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Wang L, Yang R, Sha Z, Kuraszkiewicz AM, Leonik C, Zhou L, Marshall GA. Assessing Risk Factors for Cognitive Decline Using Electronic Health Record Data: A Scoping Review. RESEARCH SQUARE 2024:rs.3.rs-4671544. [PMID: 39149490 PMCID: PMC11326370 DOI: 10.21203/rs.3.rs-4671544/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Background : The data and information contained within electronic health records (EHR) provide a rich, diverse, longitudinal view of real-world patient histories, offering valuable opportunities to study antecedent risk factors for cognitive decline. However, the extent to which such records' data have been utilized to elucidate the risk factors of cognitive decline remains unclear. Methods : A scoping review was conducted following the PRISMA guideline, examining articles published between January 2010 and April 2023, from PubMed, Web of Science, and CINAHL. Inclusion criteria focused on studies using EHR to investigate risk factors for cognitive decline. Each article was screened by at least two reviewers. Data elements were manually extracted based on a predefined schema. The studied risk factors were classified into categories, and a research gap was identified. Results : From 1,593 articles identified, 80 were selected. The majority (87.5%) were retrospective cohort studies, with 66.3% using datasets of over 10,000 patients, predominantly from the US or UK. Analysis showed that 48.8% of studies addressed medical conditions, 31.3% focused on medical interventions, and 17.5% on lifestyle, socioeconomic status, and environmental factors. Most studies on medical conditions were linked to an increased risk of cognitive decline, whereas medical interventions addressing these conditions often reduced the risk. Conclusions : EHR data significantly enhanced our understanding of medical conditions, interventions, lifestyle, socioeconomic status, and environmental factors related to the risk of cognitive decline.
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Augustine-Wofford K, Connaughton VP, McCarthy E. Are Hyperglycemia-Induced Changes in the Retina Associated with Diabetes-Correlated Changes in the Brain? A Review from Zebrafish and Rodent Type 2 Diabetes Models. BIOLOGY 2024; 13:477. [PMID: 39056672 PMCID: PMC11273949 DOI: 10.3390/biology13070477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
Diabetes is prevalent worldwide, with >90% of the cases identified as Type 2 diabetes. High blood sugar (hyperglycemia) is the hallmark symptom of diabetes, with prolonged and uncontrolled levels contributing to subsequent complications. Animal models have been used to study these complications, which include retinopathy, nephropathy, and peripheral neuropathy. More recent studies have focused on cognitive behaviors due to the increased risk of dementia/cognitive deficits that are reported to occur in older Type 2 diabetic patients. In this review, we collate the data reported from specific animal models (i.e., mouse, rat, zebrafish) that have been examined for changes in both retina/vision (retinopathy) and brain/cognition, including db/db mice, Goto-Kakizaki rats, Zucker Diabetic Fatty rats, high-fat diet-fed rodents and zebrafish, and hyperglycemic zebrafish induced by glucose immersion. These models were selected because rodents are widely recognized as established models for studying diabetic complications, while zebrafish represent a newer model in this field. Our goal is to (1) summarize the published findings relevant to these models, (2) identify similarities in cellular mechanisms underlying the disease progression that occur in both tissues, and (3) address the hypothesis that hyperglycemic-induced changes in retina precede or predict later complications in brain.
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Affiliation(s)
| | - Victoria P. Connaughton
- Department of Biology, American University, Washington, DC 20016, USA; (K.A.-W.); (E.M.)
- Center for Neuroscience and Behavior, American University, Washington, DC 20016, USA
| | - Elizabeth McCarthy
- Department of Biology, American University, Washington, DC 20016, USA; (K.A.-W.); (E.M.)
- Center for Neuroscience and Behavior, American University, Washington, DC 20016, USA
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Aderinto N, Olatunji G, Kokori E, Fawehinmi P, Moradeyo A, Igwe S, Ojabo R, Alabi BO, Okafor EC, Ologbe D, Olafimihan A, Olawade DB. Metformin mitigates dementia risk among individuals with type 2 diabetes. Clin Diabetes Endocrinol 2024; 10:10. [PMID: 38725077 PMCID: PMC11084076 DOI: 10.1186/s40842-024-00168-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 05/12/2024] Open
Abstract
This mini-narrative review explores the relationship between diabetes and dementia, focusing on the potential mitigating role of metformin in reducing cognitive decline among individuals with type 2 diabetes. The interplay of factors such as glycemic control, diabetic complications, and lifestyle influences characterises diabetes-related dementia. This review emphasises the significance of comprehensive diabetes management in addressing the heightened risk of dementia in this population. Methodologically, the review synthesises evidence from 23 studies retrieved through searches on PubMed, Embase, Google Scholar, and Scopus. Current evidence suggests a predominantly positive association between metformin use and a reduced risk of dementia in individuals with diabetes. However, the review shows the complex nature of these outcomes, revealing variations in results in some studies. These discrepancies show the importance of exploring dose-response relationships, long-term effects, and demographic diversity to unravel the complexities of metformin's impact on cognitive health. Limitations in the existing body of research, including methodological disparities and confounding variables, necessitate refined approaches in future studies. Large-scale prospective longitudinal studies and randomised controlled trials focusing specifically on cognitive effects are recommended. Propensity score matching and exploration of molecular mechanisms can enhance the validity of findings in clinical practice. From a clinical perspective, metformin can serve as a potential adjunctive therapy for individuals with diabetes at risk of cognitive decline.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Praise Fawehinmi
- Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | - Abdulrahmon Moradeyo
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Stephen Igwe
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | | | | | | | | | | | - David B Olawade
- Department of Allied and Public Health, School of Health, Sport and Bioscience, University of East London, London, UK
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4
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Ouyang F, Yuan P, Ju Y, Chen W, Peng Z, Xu H. Alzheimer's disease as a causal risk factor for diabetic retinopathy: a Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1340608. [PMID: 38699385 PMCID: PMC11064697 DOI: 10.3389/fendo.2024.1340608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives This study aims to investigate the causal relationship between Alzheimer's Disease (AD) and Diabetic Retinopathy (DR). Methods Employing Mendelian Randomization (MR), Generalized Summary-data-based Mendelian Randomization (GSMR), and the MR-Steiger test, this study scrutinizes the genetic underpinnings of the hypothesized causal association between AD and DR, as well as its Proliferative DR (PDR) and Non-Proliferative DR (NPDR) subtypes. Comprehensive data from Genome-Wide Association Studies (GWAS) were analyzed, specifically AD data from the Psychiatric Genomics Consortium (71,880 cases/383,378 controls), and DR, PDR, and NPDR data from both the FinnGen consortium (FinnGen release R8, DR: 5,988 cases/314,042 controls; PDR: 8,383 cases/329,756 controls; NPDR: 3,446 cases/314,042 controls) and the IEU OpenGWAS (DR: 14,584 cases/176,010 controls; PDR: 8,681 cases/204,208 controls; NPDR: 2,026 cases/204,208 controls). The study also incorporated Functional Mapping and Annotation (FUMA) for an in-depth analysis of the GWAS results. Results The MR analyses revealed that genetic susceptibility to AD significantly increases the risk of DR, as evidenced by GWAS data from the FinnGen consortium (OR: 2.5090; 95% confidence interval (CI):1.2102-5.2018, false discovery rate P-value (PFDR)=0.0201; GSMR: bxy=0.8936, bxy_se=0.3759, P=0.0174), NPDR (OR: 2.7455; 95% CI: 1.3178-5.7197, PFDR=0.0166; GSMR: bxy=0.9682, bxy_se=0.3802, P=0.0126), and PDR (OR: 2.3098; 95% CI: 1.2411-4.2986, PFDR=0.0164; GSMR: bxy=0.7962, bxy_se=0.3205, P=0.0129) using DR GWAS from FinnGen consortium. These results were corroborated by DR GWAS datasets from IEU OpenGWAS. The MR-Steiger test confirmed a significant association of all identified instrumental variables (IVs) with AD. While a potential causal effect of DR and its subtypes on AD was identified, the robustness of these results was constrained by a low power value. FUMA analysis identified OARD1, NFYA, TREM1 as shared risk genes between DR and AD, suggesting a potential genetic overlap between these complex diseases. Discussion This study underscores the contribution of AD to an increased risk of DR, as well as NPDR and PDR subtypes, underscoring the necessity of a holistic approach in the management of patients affected by these conditions.
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Affiliation(s)
- Fu Ouyang
- Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Ping Yuan
- Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yaxin Ju
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Chen
- Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zijun Peng
- Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Hongbei Xu
- Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
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Ciudin A, Hernández C, Simó-Servat O, Simó R. The usefulness of the retina for identifying people with type 2 diabetes with prodromal stages of dementia. Neurosci Biobehav Rev 2024; 159:105592. [PMID: 38365136 DOI: 10.1016/j.neubiorev.2024.105592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
Type 2 diabetes (T2D) is associated with cognitive impairment and dementia. The detection of cognitive impairment is important because this population is at higher risk of experiencing difficulties in the self-management of diabetes. Mild cognitive impairment (MCI) often remains undiagnosed due to lack of simple tools for screening at large scale. This represents an important gap in the patients' management because subjects with diabetes and MCI are at high risk of progressing to dementia. Due to its developmental origin as a brain-derived tissue, the retina has been proposed as a potential means of non-invasive and readily accessible exploration of brain pathology. Recent evidence showed that retinal imaging and/or functional tests are correlated with the cognitive function and brain changes in T2D. Simple retinal functional tests (i.e. retinal microperimetry) have proven to be useful as reliable tool for the cognitive evaluation and monitoring in patients with T2D>65 years. This review gives an overall update on the usefulness of retinal imaging in identifying patients with T2D at risk of developing dementia.
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Affiliation(s)
- Andreea Ciudin
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Endocrinology Department, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; CIBERDEM (Instituto de Salud Carlos III), Madrid 28029, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Endocrinology Department, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; CIBERDEM (Instituto de Salud Carlos III), Madrid 28029, Spain
| | - Olga Simó-Servat
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Endocrinology Department, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; CIBERDEM (Instituto de Salud Carlos III), Madrid 28029, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Endocrinology Department, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; CIBERDEM (Instituto de Salud Carlos III), Madrid 28029, Spain.
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Popovic N, Ždralević M, Vujosevic S, Radunović M, Adžić Zečević A, Rovčanin Dragović I, Vukčević B, Popovic T, Radulović L, Vuković T, Eraković J, Lazović R, Radunović M. Retinal microvascular complexity as a putative biomarker of biological age: a pilot study. Biogerontology 2023; 24:971-985. [PMID: 37572202 DOI: 10.1007/s10522-023-10057-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
Physiological changes associated with aging increase the risk for the development of age-related diseases. This increase is non-specific to the type of age-related disease, although each disease develops through a unique pathophysiologic mechanism. People who age at a faster rate develop age-related diseases earlier in their life. They have an older "biological age" compared to their "chronological age". Early detection of individuals with accelerated aging would allow timely intervention to postpone the onset of age-related diseases. This would increase their life expectancy and their length of good quality life. The goal of this study was to investigate whether retinal microvascular complexity could be used as a biomarker of biological age. Retinal images of 68 participants ages ranging from 19 to 82 years were collected in an observational cross-sectional study. Twenty of the old participants had age-related diseases such as hypertension, type 2 diabetes, and/or Alzheimer's dementia. The rest of the participants were healthy. Retinal images were captured by a hand-held, non-mydriatic fundus camera and quantification of the microvascular complexity was performed by using Sholl's, box-counting fractal, and lacunarity analysis. In the healthy subjects, increasing chronological age was associated with lower retinal microvascular complexity measured by Sholl's analysis. Decreased box-counting fractal dimension was present in old patients, and this decrease was 2.1 times faster in participants who had age-related diseases (p = 0.047). Retinal microvascular complexity could be a promising new biomarker of biological age. The data from this study is the first of this kind collected in Montenegro. It is freely available for use.
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Affiliation(s)
- Natasa Popovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro.
| | - Maša Ždralević
- Institute for Advanced Studies, University of Montenegro, Podgorica, Montenegro
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | | | - Antoaneta Adžić Zečević
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
- Clinical Center of Montenegro, Podgorica, Montenegro
| | | | | | - Tomo Popovic
- Faculty for Information Systems and Technologies, University of Donja Gorica, Podgorica, Montenegro
| | - Ljiljana Radulović
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
- Clinical Center of Montenegro, Podgorica, Montenegro
| | | | | | - Ranko Lazović
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
- Clinical Center of Montenegro, Podgorica, Montenegro
| | - Miodrag Radunović
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
- Clinical Center of Montenegro, Podgorica, Montenegro
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7
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García-Bermúdez MY, Vohra R, Freude K, van Wijngaarden P, Martin K, Thomsen MS, Aldana BI, Kolko M. Potential Retinal Biomarkers in Alzheimer's Disease. Int J Mol Sci 2023; 24:15834. [PMID: 37958816 PMCID: PMC10649108 DOI: 10.3390/ijms242115834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Alzheimer's disease (AD) represents a major diagnostic challenge, as early detection is crucial for effective intervention. This review examines the diagnostic challenges facing current AD evaluations and explores the emerging field of retinal alterations as early indicators. Recognizing the potential of the retina as a noninvasive window to the brain, we emphasize the importance of identifying retinal biomarkers in the early stages of AD. However, the examination of AD is not without its challenges, as the similarities shared with other retinal diseases introduce complexity in the search for AD-specific markers. In this review, we address the relevance of using the retina for the early diagnosis of AD and the complex challenges associated with the search for AD-specific retinal biomarkers. We provide a comprehensive overview of the current landscape and highlight avenues for progress in AD diagnosis by retinal examination.
