, as well as to neurotrophic, neuromodulatory, and neuroprotective effects. Alterations of these functional activities may contribute to the manifestation of several clinical entities, such as central insulin resistance, type 2 diabetes mellitus (T2DM), and Alzheimer's disease (AD). A close association between T2DM and AD has been reported, to the extent that AD is twice more frequent in diabetic patients, and some authors have proposed the name "type 3 diabetes" for this association. There are links between AD and T2DM through mitochondrial alterations and oxidative stress, altered energy and glucose metabolism, cholesterol modifications, dysfunctional protein O-GlcNAcylation, formation of amyloid plaques, altered Aβ metabolism, and tau hyperphosphorylation. Advances in the knowledge of preclinical AD and T2DM may be a major stimulus for the development of treatment for preventing the pathogenic events of these disorders, mainly those focused on reducing brain insulin resistance, which is seems to be a common ground for both pathological entities.
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Affiliation(s)
- Enrique Blázquez
- Departamento de Bioquímica y Biología Molecular III, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- The Center for Biomedical Research in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSSC), Madrid, Spain
- *Correspondence: Enrique Blázquez, Departamento de Bioquímica y Biología Molecular III, Facultad de Medicina, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, Madrid 28040, Spain e-mail:
| | - Esther Velázquez
- Departamento de Bioquímica y Biología Molecular III, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- The Center for Biomedical Research in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSSC), Madrid, Spain
| | - Verónica Hurtado-Carneiro
- Departamento de Bioquímica y Biología Molecular III, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- The Center for Biomedical Research in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSSC), Madrid, Spain
| | - Juan Miguel Ruiz-Albusac
- Departamento de Bioquímica y Biología Molecular III, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- The Center for Biomedical Research in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdiSSC), Madrid, Spain
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Cholerton B, Baker LD, Craft S. Insulin, cognition, and dementia. Eur J Pharmacol 2013; 719:170-179. [PMID: 24070815 DOI: 10.1016/j.ejphar.2013.08.008] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 08/21/2013] [Accepted: 08/26/2013] [Indexed: 01/21/2023]
Abstract
Cognitive disorders of aging represent a serious threat to the social and economic welfare of current society. It is now widely recognized that pathology related to such conditions, particularly Alzheimer's disease, likely begins years or decades prior to the onset of clinical dementia symptoms. This revelation has led researchers to consider candidate mechanisms precipitating the cascade of neuropathological events that eventually lead to clinical Alzheimer's disease. Insulin, a hormone with potent effects in the brain, has recently received a great deal of attention for its potential beneficial and protective role in cognitive function. Insulin resistance, which refers to the reduced sensitivity of target tissues to the favorable effects of insulin, is related to multiple chronic conditions known to impact cognition and increase dementia risk. With insulin resistance-associated conditions reaching epidemic proportions, the prevalence of Alzheimer's disease and other cognitive disorders will continue to rise exponentially. Fortunately, these chronic insulin-related conditions are amenable to pharmacological intervention. As a result, novel therapeutic strategies that focus on increasing insulin sensitivity in the brain may be an important target for protecting or treating cognitive decline. The following review will highlight our current understanding of the role of insulin in brain, potential mechanisms underlying the link between insulin resistance and dementia, and current experimental therapeutic strategies aimed at improving cognitive function via modifying the brain's insulin sensitivity.
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Affiliation(s)
- Brenna Cholerton
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, USA; Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Laura D Baker
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, Winston-Salem, NC 27157-1207, USA
| | - Suzanne Craft
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, Winston-Salem, NC 27157-1207, USA.
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Tolppanen AM, Taipale H, Koponen M, Lavikainen P, Tanskanen A, Tiihonen J, Hartikainen S. Use of existing data sources in clinical epidemiology: Finnish health care registers in Alzheimer's disease research - the Medication use among persons with Alzheimer's disease (MEDALZ-2005) study. Clin Epidemiol 2013; 5:277-85. [PMID: 23950660 PMCID: PMC3741080 DOI: 10.2147/clep.s46622] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Memory diseases are the most important determinant of health care service use and quality of life among older individuals. Adverse effects of medication are common among older people, but this age group is underrepresented in clinical trials. Finnish statutory health care and prescription registers, together with personal identification numbers (PINs) and a tax-supported public health plan covering all citizens provide excellent opportunities for epidemiological research. We used routinely collected data from the Finnish health care system to establish the Medication use among persons with Alzheimer’s disease (MedAlz-2005) cohort. This cohort study will be used to assess medication use and its effects on health status and hospitalization among persons with Alzheimer’s disease (Ad). The cohort includes all community-dwelling persons who had a clinically verified diagnosis of Ad, resided in Finland, and were alive on December 31, 2005 and a matched comparison person for each affected individual. data on purchased prescription medicines (1995–2009), inpatient hospital admissions (1972–2009), outpatient visits (1995–2009), details on diagnosed cancers (1972–2009), and mortality (until October 2010) are available for the whole cohort. This paper describes how this data can be utilized in etiological research and the assessment of health care service use, drug utilization, and associated adverse outcomes in a particularly vulnerable group that is often underrepresented in clinical trials.
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Affiliation(s)
- Anna-Maija Tolppanen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
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