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Affiliation(s)
| | - Rupali Vohra
- Eye Translational Research Unit, Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, 2600 Glostrup, Denmark
| | - Kristine Freude
- Group of Stem Cell Models and Embryology, Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark
| | - Peter van Wijngaarden
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Keith Martin
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Maj Schneider Thomsen
- Neurobiology Research and Drug Delivery, Department of Health, Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Blanca Irene Aldana
- Neurometabolism Research Group, Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Miriam Kolko
- Eye Translational Research Unit, Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, 2600 Glostrup, Denmark
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Xu Y, Phu J, Aung HL, Hesam-Shariati N, Keay L, Tully PJ, Booth A, Anderson CS, Anstey KJ, Peters R. Frequency of coexistent eye diseases and cognitive impairment or dementia: a systematic review and meta-analysis. Eye (Lond) 2023; 37:3128-3136. [PMID: 36922645 PMCID: PMC10564749 DOI: 10.1038/s41433-023-02481-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE We aim to quantify the co-existence of age-related macular degeneration (AMD), glaucoma, or diabetic retinopathy (DR) and cognitive impairment or dementia. METHOD MEDLINE, EMBASE, PsycINFO and CINAHL were searched (to June 2020). Observational studies reporting incidence or prevalence of AMD, glaucoma, or DR in people with cognitive impairment or dementia, and of cognitive impairment or dementia among people with AMD, glaucoma, or DR were included. RESULTS Fifty-six studies (57 reports) were included but marked by heterogeneities in the diagnostic criteria or definitions of the diseases, study design, and case mix. Few studies reported on the incidence. Evidence was sparse but consistent in individuals with mild cognitive impairment where 7.7% glaucoma prevalence was observed. Prevalence of AMD and DR among people with cognitive impairment ranged from 3.9% to 9.4% and from 11.4% to 70.1%, respectively. Prevalence of AMD and glaucoma among people with dementia ranged from 1.4 to 53% and from 0.2% to 25.9%, respectively. Prevalence of DR among people with dementia was 11%. Prevalence of cognitive impairment in people with AMD, glaucoma, and DR ranged from 8.4% to 52.4%, 12.3% to 90.2%, and 3.9% to 77.8%, respectively, and prevalence of dementia in people with AMD, glaucoma and DR ranged from 9.9% to 62.6%, 2.5% to 3.3% and was 12.5%, respectively. CONCLUSIONS Frequency of comorbid eye disease and cognitive impairment or dementia varied considerably. While more population-based estimations of the co-existence are needed, interdisciplinary collaboration might be helpful in the management of these conditions to meet healthcare needs of an ageing population. TRIAL REGISTRATION PROSPERO registration: CRD42020189484.
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Affiliation(s)
- Ying Xu
- Neuroscience Research Australia, Sydney, NSW, Australia.
- School of Psychology, Faculty of Science, UNSW, Sydney, NSW, Australia.
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia.
- Faculty of Medicine, UNSW, Sydney, NSW, Australia.
- Ageing Futures Institute, UNSW, Sydney, NSW, Australia.
| | - Jack Phu
- Centre for Eye Health, UNSW, Sydney, NSW, Australia
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Concord Clinical School, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Htein Linn Aung
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Negin Hesam-Shariati
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, UNSW, Sydney, NSW, Australia
| | - Lisa Keay
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
- Ageing Futures Institute, UNSW, Sydney, NSW, Australia
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Phillip J Tully
- School of Psychology, The University of New England, Armidale, NSW, Australia
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, UNSW, Sydney, NSW, Australia
- The George Institute for Global Health, Beijing, P.R. China
- Neurology Department, Royal Prince Alfred Hospital, Sydney Local Area Health District, Sydney, NSW, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, UNSW, Sydney, NSW, Australia
- Ageing Futures Institute, UNSW, Sydney, NSW, Australia
| | - Ruth Peters
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, UNSW, Sydney, NSW, Australia
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
- Faculty of Medicine, UNSW, Sydney, NSW, Australia
- Ageing Futures Institute, UNSW, Sydney, NSW, Australia
- School of Public Health, Imperial College London, London, UK
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9
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Lee CS, Krakauer C, Su YR, Walker RL, Blazes M, McCurry SM, Bowen JD, McCormick WC, Lee AY, Boyko EJ, O'Hare AM, Larson EB, Crane PK. Diabetic Retinopathy and Dementia Association, Beyond Diabetes Severity. Am J Ophthalmol 2023; 249:90-98. [PMID: 36513155 PMCID: PMC10106379 DOI: 10.1016/j.ajo.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate whether associations between diabetic retinopathy (DR) and dementia and Alzheimer's disease (AD) remain significant after controlling for several measures of diabetes severity. DESIGN Retrospective cohort study. METHODS Adult Changes in Thought (ACT) is a prospective cohort study of adults aged ≥65 years, randomly selected and recruited from the membership rolls of Kaiser Permanente Washington, who are dementia free at enrollment and followed biennially until incident dementia. The ACT participants were included in this study if they had type 2 diabetes mellitus at enrollment or developed it during follow-up, and data were collected through September, 2018 (3516 person-years of follow-up). Diabetes was defined by ≥ 2 diabetes medication fills in 1 year. Diagnosis of DR was based on International Classification of Diseases Ninth and Tenth Revision codes. Estimates of microalbuminuria, long-term glycemia, and renal function from longitudinal laboratory records were used as indicators of diabetes severity. Alzheimer's disease and dementia were diagnosed using research criteria at expert consensus meetings. RESULTS A total of 536 participants (median baseline age 75 [interquartile range 71-80], 54% women) met inclusion criteria. Significant associations between DR >5 years duration with dementia (hazard ratio 1.81 [95% CI 1.23, 2.65]) and AD (1.80 [1.15, 2.82]) were not altered by adjustment for estimates of microalbuminuria, long-term glycemia, and renal function (dementia: 1.69 [1.14, 2.50]; AD: 1.73 [1.10, 2.74]). CONCLUSIONS Among people with type 2 diabetes, DR itself appears to be an important biomarker of dementia risk in addition to glycemia and renal complications.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.); Roger and Angie Karalis Johnson Retina Center, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.).
| | - Chloe Krakauer
- Department of Biostatistics, University of Washington, Seattle, Washington, USA (C.K.); Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA (C.K., Y-R.S., R.L.W., E.B.L.)
| | - Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA (C.K., Y-R.S., R.L.W., E.B.L.)
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA (C.K., Y-R.S., R.L.W., E.B.L.)
| | - Marian Blazes
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.); Roger and Angie Karalis Johnson Retina Center, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.)
| | - Susan M McCurry
- School of Nursing, University of Washington, Seattle, Washington, USA (S.M.M.)
| | - James D Bowen
- Department of Neurology, Swedish Medical Center, Seattle, Washington, USA (J.D.B.)
| | - Wayne C McCormick
- Department of Medicine, University of Washington, Seattle, Washington, USA (W.C.M., E.J.B, E.B.L., P.K.C.)
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.); Roger and Angie Karalis Johnson Retina Center, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.)
| | - Edward J Boyko
- Department of Medicine, University of Washington, Seattle, Washington, USA (W.C.M., E.J.B, E.B.L., P.K.C.); Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA (E.J.B., A.M.O)
| | - Ann M O'Hare
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA (E.J.B., A.M.O)
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA (C.K., Y-R.S., R.L.W., E.B.L.); Department of Medicine, University of Washington, Seattle, Washington, USA (W.C.M., E.J.B, E.B.L., P.K.C.)
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA (W.C.M., E.J.B, E.B.L., P.K.C.)
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Zhou C, Dong C, Xie Z, Hao W, Fu C, Sun H, Zhu D. Sex-specific associations between diabetes and dementia: the role of age at onset of disease, insulin use and complications. Biol Sex Differ 2023; 14:9. [PMID: 36804018 PMCID: PMC9940390 DOI: 10.1186/s13293-023-00491-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Whether the association of type 2 diabetes (T2DM) with dementia was differed by sex remains unclear, and the roles of age at onset of disease, insulin use and diabetes' complications in their association are unknown. METHODS This study analyzed data of 447 931 participants from the UK Biobank. We used Cox proportional hazards models to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CI), and women-to-men ratio of HRs (RHR) for the association between T2DM and incident dementia [all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD)]. The roles of age at onset of disease, insulin use and diabetes' complications in their association were also analyzed. RESULTS Compared to people with no diabetes at all, people with T2DM had increased risk of all-cause dementia (HR 2.85, 95% CI 2.56-3.17). The HRs between T2DM and AD were higher in women than men, with an RHR (95%CI) of 1.56 (1.20, 2.02). There was a trend that people who experienced T2DM before age 55 had higher risk of VD than those who had T2DM after age 55. In addition, there was a trend that T2DM had higher effect on VD that occurred before age 75 years than events that occurred after age 75. Patients with T2DM using insulin had higher risk of all-cause dementia than those without insulin, with an RHR (95%CI) of 1.54 (1.00-2.37). People with complications had doubled risk of all-cause dementia, AD and VD. CONCLUSIONS Adopting a sex-sensitive strategy to address the risk of dementia in patients with T2DM is instrumental for a precision medicine approach. Meanwhile, it is warranted to consider patients' age at onset of T2DM, insulin use status and complications conditions.
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Affiliation(s)
- Chunmiao Zhou
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Caiyun Dong
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Ziwei Xie
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Wenting Hao
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, , Cheeloo College of Medicine, Shandong University, Jinan, 250012 China ,grid.27255.370000 0004 1761 1174NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012 China
| | - Chunying Fu
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Huizi Sun
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Dongshan Zhu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
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de Almeida Faria ACR, Dall'Agnol JF, Gouveia AM, De Paiva CI, Segalla VC, Ogata FE, Baena CP. Cognitive Performance and Diabetic Retinopathy: What Your Eyes Can Reveal About Your Brain. Curr Diabetes Rev 2023; 19:e050822207323. [PMID: 35929625 PMCID: PMC10617788 DOI: 10.2174/1573399819666220805154638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR) is a chronic diabetes complication. People with Type 2 Diabetes Mellitus (T2DM) have two times the risk for dementia, suggesting it is a new chronic diabetes complication. OBJECTIVE Evaluate the association of DR with cognitive performance in a T2DM population. METHODS Cross-sectional study with 400 T2DM adults from whom socio-demographic, clinical, laboratory data were collected, and screening test for depression symptoms (Patient Health Questionaire- 9 (PHQ-9)), Mini-Mental State Examination (MMSE), Semantic Verbal Fluency Test, Trail Making Test A and B, Word Memory test were performed. All cognitive test scores were converted into Global Cognition z-Score (GCS(z)). The association between GCS(z) < 0 with DR was performed using a multivariate binary logistic regression model adjusted for age ≥ 65 years, school years ≤ 6 years, DM duration ≥ 10 years, depression symptoms score > 9 at PHQ-9, arterial hypertension, physical activity, diabetic retinopathy, macular edema, and cardiovascular disease. RESULTS After exclusions, the 251 eligible patients were 56.6% female, with a mean age of 61.1 (±9.8) years, DM duration of 12.6 (±8.9) years, and 7.6 (±4.2) years of school education. DR prevalence was 46.5%. Multivariate Logistic Regression Model showed an association between DR and GCS(z) < 0, with odds ratio (CI95%) of 2.50 (1.18-5.34), adjusted for age, low education level, arterial hypertension and depression symptoms (OD and CI95% respectively: 5.46(2.42-12.34); 12.19 (5.62-26.46); 2.55 (0.88-7.39); 3.53 (1.55-8.07)). CONCLUSION In this T2DM population, having DR increased the chance for worse cognitive performance even when adjusted for age, low education level, presence of arterial hypertension, and depression symptoms.
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Affiliation(s)
- Ana Cristina Ravazzani de Almeida Faria
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Paraná, (PUCPR), Curitiba, Paraná, Brazil
- Department of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Joceline Franco Dall'Agnol
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Paraná, (PUCPR), Curitiba, Paraná, Brazil
| | - Aline Maciel Gouveia
- Department of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Clara Inácio De Paiva
- Department of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Paraná, Brazil
| | | | | | - Cristina Pellegrino Baena
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Paraná, (PUCPR), Curitiba, Paraná, Brazil
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12
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Ciudin A, Simó R. New methods for the diagnosis and monitoring of cognitive function in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2022; 13:1024794. [PMID: 36531450 PMCID: PMC9751391 DOI: 10.3389/fendo.2022.1024794] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/04/2022] [Indexed: 12/02/2022] Open
Abstract
The presence of type 2 diabetes acts as an accelerator of cognitive impairment (mild cognitive impairment and later dementia), with a significant impact on the management of the disease and its complications. Therefore, it is recommended to perform an annual evaluation of cognitive function in patients with diabetes older than 65 years. Current guidelines still recommend the use of the Minimental State Evaluation Test (MMSE) as screening test, but it has a modest sensitivity and specificity for identifying mild cognitive impairment. This represents an important gap because patients with mild cognitive impairment are at risk of progressing to dementia. The neurocognitive diagnosis is based on complex neuropsychological tests, which require specifically trained personnel and are time consuming, making its routine incorporation into daily clinical practice unfeasible. Therefore, at present there are no reliable biomarkers to identify patients with type 2 diabetes at increased risk of developing cognitive impairment. Since the brain and the retina have a common embryological origin, our Research Group, has worked over the last 10 years evaluating the usefulness of the retina as a "window" to the brain. We provided evidence that retinal microperimetry is a simple, feasible and useful tool for screening and monitoring cognitive function in patients with type 2 diabetes. We propose a review of actual tests recommended for screening of cognitive impairment as well as an update of new emerging methods, such as retinal microperimetry.
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Affiliation(s)
- Andreea Ciudin
- Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Universitat Autónoma de Barcelona, Department of Human Physiology and Inmunology, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDem), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDem), Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autónoma de Barcelona, Department of Medicine, Barcelona, Spain
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13
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Rowe CJ, Delbridge-Perry M, Bonan NF, Cohen A, Bentley M, DeCicco-Skinner KL, Davidson T, Connaughton VP. Time dependent effects of prolonged hyperglycemia in zebrafish brain and retina. FRONTIERS IN OPHTHALMOLOGY 2022; 2:947571. [PMID: 38983568 PMCID: PMC11182107 DOI: 10.3389/fopht.2022.947571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/29/2022] [Indexed: 07/11/2024]
Abstract
Prolonged hyperglycemia causes long-term vision complications and an increased risk of cognitive deficits. High blood sugar also confers an osmotic load/stress to cells. We assessed behavioral and neurochemical changes in zebrafish brain and retina following prolonged hyperglycemia for 4-weeks or 8-weeks. At each time point, behavior was assessed using 3-chamber choice task and optomotor response; tissue was then collected and levels of inflammatory markers, tight junction proteins, and neurotransmitters determined using Western Blots. After 4-weeks, brain levels of v-rel reticuloendotheliosis viral oncogene homolog A (avian) (RelA; NF-kB subunit), IkB kinase (IKK), and glial fibrillary acidic protein (GFAP) were significantly elevated; differences in zonula occludens-1 (ZO-1), claudin-5, glutamic acid decarboxylase (GAD), and tyrosine hydroxylase (TH) were not significant. In retina, significant differences were observed only for TH (decreased), Rel A (increased), and GFAP (increased) levels. Glucose-specific differences in initial choice latency and discrimination ratios were also observed. After 8-weeks, RelA, GAD, and TH were significantly elevated in both tissues; IKK and GFAP levels were also elevated, though not significantly. ZO-1 and claudin-5 levels osmotically decreased in retina but displayed an increasing trend in glucose-treated brains. Differences in discrimination ratio were driven by osmotic load. OMRs increased in glucose-treated fish at both ages. In vivo analysis of retinal vasculature suggested thicker vessels after 4-weeks, but thinner vessels at 8-weeks. In vitro, glucose treatment reduced formation of nodes and meshes in 3B-11 endothelial cells, suggesting a reduced ability to form a vascular network. Overall, hyperglycemia triggered a strong inflammatory response causing initial trending changes in tight junction and neuronal markers. Most differences after 4-weeks of exposure were observed in glucose-treated fish suggesting effects on glucose metabolism independent of osmotic load. After 8-weeks, the inflammatory response remained and glucose-specific effects on neurotransmitter markers were observed. Osmotic differences impacted cognitive behavior and retinal protein levels; protein levels in brain displayed glucose-driven changes. Thus, we not only observed differential sensitivities of retina and brain to glucose-insult, but also different cellular responses, suggesting hyperglycemia causes complex effects at the cellular level and/or that zebrafish are able to compensate for the continued high blood glucose levels.
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Affiliation(s)
- Cassie J. Rowe
- Department of Biology, American University, Washington, DC, United States
- Center for Neuroscience and Behavior, American University, Washington, DC, United States
| | - Mikayla Delbridge-Perry
- Department of Biology, American University, Washington, DC, United States
- Department of Chemistry, American University, Washington, DC, United States
| | - Nicole F. Bonan
- Department of Biology, American University, Washington, DC, United States
| | - Annastelle Cohen
- Department of Biology, American University, Washington, DC, United States
| | - Meg Bentley
- Department of Biology, American University, Washington, DC, United States
| | - Kathleen L. DeCicco-Skinner
- Department of Biology, American University, Washington, DC, United States
- Center for Neuroscience and Behavior, American University, Washington, DC, United States
| | - Terry Davidson
- Center for Neuroscience and Behavior, American University, Washington, DC, United States
- Department of Neuroscience, and American University, Washington, DC, United States
| | - Victoria P. Connaughton
- Department of Biology, American University, Washington, DC, United States
- Center for Neuroscience and Behavior, American University, Washington, DC, United States
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14
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Barrot J, Real J, Vlacho B, Romero-Aroca P, Simó R, Mauricio D, Mata-Cases M, Castelblanco E, Mundet-Tuduri X, Franch-Nadal J. Diabetic retinopathy as a predictor of cardiovascular morbidity and mortality in subjects with type 2 diabetes. Front Med (Lausanne) 2022; 9:945245. [PMID: 36052329 PMCID: PMC9424917 DOI: 10.3389/fmed.2022.945245] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022] Open
Abstract
This study aimed to evaluate the predictive value of diabetic retinopathy (DR) and its stages with the incidence of major cardiovascular events and all-cause mortality in type 2 diabetes mellitus (T2DM) persons in our large primary healthcare database from Catalonia (Spain). A retrospective cohort study with pseudo-anonymized routinely collected health data from SIDIAP was conducted from 2008 to 2016. We calculated incidence rates of major cardiovascular events [coronary heart disease (CHD), stroke, or both—macrovascular events] and all-cause mortality for subjects with and without DR and for different stages of DR. The proportional hazards regression analysis was done to assess the probability of occurrence between DR and the study events. About 22,402 T2DM subjects with DR were identified in the database and 196,983 subjects without DR. During the follow-up period among the subjects with DR, we observed the highest incidence of all-cause mortally. In the second place were the macrovascular events among the subjects with DR. In the multivariable analysis, fully adjusted for DR, sex, age, body mass index (BMI), tobacco, duration of T2DM, an antiplatelet or antihypertensive drug, and HbA1c, we observed that subjects with any stage of DR had higher risks for all of the study events, except for stroke. We observed the highest probability of all-cause death events (adjusted hazard ratios, AHRs: 1.34, 95% CI: 1.28; 1.41). In conclusion, our results show that DR is related to CHD, macrovascular events, and all-cause mortality among persons with T2DM.
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Affiliation(s)
- Joan Barrot
- Primary Health Care Center Dr. Jordi Nadal i Fàbregas (Salt), Gerència d’Atenció Primària, Institut Català de la Salut, Girona, Spain
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGOL), Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Real
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGOL), Barcelona, Spain
| | - Bogdan Vlacho
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- *Correspondence: Bogdan Vlacho,
| | - Pedro Romero-Aroca
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), University of Rovira and Virgili, Reus, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Department of Endocrinology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Didac Mauricio
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament of Medicine, University of Vic—Central University of Catalonia, Vic, Spain
| | - Manel Mata-Cases
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Centre d’Atenció Primària La Mina, Gerència d’Àmbit d’Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Esmeralda Castelblanco
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Division of Endocrinology, Metabolism and Lipid Research, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Xavier Mundet-Tuduri
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Xavier Mundet-Tuduri,
| | - Josep Franch-Nadal
- Diabetis des de l’Atenció Primária (DAP)-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGOL), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d’Àmbit d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
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15
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Chai YH, Zhang YP, Qiao YS, Gong HJ, Xu H, She HC, Patel I, Liu W, Stehouwer CDA, Zhou JB, Simó R. Association Between Diabetic Retinopathy, Brain Structural Abnormalities, and Cognitive Impairment for Accumulated Evidence in Observational Studies. Am J Ophthalmol 2022; 239:37-53. [PMID: 35063409 DOI: 10.1016/j.ajo.2022.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the association between diabetic retinopathy (DR) and cerebral disease or cognitive impairment. DESIGN Systematic review and meta-analysis. METHOD The hypothesis was formulated prior to data collection. Cross-sectional studies and cohort studies that assessed the association between any measure of DR and cerebral small vessel disease or any type of cognitive impairment in diabetic participants were included. The data were independently extracted by two investigators. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines RESULTS: A total of 27 studies were included. The combined odds ratio of 5 cross-sectional/cohort studies that reported that the associations between DR and cerebral structural changes was 1.75 (95% confidence interval [CI]: 1.36-2.25). The combined hazard ratio of 4 cohort studies that examined the association between DR and cognitive impairment events was 1.47 (95% CI: 1.22-1.78). The combined odds ratio of 14 cross-sectional/cohort studies that examined the association between DR and different cognitive impairment events was 1.43 (95% CI: 1.06-1.93). The overall coefficient (β) of 4 studies that examined the relationship between DR and specific cognitive performance was 0.09 (95% CI: 0.00-0.18). Considering the quality of the data, we have performed subgroup analysis in studies scored >7 and studies scored ≤7, respectively, according to the Newcastle-Ottawa scale. CONCLUSION The present meta-analysis suggests that DR is associated with an increased risk of structural abnormalities in the brain and cognitive impairment. This association remained significant after adjusting for blood glucose, and the presence of hypertension, indicating that DR is an important danger signal for cerebral abnormalities.
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Affiliation(s)
- Yin-He Chai
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yong-Peng Zhang
- Beijing Tongren Eye Center (Y.P.Z., H.C.S.), Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu-Shun Qiao
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hong-Jian Gong
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui Xu
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hai-Cheng She
- Beijing Tongren Eye Center (Y.P.Z., H.C.S.), Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ikramulhaq Patel
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Coen D A Stehouwer
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases (C.D.A.S.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jian-Bo Zhou
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Rafael Simó
- Department of Endocrinology and Nutrition (R.S.), Vall d'Hebron University Hospital, Autonomous University, Barcelona, Spain; Diabetes and Metabolism Research Unit (R.S.), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) (R.S.), Instituto de Salud Carlos III (ICSIII), Madrid, Spain
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16
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Diagnostic, Prognostic, and Mechanistic Biomarkers of Diabetes Mellitus-Associated Cognitive Decline. Int J Mol Sci 2022; 23:ijms23116144. [PMID: 35682821 PMCID: PMC9181591 DOI: 10.3390/ijms23116144] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023] Open
Abstract
Cognitive dysfunctions such as mild cognitive impairment (MCI), Alzheimer’s disease (AD), and other forms of dementia are recognized as common comorbidities of type 2 diabetes mellitus (T2DM). Currently, there are no disease-modifying therapies or definitive clinical diagnostic and prognostic tools for dementia, and the mechanisms underpinning the link between T2DM and cognitive dysfunction remain equivocal. Some of the suggested pathophysiological mechanisms underlying cognitive decline in diabetes patients include hyperglycemia, insulin resistance and altered insulin signaling, neuroinflammation, cerebral microvascular injury, and buildup of cerebral amyloid and tau proteins. Given the skyrocketing global rates of diabetes and neurodegenerative disorders, there is an urgent need to discover novel biomarkers relevant to the co-morbidity of both conditions to guide future diagnostic approaches. This review aims to provide a comprehensive background of the potential risk factors, the identified biomarkers of diabetes-related cognitive decrements, and the underlying processes of diabetes-associated cognitive dysfunction. Aging, poor glycemic control, hypoglycemia and hyperglycemic episodes, depression, and vascular complications are associated with increased risk of dementia. Conclusive research studies that have attempted to find specific biomarkers are limited. However, the most frequent considerations in such investigations are related to C reactive protein, tau protein, brain-derived neurotrophic factor, advanced glycation end products, glycosylated hemoglobin, and adipokines.
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17
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Mukherjee S, Ghosh S, Ghosh S. Association of midlife cognition impairment with diabetic retinopathy in type 2 diabetes mellitus in an Indian population. PRACTICAL DIABETES 2022. [DOI: 10.1002/pdi.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Yang Y, Zhao JJ, Yu XF. Expert Consensus on Cognitive Dysfunction in Diabetes. Curr Med Sci 2022; 42:286-303. [PMID: 35290601 DOI: 10.1007/s11596-022-2549-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/02/2022] [Indexed: 12/14/2022]
Abstract
The incidence of diabetes is gradually increasing in China, and diabetes and associated complications, such as cognitive dysfunction have gained much attention in recent time. However, the concepts, clinical treatment, and prevention of cognitive dysfunction in patients with diabetes remain unclear. The Chinese Society of Endocrinology investigated the current national and overseas situation of cognitive dysfunction associated with diabetes. Based on research both in China and other countries worldwide, the Expert Consensus on Cognitive Dysfunction in Diabetes was established to guide physicians in the comprehensive standardized management of cognitive dysfunction in diabetes and to improve clinical outcomes in Chinese patients. This consensus presents an overview, definition and classification, epidemiology and pathogenesis, risk factors, screening, diagnosis, differential diagnosis, treatment, and prevention of cognitive dysfunction in patients with diabetes.
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Affiliation(s)
- Yan Yang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jia-Jun Zhao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 25000, China.
| | - Xue-Feng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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19
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Wu M, Mei F, Hu K, Feng L, Wang Z, Gao Q, Chen F, Zhao L, Li X, Ma B. Diabetic retinopathy and cognitive dysfunction: a systematic review and meta-analysis. Acta Diabetol 2022; 59:443-459. [PMID: 35112186 DOI: 10.1007/s00592-021-01829-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/21/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study aims to determine the relationship between diabetic retinopathy (DR) and cognitive dysfunction as well as explores the effects of DR on different cognitive domains. METHODS A systematic search of PubMed, Embase, Web of Science, Wanfang data, CBM, CNKI, and VIP databases from their inception to October 2021. The pooled odds ratio (ORs), hazard ratio (HRs), and 95% confidence interval (CIs) were calculated. RESULTS Twenty-two studies met the inclusion criteria and meta-analysis included 15 studies. The presence of DR reflects a higher risk of cognitive dysfunction (OR = 2.45; 95% CI: 1.76-3.41; HR = 1.34 95% CI: 1.10-1.62). Cohort study combined risk was 2.62 (95% CI: 1.93-3.56), in cross-sectional study was 2.07 (95% CI: 1.11-3.88). The pooled OR was 2.38 (95% CI: 1.83-3.10) and 3.11 (95% CI: 1.15-8.40) in Asia and Oceania. No such association was found in North America (OR = 2.22; 95% CI: 0.77-6.38). The pooled risk was 2.47 (95% CI: 1.76-3.48) in patients with T2DM, while did not identify an association between these two conditions in T1DM. The combined unadjusted and adjusted ORs were 2.72 (95% CI: 1.99-3.73) and 2.06 (95% CI: 1.49-2.85). DR severity and the risk of cognitive impairment showed a positive correlation and mainly impaired the speeds of psychomotor and information processing. CONCLUSIONS DR can help to identify people at high risk of cognitive dysfunction. Further studies are indispensable for exploring the relationship between DR and cognitive impairment in the patients for different age, gender and race, as well as to assess the risk of cognitive impairment in different populations.
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Affiliation(s)
- Mei Wu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Fan Mei
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Kaiyan Hu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Liyuan Feng
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Zhe Wang
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Qianqian Gao
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Fei Chen
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Li Zhao
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Xiaohui Li
- Lanzhou University second hospital, Lanzhou University, Lanzhou, China.
| | - Bin Ma
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, School of Nursing, Lanzhou University, Lanzhou, 730030, Gansu, China.
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
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20
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Pedersen FN, Stokholm L, Pouwer F, Hass Rubin K, Peto T, Frydkjær-Olsen U, Thykjær AS, Andersen N, Andresen J, Bek T, La Cour M, Heegaard S, Højlund K, Kawasaki R, Hajari JN, Ohm Kyvik K, Laugesen CS, Schielke KC, Simó R, Grauslund J. Diabetic Retinopathy Predicts Risk of Alzheimer’s Disease: A Danish Registry-Based Nationwide Cohort Study. J Alzheimers Dis 2022; 86:451-460. [PMID: 35068460 PMCID: PMC9028615 DOI: 10.3233/jad-215313] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Retinal neurodegeneration is evident in early diabetic retinopathy (DR) which may be associated with other neurodegenerative diseases like Alzheimer's disease (AD). Objective: To investigate diabetes and DR as a risk marker of present and incident AD. Methods: A register-based cohort study was performed. We included 134,327 persons with diabetes above 60 years of age, who had attended DR screening, and 651,936 age- and gender-matched persons without diabetes. Results: At baseline, the prevalence of AD was 0.7% and 1.3% among patients with and without diabetes, respectively. In a multivariable regression model, patients with diabetes were less likely to have AD at baseline (adjusted OR 0.63, 95% CI 0.59–0.68). During follow-up, incident AD was registered for 1473 (0.35%) and 6,899 (0.34%) persons with and without diabetes, respectively. Compared to persons without diabetes, persons with diabetes and no DR had a lower risk to develop AD (adjusted HR 0.87, 95% CI 0.81–0.93), while persons with diabetes and DR had higher risk of AD (adjusted HR 1.24, 95% CI 1.08–1.43). When persons with diabetes and no DR were used as references, a higher risk of incident AD was observed in persons with DR (adjusted HR 1.34, 95% CI 1.18–1.53). Conclusion: Individuals with diabetes without DR were less likely to develop AD compared to persons without diabetes. However, individuals with DR had a 34% higher risk of incident AD, which raise the question whether screening for cognitive impairment should be done among individuals with DR.
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Affiliation(s)
- Frederik Nørregaard Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient Data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Frans Pouwer
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Katrine Hass Rubin
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient Data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, Northern Ireland, UK
| | | | - Anne Suhr Thykjær
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten La Cour
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - Javad Nouri Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Kirsten Ohm Kyvik
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Rafael Simó
- Department of Endocrinology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institut (VHIR) and CIBERDEM (ISCIII), Barcelona, Spain
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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21
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Zhang D, Huang Y, Gao J, Lei Y, Ai K, Tang M, Yan X, Lei X, Yang Z, Shao Z, Zhang X. Altered Functional Topological Organization in Type-2 Diabetes Mellitus With and Without Microvascular Complications. Front Neurosci 2021; 15:726350. [PMID: 34630014 PMCID: PMC8493598 DOI: 10.3389/fnins.2021.726350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/31/2021] [Indexed: 01/19/2023] Open
Abstract
Microvascular complications can accelerate cognitive impairment in patients with type 2 diabetes mellitus (T2DM) and have a high impact on their quality of life; however, the underlying mechanism is still unclear. The complex network in the human brain is the physiological basis for information processing and cognitive expression. Therefore, this study explored the relationship between the functional network topological properties and cognitive function in T2DM patients with and without microvascular complications (T2DM-C and T2DM-NC, respectively). Sixty-seven T2DM patients and 41 healthy controls (HCs) underwent resting-state functional MRI and neuropsychological assessment. Then, graph theoretical network analysis was performed to explore the global and nodal topological alterations in the functional whole brain networks of T2DM patients. Correlation analyses were performed to investigate the relationship between the altered topological parameters and cognitive/clinical variables. The T2DM-C group exhibited significantly higher local efficiency (Eloc), normalized cluster coefficient (γ), and small-world characteristics (σ) than the HCs. Patients with T2DM at different clinical stages (T2DM-C and T2DM-NC) showed varying degrees of abnormalities in node properties. In addition, compared with T2DM-NC patients, T2DM-C patients showed nodal properties disorders in the occipital visual network, cerebellum and middle temporal gyrus. The Eloc metrics were positively correlated with HbA1c level (P = 0.001, r = 0.515) and the NE values in the right paracentral lobule were negatively related with serum creatinine values (P = 0.001, r = −0.517) in T2DM-C patients. This study found that T2DM-C patients displayed more extensive changes at different network topology scales. The visual network and cerebellar may be the central vulnerable regions of T2DM-C patients.
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Affiliation(s)
- Dongsheng Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yang Huang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Jie Gao
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yumeng Lei
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Kai Ai
- Department of Clinical Science, Philips Healthcare, Xi'an, China
| | - Min Tang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xuejiao Yan
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Zhen Yang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Zhirong Shao
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
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22
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Hwang PH, Longstreth W, Thielke SM, Francis CE, Carone M, Kuller LH, Fitzpatrick AL. Ophthalmic conditions associated with dementia risk: The Cardiovascular Health Study. Alzheimers Dement 2021; 17:1442-1451. [PMID: 33788406 PMCID: PMC8527838 DOI: 10.1002/alz.12313] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ophthalmic conditions and dementia appear to overlap and may share common pathways, but research has not differentiated dementia subtypes. METHODS Diagnoses of cataracts, age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma were based on medical histories and International Classification of Diseases, Ninth Revision (ICD-9) codes for 3375 participants from the Cardiovascular Health Study. Dementia, including Alzheimer's disease (AD) and vascular dementia (VaD), was classified using standardized research criteria. RESULTS Cataracts were associated with AD (hazard ratio [HR] = 1.34; 95% confidence interval [CI] = 1.01-1.80) and VaD/mixed dementia (HR = 1.41; 95% CI = 1.02-1.95). AMD was associated with AD only (HR = 1.87; 95% CI = 1.13-3.09), whereas DR was associated with VaD/mixed dementia only (HR = 2.63; 95% CI = 1.10-6.27). DISCUSSION Differential associations between specific ophthalmic conditions and dementia subtypes may elucidate pathophysiologic pathways. Lack of association between glaucoma and dementia was most surprising from these analyses.
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Affiliation(s)
- Phillip H. Hwang
- Department of Epidemiology, University of Washington, Seattle, WA, USA;,Corresponding author contact information: University of Washington, Department of Epidemiology, 3980 15 Avenue Northeast, Box 351619, Seattle, WA 98195, , Phone: (206) 331-8633
| | - W.T. Longstreth
- Department of Epidemiology, University of Washington, Seattle, WA, USA;,Department of Neurology, University of Washington, Seattle, WA, USA
| | - Stephen M. Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA;,Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA
| | | | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Lewis H. Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Annette L. Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, WA, USA;,Department of Global Health, University of Washington, Seattle, WA, USA;,Department of Family Medicine, University of Washington, Seattle, WA, USA
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23
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Kuźma E, Littlejohns TJ, Khawaja AP, Llewellyn DJ, Ukoumunne OC, Thiem U. Visual Impairment, Eye Diseases, and Dementia Risk: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 83:1073-1087. [PMID: 34397414 DOI: 10.3233/jad-210250] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Visual impairment and eye diseases have been associated with dementia, though with mixed findings and often in cross-sectional studies. OBJECTIVE To identify prospective studies investigating associations between visual impairment or common eye diseases and risk of all-cause dementia or key dementia subtypes. METHODS We searched Medline, PsycINFO, and Embase from inception to January 2020. We also conducted backward and forward citation searches of included studies and set up alerts to identify studies published after the search date. Random-effects meta-analysis was used to combine adjusted estimates across studies. RESULTS Thirty studies met our eligibility criteria. For visual impairment, pooled estimates indicated an increased risk of all-cause dementia (37,705 participants, 3,415 cases, risk ratio [RR] = 1.38, 95%confidence interval [CI]: 1.19-1.59, I2 = 28.6%). Pooled estimates also suggested an increased dementia risk associated with cataract (6,659 participants, 1,312 cases, hazard ratio [HR] = 1.17, 95%CI 1.00-1.38, I2 = 0.0%) and diabetic retinopathy (43,658 participants, 7,060 cases, HR = 1.34, 95%CI 1.11-1.61, I2 = 63.9%), respectively. There was no evidence of an association between glaucoma (175,357 participants, 44,144 cases, HR = 0.97, 95%CI 0.90-1.04, I2 = 51.5%) or age-related macular degeneration (7,800,692 participants, > 2,559 cases, HR = 1.15, 95%CI 0.88-1.50, I2 = 91.0%) and risk of dementia, respectively. CONCLUSION As visual impairment, cataract, and diabetic retinopathy are associated with an increased likelihood of developing dementia, early diagnosis may help identify those at risk of dementia. Given most causes of visual impairment are treatable or preventable, the potential for dementia prevention warrants further investigation.
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Affiliation(s)
- Elżbieta Kuźma
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany
| | - Thomas J Littlejohns
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,Alan Turing Institute, London, United Kingdom
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, Exeter, United Kingdom
| | - Ulrich Thiem
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany.,University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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24
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Pedersen HE, Sandvik CH, Subhi Y, Grauslund J, Pedersen FN. Relationship between Diabetic Retinopathy and Systemic Neurodegenerative Diseases: A Systematic Review and Meta-analysis. Ophthalmol Retina 2021; 6:139-152. [PMID: 34256192 DOI: 10.1016/j.oret.2021.07.002] [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: 03/16/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 01/01/2023]
Abstract
TOPIC To examine the potential role of systemic neurodegeneration, this study aimed to provide an overview of the available evidence on the relationship between diabetic retinopathy (DR) and systemic neurodegeneration. CLINICAL RELEVANCE The association between DR and systemic neurodegeneration is inconsistent in the literature. A summary estimate on the measures of association is important to establish whether DR may be used as a risk marker of systemic neurodegeneration. METHODS We searched the literature databases PubMed/MEDLINE, EMBASE, and Cochrane Library on October 3, 2020, for all observational studies on humans evaluating the association between DR and systemic neurodegenerative diseases. Two authors conducted the literature search, study selection, and data extraction in an independent fashion. Studies were reviewed qualitatively in text and quantitatively in meta-analyses. Heterogeneity was evaluated with Cochran's Q and I2, and Funnel plot was used to investigate for skewed results and possible publication bias. RESULTS We identified 27 eligible studies with a total of 1 398 041 patients with diabetes. Diagnosis of DR was made using fundus photography or examination (n = 20), health registries (n = 4), was self-reported (n = 1), or was not disclosed in the remaining studies. Neurodegenerative conditions studied were cognitive impairment (n = 23), Alzheimer's disease (n = 3), and Parkinson's disease (n = 1). In cross-sectional and longitudinal studies, respectively, presence of any DR was associated with present (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.02-2.43, P = 0.043) and incident (OR, 2.36; 95% CI, 1.50-3.71, P = 0.00021) systemic neurodegeneration, but severity of DR was not associated with differences in systemic neurodegeneration (OR, 0.98; 95% CI, 0.45-2.15, P = 0.96). CONCLUSIONS In this systematic review, DR appears to be a marker of systemic neurodegeneration. Further studies are warranted to better elucidate the clinical practical implications of this relationship.
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Affiliation(s)
- Helene E Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Caroline H Sandvik
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark; Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Frederik N Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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25
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Chang PY, Wang ITI, Chiang CE, Chen CH, Yeh WY, Henderson VW, Tsai YW, Cheng HM. Vascular complications of diabetes: natural history and corresponding risks of dementia in a national cohort of adults with diabetes. Acta Diabetol 2021; 58:859-867. [PMID: 33624125 DOI: 10.1007/s00592-021-01685-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/02/2021] [Indexed: 01/01/2023]
Abstract
AIMS This study aimed to determine the trajectory of diabetic vascular diseases and to investigate the association between vascular diseases and dementia. METHODS We included adults aged ≥ 50 years with newly diagnosed type 2 diabetes (n = 173,118) from 2001 to 2005 who were followed-up until December 31, 2013 in the Taiwan's National Health Insurance Research Database. Multivariable Cox regression models were constructed to estimate hazard ratios (HRs) and confidence limits (CLs) for all-cause dementia in relation to the number, types, and occurrence patterns of vascular disease. RESULTS Within 1 year of diabetes diagnosis, 26.3% of adults developed their first vascular disease. During the 1,864,279 person-years of follow-up, 17,426 adults had all-cause dementia, corresponding to an incidence of 97.9 cases/10,000 person-years in 127,718 adults with at least one vascular disease and 67.5 cases/10,000 person-years in 45,400 adults without vascular diseases. Across all age groups, adults who subsequently developed a vascular disease in two one-year windows since diabetes diagnosis had the highest incidence of all-cause dementia. In comparison with adults without vascular diseases, HR for all-cause dementia was 1.99 (CL: 1.92-2.07) for those with one vascular disease only; 2.04 (CL: 1.98-2.13) for two or more vascular diseases; 3.56 (CL: 3.44-3.70) for stroke only; and 2.06 (CL: 1.99-2.14) for neuropathy alone. Similar associations were also observed with a smaller magnitude for adults with nephropathy, retinopathy, cardiovascular disease, or peripheral arterial disease. CONCLUSIONS Patients with diabetes-related complications, particularly stroke and neuropathy, and those with rapidly developed vascular diseases appeared to have a high risk of dementia.
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Affiliation(s)
- Po-Yin Chang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - I-T Ing Wang
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chern-En Chiang
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Yu Yeh
- Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Victor W Henderson
- Department of Health Research and Policy and Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Hao-Min Cheng
- Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan.
- Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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26
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Cheng D, Zhao X, Yang S, Wang G, Ning G. Association Between Diabetic Retinopathy and Cognitive Impairment: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:692911. [PMID: 34276346 PMCID: PMC8278198 DOI: 10.3389/fnagi.2021.692911] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/07/2021] [Indexed: 01/11/2023] Open
Abstract
Diabetic retinopathy (DR) is one of the most common microvascular complications associated with diabetes mellitus. However, its correlation with another diabetes-related disorder, cognitive impairment, has not been well studied. This systematic review and meta-analysis aimed to explore the association between DR and cognitive impairment. MEDLINE (PubMed), the Cochrane Library, and EMBASE databases were searched for observational studies that reported an association between DR and cognitive impairment. Data from selected studies were extracted, and a meta-analysis was conducted using fixed-effects modeling. Fifteen observational studies were included in the systematic review, and 10 studies were included in the meta-analysis. The odds ratio of the association between DR and cognitive impairment was 2.24 (95% confidence interval [CI], 1.89-2.66; I 2 = 0.8%). The hazard ratio of the association between DR and cognitive impairment was significant in four studies, ranging from 1.09-1.32. Minimal or mild DR was not significantly associated with cognitive impairment (odds ratio [OR], 2.04; 95% CI, 0.87-4.77). However, the association between proliferative DR and cognitive impairment (OR, 3.57; 95% CI, 1.79-7.12; I 2 = 16.6%) was not stronger than the association between moderate or worse DR and cognitive impairment (OR, 4.26; 95% CI, 2.01-9.07; I 2 = 0.0%). DR is associated with cognitive impairment, and screening for DR will be helpful for the early identification of individuals with cognitive impairment. Further studies are needed to confirm the association between proliferative DR and cognitive impairment.
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Affiliation(s)
- Dihe Cheng
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Shuo Yang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guang Ning
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health of China, Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Shanghai Institute for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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27
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Anderson J, Meneghini L, Hinnen D, Gill J, Coudert M, Evenou P, Munshi M. Target attainment in insulin-naive patients at high risk for hypoglycemia: Results from ACHIEVE Control. J Diabetes Complications 2021; 35:107831. [PMID: 33509703 DOI: 10.1016/j.jdiacomp.2020.107831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
AIMS To better understand outcomes in people with type 2 diabetes at high risk of hypoglycemia, we conducted post hoc analyses in subgroups of participants from the real-world ACHIEVE Control study (NCT02451137) with ≥1 hypoglycemia risk factor. METHODS Insulin-naive adults with type 2 diabetes and A1c ≥8% were randomized 1:1 to insulin glargine 300 U/mL (Gla-300) or standard-of-care basal insulin (SOC-BI). Participants had documented history of ≥1 risk factors for hypoglycemia: chronic kidney disease, cardiovascular disease, dementia or blindness, age ≥65 years, or history of hypoglycemia. Outcomes included individualized A1c target attainment without documented symptomatic hypoglycemia (blood glucose [BG] ≤3.9 mmol/L or <3.0 mmol/L) or severe hypoglycemia, A1c target attainment, and absence of documented symptomatic or severe hypoglycemia at 6 and 12 months. RESULTS Within subgroups, odds ratios generally showed trends favoring Gla-300 versus SOC-BI, particularly for hypoglycemia avoidance in participants ≥65 years of age (BG ≤3.9 mmol/L; odds ratio, 1.52; 95% confidence interval, 1.14-2.03) and those with chronic kidney disease (BG ≤3.9 mmol/L; odds ratio, 2.28; 95% confidence interval, 1.26-4.12). Results were consistent with the overall population. CONCLUSIONS These data suggest potential benefit of Gla-300 versus SOC-BI for avoiding hypoglycemia in participants with ≥1 hypoglycemia risk factor.
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Affiliation(s)
- John Anderson
- The Frist Clinic, 2400 Patterson Street, Suite 400, Nashville, TN, USA.
| | - Luigi Meneghini
- University of Texas Southwestern Medical Center and Parkland Health & Hospital System, 5323 Harry Hines Boulevard, Dallas, TX, USA.
| | - Debbie Hinnen
- Memorial Hospital Diabetes Center, University of Colorado Health, 175 S Union Boulevard, Suite 305, Colorado Springs, CO, USA.
| | | | - Mathieu Coudert
- Sanofi, 1 Avenue Pierre Brossolette, Chilly-Mazarin, France.
| | - Pierre Evenou
- Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, UK.
| | - Medha Munshi
- Joslin Diabetes Center, 1 Joslin Place, Boston, MA, USA.
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Huang X, Wen Z, Tong Y, Qi CX, Shen Y. Altered resting cerebral blood flow specific to patients with diabetic retinopathy revealed by arterial spin labeling perfusion magnetic resonance imaging. Acta Radiol 2021; 62:524-532. [PMID: 32551803 DOI: 10.1177/0284185120932391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous neuroimaging studies have shown that patients with diabetic retinopathy (DR) were accompanied by abnormalities in cerebral functional and structural architecture, whereas the resting cerebral blood flow (CBF) alterations in patients with DR are not well understood. PURPOSE To explore CBF alterations in patients with DR using pseudo-continuous arterial spin labeling (pCASL) imaging. MATERIAL AND METHODS Thirty-one individuals with DR (15 men, 16 women; mean age = 53.38 ± 9.12 years) and 33 healthy controls (HC) (12 men, 21 women; mean age = 51.61 ± 9.84 years) closely matched for age, sex, and education, underwent pCASL imaging scans. Two-sample T test was conducted to compare different CBF values between two groups. RESULTS Patients with DR exhibited significantly increased CBF values in the left middle temporal gyrus (Brodmann's area, BA 22) and the bilateral supplementary motor area (BA3) and decreased CBF values in the bilateral calcarine (BA17,18) and bilateral caudate relative to HC group (two-tailed, voxel level at P < 0.01, Gaussian random field (GRF), cluster level at P < 0.05). Moreover, the HbA1c (%) level showed a positive correlation with CBF values in the bilateral caudate (r = 0.473, P = 0.007) in patients with DR. CONCLUSION Our results highlighted that patients with DR had abnormal CBF values in the visual cortices, caudate, middle temporal gyrus, and supplementary motor area, which might reflect vision and sensorimotor and cognition dysfunction in patients with DR. These findings might help us to understanding the neural mechanism of patients with DR.
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Affiliation(s)
- Xin Huang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Yan Tong
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Chen-Xing Qi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
- Medical Research Institute, Wuhan University, Wuhan, Hubei, PR China
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Abstract
The eye and brain share common mechanisms of aging and disease, thus the retina is an essential source of accessible information about neurodegenerative processes occurring in the brain. Advances in retinal imaging have led to the discovery of many potential biomarkers of Alzheimer's disease, although further research is needed to validate these associations. Understanding the mechanisms of retinal disease in the context of aging will extend our knowledge of AD and may enable advancements in diagnosis, monitoring, and treatment.
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30
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Huang X, Wen Z, Qi CX, Tong Y, Shen Y. Dynamic Changes of Amplitude of Low-Frequency Fluctuations in Patients With Diabetic Retinopathy. Front Neurol 2021; 12:611702. [PMID: 33643197 PMCID: PMC7905082 DOI: 10.3389/fneur.2021.611702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/18/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Growing evidence demonstrate that diabetic retinopathy (DR) patients have a high risk of cognitive decline and exhibit abnormal brain activity. However, neuroimaging studies thus far have focused on static cerebral activity changes in DR patients. The characteristics of dynamic cerebral activity in patients with DR are poorly understood. Purpose: The purpose of the study was to investigate the dynamic cerebral activity changes in patients with DR using the dynamic amplitude of low-frequency fluctuation (dALFF) method. Materials and methods: Thirty-four DR patients (18 men and 16 women) and 38 healthy controls (HCs) (18 males and 20 females) closely matched in age, sex, and education were enrolled in this study. The dALFF method was used to investigate dynamic intrinsic brain activity differences between the DR and HC groups. Results: Compared with HCs, DR patients exhibited increased dALFF variability in the right brainstem, left cerebellum_8, left cerebellum_9, and left parahippocampal gyrus. In contrast, DR patients exhibited decreased dALFF variability in the left middle occipital gyrus and right middle occipital gyrus. Conclusion: Our study highlighted that DR patients showed abnormal variability of dALFF in the visual cortices, cerebellum, and parahippocampal gyrus. These findings suggest impaired visual and motor and memory function in DR individuals. Thus, abnormal dynamic spontaneous brain activity might be involved in the pathophysiology of DR.
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Affiliation(s)
- Xin Huang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Ophthalmology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chen-Xing Qi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Tong
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China.,Medical Research Institute, Wuhan University, Wuhan, China
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31
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Bello-Chavolla OY, Aguilar-Salinas CA, Avila-Funes JA. The type 2 diabetes-specific dementia risk score (DSDRS) is associated with frailty, cognitive and functional status amongst Mexican community-dwelling older adults. BMC Geriatr 2020; 20:363. [PMID: 32962659 PMCID: PMC7510254 DOI: 10.1186/s12877-020-01776-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background The type 2 diabetes (T2D) specific dementia-risk score (DSDRS) was developed to evaluate dementia risk in older adults with T2D. T2D-related factors have been shown increase the risk of age-related conditions, which might also increase dementia risk. Here, we investigate the associations of DSDRS with frailty, disability, quality of life (QoL) and cognition in community-dwelling older adults with T2D. Methods We included 257 community-dwelling older adults with T2D to evaluate the association between DSDRS and Mini-mental state examination (MMSE), Isaac’s set-test (IST), clock drawing test (CDT), quality of life (SF-36), risk of malnutrition (Mini-Nutritional Assessment or MNA), as well as frailty, Katz’ and Lawton-Brody scores. We also assessed the phenotype and correlates of high-estimated dementia risk by assessing individuals with DSDRS >75th age-specific percentiles. Results Mean age of participants was 78.0 ± 6.2 years. DSDRS showed a significant correlation with MMSE test, IST, CDT, SF-36, MNA, Lawton-Brody and Katz scores, and an increasing number of frailty components. DSDRS was higher among frail, pre-frail, and subjects with limited ADL and IADL (p < 0.001). Participants with DSDRS >75th age-specific percentiles had lower education, MMSE, IST, SF-36, MNA, Katz, Lawton-Brody, and higher frailty scores. High-estimated 10-year dementia risk was associated with ADL and IADL disability, frailty and risk of malnutrition. When assessing individual components of DSDRS, T2D-related microvascular complications were associated to all outcome measures. Conclusion The DSDRS is associated with frailty, disability, malnutrition and lower cognitive performance. These findings support that T2D-related factors have significant burden on functional status, QoL, disability and dementia risk.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico. .,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15. CP 14080, Tlalpan, Mexico City, Mexico. .,Department of Physiology, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico.
| | - Carlos Alberto Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15. CP 14080, Tlalpan, Mexico City, Mexico.,Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Instituto Tecnologico y de Estudios Superiores de Monterrey Tec Salud, Nuevo León, Mexico
| | - José Alberto Avila-Funes
- Geriatrics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Centre de recherche INSERM, U1219, F-33076, Bordeaux, France
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32
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Simó R, Frontoni S. Neuropathic damage in the diabetic eye: clinical implications. Curr Opin Pharmacol 2020; 55:1-7. [PMID: 32932105 DOI: 10.1016/j.coph.2020.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/11/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
In recent years, emerging evidence support that the eye is target of diabetes neuropathy. There are two components of the eye that are mainly involved in the neurodegenerative process induced by diabetes: the retina and the cornea. The study of functional and structural changes in these components of the eye will provide useful information to identify subjects with diabetes at risk of diabetic peripheral neuropathy and dementia. In this review the state of the art regarding the evidence and clinical implications of this emerging concept will be provided. In addition, the relationship between retinal and corneal neurodegeneration with peripheral neuropathy and cognitive decline will be analyzed. Finally, the scientific gaps than need to be covered and will be critically examined.
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Affiliation(s)
- Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERDEM (ISCIII), Madrid, Spain.
| | - Simona Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fate Bene Fratelli Hospital, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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33
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Biessels GJ, Nobili F, Teunissen CE, Simó R, Scheltens P. Understanding multifactorial brain changes in type 2 diabetes: a biomarker perspective. Lancet Neurol 2020; 19:699-710. [PMID: 32445622 DOI: 10.1016/s1474-4422(20)30139-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022]
Abstract
People with type 2 diabetes are at an increased risk of cognitive impairment and dementia (including Alzheimer's disease), as well as subtle forms of cognitive dysfunction. Current diabetes guidelines recommend screening for cognitive impairment in groups at high risk and providing guidance for diabetes management in patients with diabetes and cognitive impairment. Yet, no disease-modifying treatment is available and important questions remain about the mechanisms underlying diabetes-associated cognitive dysfunction. These mechanisms are likely to be multifactorial and different for subtle and more severe forms of diabetes-associated cognitive dysfunction. Over the past years, research on dementia, brain ageing, diabetes, and vascular disease has identified novel biomarkers of specific dementia aetiologies, brain parenchymal injury, and cerebral blood flow and metabolism. These markers shed light on the processes underlying diabetes-associated cognitive dysfunction, have clear applications in current research and increasingly in clinical diagnosis, and might ultimately guide targeted treatment.
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Affiliation(s)
- Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Flavio Nobili
- Department of Neuroscience, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genoa, Italy; Clinical Neurology Unit, IRCSS Ospedale Policlinico San Martino, Genoa, Italy
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam, Netherlands
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Philip Scheltens
- Department of Neurology and Alzheimer Center, VU University Medical Center Amsterdam, Amsterdam, Netherlands
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34
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van Sloten TT, Sedaghat S, Carnethon MR, Launer LJ, Stehouwer CDA. Cerebral microvascular complications of type 2 diabetes: stroke, cognitive dysfunction, and depression. Lancet Diabetes Endocrinol 2020; 8:325-336. [PMID: 32135131 DOI: 10.1016/s2213-8587(19)30405-x] [Citation(s) in RCA: 265] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 12/19/2022]
Abstract
Adults with type 2 diabetes are at an increased risk of developing certain brain or mental disorders, including stroke, dementia, and depression. Although these disorders are not usually considered classic microvascular complications of diabetes, evidence is growing that microvascular dysfunction is one of the key underlying mechanisms. Microvascular dysfunction is a widespread phenomenon in people with diabetes, including effects on the brain. Cerebral microvascular dysfunction is also apparent in adults with prediabetes, suggesting that cerebral microvascular disease processes start before the onset of diabetes. The microvasculature is involved in the regulation of many cerebral processes that when impaired predispose to lacunar and haemorrhagic stroke, cognitive dysfunction, and depression. Main drivers of diabetes-related cerebral microvascular dysfunction are hyperglycaemia, obesity and insulin resistance, and hypertension. Increasing amounts of data from observational studies suggest that diabetes-related microvascular dysfunction is associated with a higher risk of stroke, cognitive dysfunction, and depression. Cerebral outcomes in diabetes might be improved following treatments targeting the pathways through which diabetes damages the microcirculation. These treatments might include drugs that reduce dicarbonyl compounds, augment cerebral insulin signalling, or improve blood-brain barrier permeability and cerebral vasoreactivity.
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Affiliation(s)
- Thomas T van Sloten
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sanaz Sedaghat
- Department of Preventive Medicine and Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine and Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands.
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35
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Chen KC, Chung CH, Lu CH, Tzeng NS, Lee CH, Su SC, Kuo FC, Liu JS, Hsieh CH, Chien WC. Association between the Use of Dipeptidyl Peptidase 4 Inhibitors and the Risk of Dementia among Patients with Type 2 Diabetes in Taiwan. J Clin Med 2020; 9:E660. [PMID: 32121372 PMCID: PMC7141309 DOI: 10.3390/jcm9030660] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/22/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES Diabetes mellitus per se and its related therapy have been frequently associated with an increased risk of developing dementia. However, studies that explored the risk of dementia from the use of the novel oral antidiabetic medication dipeptidyl peptidase 4 inhibitor (DPP-4i) have been limited, especially in Asian populations. The present study aimed to determine the effect of DPP-4i on the subsequent risk of dementia among patients with type 2 diabetes (T2D) in Taiwan. METHODS This study utilized data from the Longitudinal Health Insurance Database between 2008 and 2015. We enrolled 2903 patients aged ≥50 years, who were on DPP-4i for a diagnosis of T2D and had no dementia. A total of 11,612 subjects were included and compared with a propensity score-matched control group who did not use DPP-4i (non-DPP-4i group). Survival analysis was performed to estimate and compare the risk of dementia-including Alzheimer's disease, vascular dementia, and other dementia types-between the two groups. Results: Both groups had a mean age of 68 years, had a preponderance of women (61.8%), and were followed up for a mean duration of 7 years. The risk of all-cause dementia was significantly lower in the DPP-4i group than in the non-DPP-4i group (hazard ratio (HR) 0.798; 95% confidence interval (CI) 0.681-0.883; p < 0.001), with a class effect. This trend was particularly observed for vascular dementia (HR 0.575; 95% CI 0.404-0.681; p < 0.001), but not in Alzheimer's disease (HR 0.891; 95% CI 0.712-1.265; p = 0.297). The Kaplan-Meier analysis showed that the preventive effect on dementia was positively correlated with the cumulative dose of DPP-4i. Conclusions: DPP-4i decreased the risk of dementia with a class effect, especially vascular dementia, but not in Alzheimer's disease. Our results provide important information on the drug choice when managing patients with T2D in clinical practice.
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Affiliation(s)
- Kuan-Chan Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (K.-C.C.); (C.-H.L.); (C.-H.L.); (S.-C.S.); (F.-C.K.); (J.-S.L.)
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Chieh-Hua Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (K.-C.C.); (C.-H.L.); (C.-H.L.); (S.-C.S.); (F.-C.K.); (J.-S.L.)
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan;
- Student Counseling Center, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chien-Hsing Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (K.-C.C.); (C.-H.L.); (C.-H.L.); (S.-C.S.); (F.-C.K.); (J.-S.L.)
| | - Sheng-Chiang Su
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (K.-C.C.); (C.-H.L.); (C.-H.L.); (S.-C.S.); (F.-C.K.); (J.-S.L.)
| | - Feng-Chih Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (K.-C.C.); (C.-H.L.); (C.-H.L.); (S.-C.S.); (F.-C.K.); (J.-S.L.)
| | - Jhih-Syuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (K.-C.C.); (C.-H.L.); (C.-H.L.); (S.-C.S.); (F.-C.K.); (J.-S.L.)
| | - Chang-Hsun Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (K.-C.C.); (C.-H.L.); (C.-H.L.); (S.-C.S.); (F.-C.K.); (J.-S.L.)
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan;
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Graduate Institute of Life Science, National Defense Medical Center 11490, Taipei, Taiwan
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36
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Diabetes mellitus in the young and the old: Effects on cognitive functioning across the life span. Neurobiol Dis 2020; 134:104608. [DOI: 10.1016/j.nbd.2019.104608] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/06/2019] [Accepted: 09/04/2019] [Indexed: 01/12/2023] Open
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Gilsanz P, Beeri MS, Karter AJ, Quesenberry CP, Adams AS, Whitmer RA. Depression in type 1 diabetes and risk of dementia. Aging Ment Health 2019; 23:880-886. [PMID: 29634288 PMCID: PMC6179940 DOI: 10.1080/13607863.2018.1455167] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk. We examined if depression is a dementia risk factor among elderly individuals with T1D. METHODS 3,742 individuals with T1D age ≥50 were followed for dementia from 1/1/96-9/30/2015. Depression, dementia, and comorbidities were abstracted from electronic medical records. Cox proportional hazard models estimated the association between depression and dementia adjusting for demographics, glycosylated hemoglobin, severe dysglycemic epidsodes, stroke, heart disease, nephropathy, and end stage renal disease. The cumulative incidence of dementia by depression was estimated conditional on survival dementia-free to age 55. RESULTS Five percent (N = 182) were diagnosed with dementia and 20% had baseline depression. Depression was associated with a 72% increase in dementia (fully adjusted HR = 1.72; 95% CI:1.12-2.65). The 25-year cumulative incidence of dementia was more than double for those with versus without depression (27% vs. 12%). CONCLUSIONS For people with T1D, depression significantly increases dementia risk. Given the pervasiveness of depression in T1D, this has major implications for successful aging in this population recently living to old age.
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Affiliation(s)
- Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, CA, USA,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Michal Schnaider Beeri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | | | | | - Alyce S. Adams
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Rachel A. Whitmer
- Kaiser Permanente Division of Research, Oakland, CA, USA,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Popovic N, Lipovac M, Radunovic M, Ugarte J, Isusquiza E, Beristain A, Moreno R, Aranjuelo N, Popovic T. Fractal characterization of retinal microvascular network morphology during diabetic retinopathy progression. Microcirculation 2019; 26:e12531. [PMID: 30659745 DOI: 10.1111/micc.12531] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/23/2018] [Accepted: 01/15/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The study aimed to characterize morphological changes of the retinal microvascular network during the progression of diabetic retinopathy. METHODS Publicly available retinal images captured by a digital fundus camera from DIARETDB1 and STARE databases were used. The retinal microvessels were segmented using the automatic method, and vascular network morphology was analyzed by fractal parametrization such as box-counting dimension, lacunarity, and multifractals. RESULTS The results of the analysis were affected by the ability of the segmentation method to include smaller vessels with more branching generations. In cases where the segmentation was more detailed and included a higher number of vessel branching generations, increased severity of diabetic retinopathy was associated with increased complexity of microvascular network as measured by box-counting and multifractal dimensions, and decreased gappiness of retinal microvascular network as measured by lacunarity parameter. This association was not observed if the segmentation method included only 3-4 vessel branching generations. CONCLUSIONS Severe stages of diabetic retinopathy could be detected noninvasively by using high resolution fundus photography and automatic microvascular segmentation to the high number of branching generations, followed by fractal analysis parametrization. This approach could improve risk stratification for the development of microvascular complications, cardiovascular disease, and dementia in diabetes.
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Affiliation(s)
- Natasa Popovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Mirko Lipovac
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | | | | | | | | | | | | | - Tomo Popovic
- Faculty for Information Systems and Technologies, University of Donja Gorica, Podgorica, Montenegro
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Bello-Chavolla OY, Antonio-Villa NE, Vargas-Vázquez A, Ávila-Funes JA, Aguilar-Salinas CA. Pathophysiological Mechanisms Linking Type 2 Diabetes and Dementia: Review of Evidence from Clinical, Translational and Epidemiological Research. Curr Diabetes Rev 2019; 15:456-470. [PMID: 30648514 DOI: 10.2174/1573399815666190129155654] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/26/2018] [Accepted: 01/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Type 2 diabetes represents an increasing health burden world-wide and its prevalence in particularly higher in elderly population. Consistent epidemiological evidence suggests an increased risk of dementia associated to type 2 diabetes; the mechanisms underlying these associations, however, remain unclear. OBJECTIVE The study aims to review epidemiological, clinical and pre-clinical data that weigh on pathophysiological links, mechanisms of disease and associations between type 2 diabetes and dementia to identify areas of opportunity for future research. METHODS We searched the following electronic bibliographic databases: PUBMED, EMBASE, SCIELO, MEDLINE and OVID for clinical, translational and epidemiological research literature that summarize diabetes-related risk factors for dementia, metabolic and neurological changes associated to T2D, evidence of therapeutic approaches in type 2 diabetes and its pathophysiological implications for dementia. RESULTS Type 2 diabetes mellitus increases risk for all-cause dementia, vascular dementia and Alzheimer's disease. The most evaluated mechanisms linking both disorders in pre-clinical studies include an increase in neuronal insulin resistance, impaired insulin signaling, pro-inflammatory state, mitochondrial dysfunction and vascular damage which increase deposition of β-amyloid, tau proteins and GSK3β, leading to an earlier onset of dementia in individuals with impairment in the glucose metabolism. Neuroimaging and neuropathology evidence linking cerebrovascular lesions, neurodegeneration and particularly small-vessel disease in the onset of dementia is consistent with the increased risk of incident dementia in type 2 diabetes, but consistent evidence of AD-related pathology is scarce. Epidemiological data shows increased risk of dementia related to hypoglycemic episodes, glycemic control, metabolic syndrome, insulin resistance and genetic predisposition, but the evidence is not consistent and statistical analysis might be affected by inconsistent covariate controlling. Therapeutic approaches for T2D have shown inconsistent result in relation to dementia prevention and delay of cognitive decline; lifestyle intervention, particularly physical activity, is a promising alternative to ameliorate the impact of disability and frailty on T2D-related dementia. CONCLUSION Vascular disease, inflammation and impaired brain insulin signaling might occur in T2D and contribute to dementia risk. Evidence from epidemiological studies has not consistently reported associations that could integrate a unified mechanism of disease in humans. Evaluation of the effect of antidiabetic medications and non-pharmacological interventions in dementia prevention in type 2 diabetes is promising but has thus far offered inconsistent results.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Metabolic Disease Research Unit, National Institute of Medical Sciences and Nutrition, Mexico, United States
- Faculty of Medicine, National Autonomous, University of Mexico, Mexico, United States
| | - Neftali Eduardo Antonio-Villa
- Metabolic Disease Research Unit, National Institute of Medical Sciences and Nutrition, Mexico, United States
- Faculty of Medicine, National Autonomous, University of Mexico, Mexico, United States
| | - Arsenio Vargas-Vázquez
- Metabolic Disease Research Unit, National Institute of Medical Sciences and Nutrition, Mexico, United States
- Faculty of Medicine, National Autonomous, University of Mexico, Mexico, United States
| | - José Alberto Ávila-Funes
- Department of Geriatrics, National Institute of Medical Sciences and Nutrition, Mexico, United States
- University of Bordeaux, Bordeaux Population Health Research Center, 33076 Bordeaux, France
| | - Carlos Alberto Aguilar-Salinas
- Department of Endocrinology and Metabolism, National Institute of Medical Sciences and Nutrition, Mexico, United States
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Sertoma, 64710 Monterrey, N.L., Mexico, United States
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Gilsanz P, Albers K, Beeri MS, Karter AJ, Quesenberry CP, Whitmer RA. Traumatic brain injury associated with dementia risk among people with type 1 diabetes. Neurology 2018; 91:e1611-e1618. [PMID: 30258015 PMCID: PMC6205690 DOI: 10.1212/wnl.0000000000006391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/08/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To examine the association between traumatic brain injury (TBI) and dementia risk among a cohort of middle-aged and elderly individuals with type 1 diabetes (T1D). METHODS We evaluated 4,049 members of an integrated health care system with T1D ≥50 years old between January 1, 1996, and September 30, 2015. Dementia and TBI diagnoses throughout the study period were abstracted from medical records. Cox proportional hazards models estimated associations between time-dependent TBI and dementia adjusting for demographics, HbA1c, nephropathy, neuropathy, stroke, peripheral artery disease, depression, and dysglycemic events. Fine and Gray regression models evaluated the association between baseline TBI and dementia risk accounting for competing risk of death. RESULTS A total of 178 individuals (4.4%) experienced a TBI and 212 (5.2%) developed dementia. In fully adjusted models, TBI was associated with 3.6 times the dementia risk (hazard ratio [HR] 3.64; 95% confidence interval [CI] 2.34, 5.68). When accounting for the competing risk of death, TBI was associated with almost 3 times the risk of dementia (HR 2.91; 95% CI 1.29, 5.68). CONCLUSION This study demonstrates a marked increase in risk of dementia associated with TBI among middle-aged and elderly people with T1D. Given the complexity of self-care for individuals with T1D, and the comorbidities that predispose them to trauma and falls, future work is needed on interventions protecting brain health in this vulnerable population, which is now living to old age.
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Affiliation(s)
- Paola Gilsanz
- From the Kaiser Permanente Division of Research (P.G., K.A., A.J.K., C.P.Q., R.A.W.), Oakland, CA; Department of Epidemiology and Biostatistics (P.G., R.A.W.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; Icahn School of Medicine at Mount Sinai (M.S.B.), New York, NY; The Joseph Sagol Neuroscience Center (M.S.B.), Sheba Medical Center, Ramat Gan, Israel; and Department of Epidemiology (A.J.K.), University of Washington, Seattle.
| | - Kathleen Albers
- From the Kaiser Permanente Division of Research (P.G., K.A., A.J.K., C.P.Q., R.A.W.), Oakland, CA; Department of Epidemiology and Biostatistics (P.G., R.A.W.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; Icahn School of Medicine at Mount Sinai (M.S.B.), New York, NY; The Joseph Sagol Neuroscience Center (M.S.B.), Sheba Medical Center, Ramat Gan, Israel; and Department of Epidemiology (A.J.K.), University of Washington, Seattle
| | - Michal Schnaider Beeri
- From the Kaiser Permanente Division of Research (P.G., K.A., A.J.K., C.P.Q., R.A.W.), Oakland, CA; Department of Epidemiology and Biostatistics (P.G., R.A.W.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; Icahn School of Medicine at Mount Sinai (M.S.B.), New York, NY; The Joseph Sagol Neuroscience Center (M.S.B.), Sheba Medical Center, Ramat Gan, Israel; and Department of Epidemiology (A.J.K.), University of Washington, Seattle
| | - Andrew J Karter
- From the Kaiser Permanente Division of Research (P.G., K.A., A.J.K., C.P.Q., R.A.W.), Oakland, CA; Department of Epidemiology and Biostatistics (P.G., R.A.W.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; Icahn School of Medicine at Mount Sinai (M.S.B.), New York, NY; The Joseph Sagol Neuroscience Center (M.S.B.), Sheba Medical Center, Ramat Gan, Israel; and Department of Epidemiology (A.J.K.), University of Washington, Seattle
| | - Charles P Quesenberry
- From the Kaiser Permanente Division of Research (P.G., K.A., A.J.K., C.P.Q., R.A.W.), Oakland, CA; Department of Epidemiology and Biostatistics (P.G., R.A.W.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; Icahn School of Medicine at Mount Sinai (M.S.B.), New York, NY; The Joseph Sagol Neuroscience Center (M.S.B.), Sheba Medical Center, Ramat Gan, Israel; and Department of Epidemiology (A.J.K.), University of Washington, Seattle
| | - Rachel A Whitmer
- From the Kaiser Permanente Division of Research (P.G., K.A., A.J.K., C.P.Q., R.A.W.), Oakland, CA; Department of Epidemiology and Biostatistics (P.G., R.A.W.), University of California, San Francisco; Department of Public Health Sciences (R.A.W.), University of California, Davis; Icahn School of Medicine at Mount Sinai (M.S.B.), New York, NY; The Joseph Sagol Neuroscience Center (M.S.B.), Sheba Medical Center, Ramat Gan, Israel; and Department of Epidemiology (A.J.K.), University of Washington, Seattle
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Lee CS, Larson EB, Gibbons LE, Lee AY, McCurry SM, Bowen JD, McCormick WC, Crane PK. Associations between recent and established ophthalmic conditions and risk of Alzheimer's disease. Alzheimers Dement 2018; 15:34-41. [PMID: 30098888 DOI: 10.1016/j.jalz.2018.06.2856] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/14/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Identifying ophthalmic diseases associated with increased risk of Alzheimer's disease (AD) may enable better screening and understanding of those at risk of AD. METHODS Diagnoses of glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR) were based on International Classification of Diseases, 9th revision, codes for 3877 participants from the Adult Changes in Thought study. The adjusted hazard ratio for developing probable or possible AD for recent (within 5 years) and established (>5 years) diagnoses were assessed. RESULTS Over 31,142 person-years of follow-up, 792 AD cases occurred. The recent and established hazard ratio were 1.46 (P = .01) and 0.87 (P = .19) for glaucoma, 1.20 (P = .12) and 1.50 (P < .001) for AMD, and 1.50 (P = .045) and 1.50 (P = .03) for DR. DISCUSSION Increased AD risk was found for recent glaucoma diagnoses, established AMD diagnoses, and both recent and established DR. People with certain ophthalmic conditions may have increased AD risk.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Laura E Gibbons
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Susan M McCurry
- School of Nursing, University of Washington, Seattle, WA, USA
| | - James D Bowen
- Department of Neurology, Swedish Medical Center, Seattle, WA, USA
| | | | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
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Rodill LG, Exalto LG, Gilsanz P, Biessels GJ, Quesenberry CP, Whitmer RA. Diabetic Retinopathy and Dementia in Type 1 Diabetes. Alzheimer Dis Assoc Disord 2018; 32:125-130. [PMID: 29261519 PMCID: PMC5963957 DOI: 10.1097/wad.0000000000000230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Retinopathy impacts over one-third of those with diabetes mellitus and is associated with impaired cognitive performance and cerebrovascular lesions in middle-aged adults with type 1 diabetes. However, the association between diabetic retinopathy (DR) and risk of dementia in type 1 diabetes is unknown. We investigated the association between DR and incident dementia in a large, elderly population with type 1 diabetes. METHODS A cohort of 3742 patients with type 1 diabetes aged 50 years and above was followed from January 1, 1996 to September 30, 2015 for incident dementia. DR diagnoses were identified from electronic medical records. Age as timescale Cox proportional hazard models evaluated associations between time-updated DR and dementia risk. Models were adjusted for demographics, severe glycemic events, glycosylated hemoglobin, and vascular comorbidities. RESULTS Among 3742 patients with type 1 diabetes (47% female, 21% nonwhite), 182 (5%) were diagnosed with dementia during a mean follow-up of 6.2 years. No significant association was found between DR and incident dementia in the main analyses [adjusted Hazard Ratio=1.12; 95% confidence interval, 0.82-1.54), nor among subgroup restricted to those aged 60 years and above or 70 years and above. CONCLUSIONS DR was not associated with risk of dementia, suggesting that pathophysiological processes underlying dementia may be different in type 1 versus type 2 diabetes.
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Affiliation(s)
- Liora G Rodill
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lieza G Exalto
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Paola Gilsanz
- Kaiser Permanente Division of Research
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Rachel A Whitmer
- Kaiser Permanente Division of Research
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
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Li W, Huang E. An Update on Type 2 Diabetes Mellitus as a Risk Factor for Dementia. J Alzheimers Dis 2018; 53:393-402. [PMID: 27163819 DOI: 10.3233/jad-160114] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With the rapidly expanding evidence on brain structural and functional changes in type 2 diabetes mellitus (T2DM) patients, there is an increasing need to update our understanding on how T2DM associates with dementia as well as the underlying pathophysiological mechanisms. A literature search of T2DM and dementia or cognition impairments was carried out in electronic databases Medline, EMBASE, and Google Scholar. In this review, the chosen evidence was limited to human subject studies only, and data on either type 1 diabetes mellitus (T1DM) or non-classified diabetes were excluded. T2DM is a risk factor for both vascular dementia (VaD) and Alzheimer's disease (AD), although AD pathological marker studies have not provided sufficient evidence. T2DM interacts additively or synergistically with many factors, including old age, hypertension, total cholesterol, and APOEɛ4 carrier status for impaired cognition functions seen in patients with T2DM. In addition, comorbid T2DM can worsen the clinical presentations of patients with either AD or VaD. In summary, T2DM increases the risk for AD through different mechanisms for VaD although some mechanisms may overlap. Tau-related neurofibrillary tangles instead of amyloid-β plaques are more likely to be the pathological biomarkers for T2DM-related dementia. Degeneration of neurons in the brain, impaired regional blood supply/metabolism, and genetic predisposition are all involved in T2DM-associated dementia or cognitive impairments.
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Affiliation(s)
- Wei Li
- Master of Physician Assistant Studies, School of Health and Rehabilitation Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Edgar Huang
- School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Gilsanz P, Mayeda ER, Glymour MM, Quesenberry CP, Mungas DM, DeCarli C, Dean A, Whitmer RA. Female sex, early-onset hypertension, and risk of dementia. Neurology 2017; 89:1886-1893. [PMID: 28978656 DOI: 10.1212/wnl.0000000000004602] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To evaluate the association of early-adulthood and mid-adulthood hypertension with dementia in men and women. METHODS We evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean age 32.7 years; early adulthood) and 1978-1985 (mean age 44.3 years; mid-adulthood) and were members as of January 1, 1996 (mean age 59.8 years). Hypertension categories based on measurements of blood pressure (BP) and change in hypertension categories between the 2 examinations (e.g., onset hypertension) were used to predict dementia incidence from January 1, 1996, to September 30, 2015. Cox proportional hazard models were adjusted for demographics, vascular comorbidities, and hypertension treatment; inverse probability weighting accounted for differential attrition between first BP measurement and start of follow-up. RESULTS A total of 532 individuals (9.4%) were diagnosed with dementia. Early adulthood hypertension was not associated with dementia, though effect estimates were elevated among women. Mid-adulthood hypertension was associated with 65% (95% confidence interval [CI] 1.25-2.18) increased dementia risk among women but not men. Onset of hypertension in mid-adulthood predicted 73% higher dementia risk in women (95% CI 1.24-2.40) compared to stable normotensive. There was no evidence that hypertension or changes in hypertension increased dementia risk among men. CONCLUSIONS Though midlife hypertension was more common in men, it was only associated with dementia risk in women. Sex differences in the timing of dementia risk factors have important implications for brain health and hypertension management.
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Affiliation(s)
- Paola Gilsanz
- From the Kaiser Permanente Division of Research (P.G., C.P.Q., A.D., R.A.W.), Oakland; Department of Epidemiology and Biostatistics (P.G., E.R.M., M.M.G., R.A.W.), University of California, San Francisco; Department of Epidemiology (E.R.M.), Fielding School of Public Health, University of California, Los Angeles; and Department of Neurology (D.M.M., C.D.), University of California Davis, Sacramento
| | - Elizabeth Rose Mayeda
- From the Kaiser Permanente Division of Research (P.G., C.P.Q., A.D., R.A.W.), Oakland; Department of Epidemiology and Biostatistics (P.G., E.R.M., M.M.G., R.A.W.), University of California, San Francisco; Department of Epidemiology (E.R.M.), Fielding School of Public Health, University of California, Los Angeles; and Department of Neurology (D.M.M., C.D.), University of California Davis, Sacramento
| | - M Maria Glymour
- From the Kaiser Permanente Division of Research (P.G., C.P.Q., A.D., R.A.W.), Oakland; Department of Epidemiology and Biostatistics (P.G., E.R.M., M.M.G., R.A.W.), University of California, San Francisco; Department of Epidemiology (E.R.M.), Fielding School of Public Health, University of California, Los Angeles; and Department of Neurology (D.M.M., C.D.), University of California Davis, Sacramento
| | - Charles P Quesenberry
- From the Kaiser Permanente Division of Research (P.G., C.P.Q., A.D., R.A.W.), Oakland; Department of Epidemiology and Biostatistics (P.G., E.R.M., M.M.G., R.A.W.), University of California, San Francisco; Department of Epidemiology (E.R.M.), Fielding School of Public Health, University of California, Los Angeles; and Department of Neurology (D.M.M., C.D.), University of California Davis, Sacramento
| | - Dan M Mungas
- From the Kaiser Permanente Division of Research (P.G., C.P.Q., A.D., R.A.W.), Oakland; Department of Epidemiology and Biostatistics (P.G., E.R.M., M.M.G., R.A.W.), University of California, San Francisco; Department of Epidemiology (E.R.M.), Fielding School of Public Health, University of California, Los Angeles; and Department of Neurology (D.M.M., C.D.), University of California Davis, Sacramento
| | - Charles DeCarli
- From the Kaiser Permanente Division of Research (P.G., C.P.Q., A.D., R.A.W.), Oakland; Department of Epidemiology and Biostatistics (P.G., E.R.M., M.M.G., R.A.W.), University of California, San Francisco; Department of Epidemiology (E.R.M.), Fielding School of Public Health, University of California, Los Angeles; and Department of Neurology (D.M.M., C.D.), University of California Davis, Sacramento
| | - Alexander Dean
- From the Kaiser Permanente Division of Research (P.G., C.P.Q., A.D., R.A.W.), Oakland; Department of Epidemiology and Biostatistics (P.G., E.R.M., M.M.G., R.A.W.), University of California, San Francisco; Department of Epidemiology (E.R.M.), Fielding School of Public Health, University of California, Los Angeles; and Department of Neurology (D.M.M., C.D.), University of California Davis, Sacramento
| | - Rachel A Whitmer
- From the Kaiser Permanente Division of Research (P.G., C.P.Q., A.D., R.A.W.), Oakland; Department of Epidemiology and Biostatistics (P.G., E.R.M., M.M.G., R.A.W.), University of California, San Francisco; Department of Epidemiology (E.R.M.), Fielding School of Public Health, University of California, Los Angeles; and Department of Neurology (D.M.M., C.D.), University of California Davis, Sacramento.
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Gilsanz P, Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Association Between Birth in a High Stroke Mortality State, Race, and Risk of Dementia. JAMA Neurol 2017; 74:1056-1062. [PMID: 28759663 DOI: 10.1001/jamaneurol.2017.1553] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Birth in a group of predominantly southern US states is robustly linked to increased stroke risk. Given the role of cerebrovascular disease in dementia risk, geographic patterning may also occur for dementia incidence. Objective To determine whether birth in 9 high stroke mortality states (HSMSs) is associated with dementia in a diverse cohort of individuals living in Northern California. Design, Setting, and Participants An observational cohort study included 7423 members of Kaiser Permanente Northern California (KPNC), an integrated health care delivery system, with health survey and clinical examination data available. Data were collected between 1964 and 1973 when the individuals were middle-aged and 1996 and 2015 when participants were in later life. Exposures Self-reported state of birth in an HSMS (top quintile of states for stroke mortality). Main Outcomes and Measures Dementia diagnoses obtained from electronic health records from January 1, 1996, to October 15, 2015. Place of birth, race, educational level, and midlife vascular risk factors data were collected between 1964 and 1973. Results Of the 7423 persons included in the analysis, 4049 (54.5%) were women; 1354 (18.2%) were black. The mean (SD) age of study participants at their first visit between 1963 and 1974 was 42.94 (1.73) years and mean (SD) age at the beginning of follow-up for dementia in 1996 was 71.14 (2.72) years. Dementia was diagnosed in 2254 (30.4%) of the participants and was more common among those born in an HSMS than those born outside of one (455 [39.0%] vs 1799 [28.8%]). Birth in an HSMS was 9.6 times more common for black participants (795 [58.7%]) than nonblack participants (371 [6.1%]). Overall, birth in an HSMS was associated with a 28% higher risk of dementia (adjusted hazard ratio [aHR], 1.28; 95% CI, 1.13-1.46) adjusted for age, sex, and race. Compared with nonblack persons born outside of an HSMS, black individuals born in an HSMS had the highest dementia risk (aHR, 1.67; 95% CI, 1.48-1.88), followed by black individuals not born in an HSMS (aHR, 1.48; 95% CI, 1.28-1.72), and nonblack persons born in an HSMS had a 46% increased risk (aHR, 1.46; 95% CI, 1.23-1.74). Cumulative 20-year dementia risks at age 65 years were 30.13% (95% CI, 26.87%-32.93%) and 21.80% (95% CI, 20.51%-22.91%) for individuals born in and outside an HSMS, respectively. Conclusions and Relevance To our knowledge, this is the first study to date of place of birth and incident dementia and shows increased risk for individuals born in an HSMS, even though all participants subsequently resided in California. Birth in an HSMS was common among black participants. Place of birth has enduring consequences for dementia risk and may be a major contributor to racial disparities in dementia.
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Affiliation(s)
- Paola Gilsanz
- Division of Research, Kaiser Permanente, Oakland, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Elizabeth Rose Mayeda
- Department of Epidemiology and Biostatistics, University of California, San Francisco.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Rachel A Whitmer
- Division of Research, Kaiser Permanente, Oakland, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco
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Chen H, Jiang Y, Yang Z, Hu W, Xiong L, Wang N, Liu X, Zheng G, Ouyang K, Wang W. Effects of Chimonanthus nitens Oliv. Leaf Extract on Glycolipid Metabolism and Antioxidant Capacity in Diabetic Model Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:7648505. [PMID: 29057036 PMCID: PMC5625751 DOI: 10.1155/2017/7648505] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 08/09/2017] [Indexed: 02/07/2023]
Abstract
The paper investigated the antihyperglycemic and antihyperlipidemic efficacy and antioxidant capacity of Chimonanthus nitens Oliv. leaf extract (COE) in combination of high-glucose-fat diet-fed and streptozotocin-induced diabetic model mice. Various physiological indexes in diabetic model mice were well improved especially by oral administration of high dose of COE; the results were listed as follows. Fast blood glucose (FBG) level and serum triglyceride (TC), total cholesterol (TG), low-density lipoprotein cholesterol (LDLC), and malondialdehyde (MDA) as well as MDA in liver were significantly reduced; fasting serum insulin (FINS) and insulin sensitivity index (ISI) were both increased; high-density lipoprotein cholesterol (HDLC) in serum was significantly increased; total antioxidant capacity (T-AOC), activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) in serum and liver were apparently enhanced; liver coefficient (LC), liver transaminase, and alkaline phosphatase (ALP) were decreased. Furthermore, pancreas islets and liver in diabetic model mice showed some extend of improvement in morphology and function after 4 weeks of COE treatment. In consequence, COE was advantageous to regulate glycolipid metabolism and elevate antioxidant capacity in diabetic model mice. Thus, the present study will provide a scientific evidence for the use of COE in the management of diabetes and its related complications.
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Affiliation(s)
- Hui Chen
- Key Lab for Agro-product Processing and Quality Control of Nanchang City, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Yan Jiang
- Key Lab for Agro-product Processing and Quality Control of Nanchang City, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Zhanwei Yang
- Key Lab for Agro-product Processing and Quality Control of Nanchang City, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Wenbing Hu
- Key Lab for Agro-product Processing and Quality Control of Nanchang City, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Lei Xiong
- Key Lab for Agro-product Processing and Quality Control of Nanchang City, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Ning Wang
- Key Lab for Agro-product Processing and Quality Control of Nanchang City, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Xin Liu
- Key Lab for Agro-product Processing and Quality Control of Nanchang City, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Guodong Zheng
- Key Lab for Agro-product Processing and Quality Control of Nanchang City, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Kehui Ouyang
- College of Animal Science and Technology, Jiangxi Agricultural University, Nanchang 330045, China
| | - Wenjun Wang
- Key Lab for Agro-product Processing and Quality Control of Nanchang City, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
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Ciudin A, Espinosa A, Simó-Servat O, Ruiz A, Alegret M, Hernández C, Boada M, Simó R. Type 2 diabetes is an independent risk factor for dementia conversion in patients with mild cognitive impairment. J Diabetes Complications 2017; 31:1272-1274. [PMID: 28545893 DOI: 10.1016/j.jdiacomp.2017.04.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/12/2017] [Accepted: 04/16/2017] [Indexed: 02/06/2023]
Abstract
AIMS To explore whether type 2 diabetes (T2D) is a risk factor for dementia conversion in patients with mild cognitive impairment (MCI). METHODS A longitudinal nested case-control study in which 101 T2D patients and 101 non-diabetic patients with MCI matched by age and gender were included. RESULTS The dementia conversion rate was 57.4% in T2D patients vs. 42.6% in non-diabetic subjects (p=0.02). T2D and APOE ε4 allele were independent risk factors for developing dementia. CONCLUSION T2D is an independent risk factor for dementia conversion in MCI patients. This finding has significant clinical implications.
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Affiliation(s)
- Andreea Ciudin
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Ana Espinosa
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Olga Simó-Servat
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Agustín Ruiz
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Montserrat Alegret
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Cristina Hernández
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Mercè Boada
- Fundació ACE, Barcelona Alzheimer Treatment & Research Center, Barcelona, Spain
| | - Rafael Simó
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.
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49
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Areosa Sastre A, Vernooij RWM, González‐Colaço Harmand M, Martínez G. Effect of the treatment of Type 2 diabetes mellitus on the development of cognitive impairment and dementia. Cochrane Database Syst Rev 2017; 6:CD003804. [PMID: 28617932 PMCID: PMC6481422 DOI: 10.1002/14651858.cd003804.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prevention of cognitive impairment and dementia is an important public health goal. Epidemiological evidence shows a relationship between cognitive impairment and Type 2 diabetes mellitus. The risk of dementia increases with duration of disease. This updated systematic review investigated the effect on cognitive function of the type of treatment and level of metabolic control in people with Type 2 diabetes. OBJECTIVES To assess the effects of different strategies for managing Type 2 diabetes mellitus on cognitive function and the incidence of dementia. SEARCH METHODS We searched ALOIS (the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG)), the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL and LILACS on 15 October 2016. ALOIS contains records from all major health care databases, (CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS), as well as from many trials' registers and grey literature sources. SELECTION CRITERIA We included randomised controlled trials (RCTs) which compared two or more different treatments for Type 2 diabetes mellitus and in which cognitive function was measured at baseline and after treatment. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the quality of the included RCTs. We pooled data for comparable trials and estimated the effects of treatment by using risk ratios (RRs) and mean differences (MDs), according to the nature of the outcome. We assessed the quality of the evidence using GRADE methods. MAIN RESULTS We identified seven eligible studies but only four provided data we could include in efficacy analyses. Two of these studies compared intensive versus standard glycaemic control and two compared different pharmacological treatments. All studies were at unclear risk of bias in at least two domains and one large study was at high risk of performance and detection bias.(a) Two studies with 13,934 participants at high cardiovascular risk provided efficacy data on intensive versus standard glycaemic control. A third study with 1791 participants provided additional data on hypoglycaemic episodes and mortality. There is probably no difference between treatment groups in the number of participants who decline by at least 3 points on the Mini-Mental State Examination (MMSE) over five years (RR 0.98, 95% CI 0.88 to 1.08; 1 study; n = 11,140; moderate-quality evidence); and there may also be little or no difference in the incidence of dementia (RR 1.27, 95% CI 0.87 to 1.85; 1 study; n = 11,140; low-quality evidence). From another study, there was probably little or no difference in MMSE score after 40 months (MD -0.01, 95% CI -0.18 to 0.16; 1 study; n = 2794; moderate quality evidence). Participants exposed to the intensive glycaemic control strategy probably experience more episodes of severe hypoglycaemia than those who have standard treatment (RR 2.18, 95% CI 1.52 to 3.14; 2 studies; n = 12,827; moderate-quality evidence). The evidence from these trials suggests that the intensity of glycaemic control may have little or no effect on all-cause mortality (RR 0.99, 95% CI 0.87 to 1.13; 3 studies; n = 15,888; low-quality evidence).(b) One study with 156 participants compared glibenclamide (glyburide) with repaglinide. There may be a small advantage of glibenclamide on global cognitive function measured with the MMSE after 12 months (MD -0.90, 95% CI -1.68 to -0.12; low-quality evidence). No data were reported on the incidence of dementia, hypoglycaemic events or all-cause mortality.(c) One study with 145 participants compared rosiglitazone plus metformin to glibenclamide (glyburide) plus metformin over 24 weeks. It reported only on cognitive subdomains and not on global cognitive function, incidence of MCI or dementia, hypoglycaemic events or all causes of mortality. AUTHORS' CONCLUSIONS We found no good evidence that any specific treatment or treatment strategy for Type 2 diabetes can prevent or delay cognitive impairment. The best available evidence related to the comparison of intensive with standard glycaemic control strategies. Here there was moderate-quality evidence that the strategies do not differ in their effect on global cognitive functioning over 40 to 60 months.
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Affiliation(s)
- Almudena Areosa Sastre
- Hospital Universitario de GetafeGeriatric UnitCarretera de Toledo (Km 12,500)MadridSpain28905 Getafe (Madrid)
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaBarcelonaSpain08025
| | | | - Gabriel Martínez
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaBarcelonaSpain08025
- Universidad de AntofagastaFaculty of Medicine and DentistryAntofagastaChile
- Servicio de Salud AntofagastaAntofagastaChile
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50
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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: 114] [Impact Index Per Article: 16.3] [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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