Diabetes mellitus and risk of dementia in the Kungsholmen project

Xu, Weili; Qiu, Chengxuan; Wåhlin, Åke; Winblad, Bengt; Fratiglioni, Laura

doi:10.1212/01.wnl.0000140291.86406.d1

Cited by 375 publications

(282 citation statements)

References 44 publications

(50 reference statements)

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“…Both PAD and diabetes duration were independent predictors of dementia in analyses that controlled for a range of potential confounders, including age and previously implicated risk factors, glycaemic control [9,13], insulin treatment [14,15] and hypertension [8,9]. The association between PAD and dementia was strong and participants with PAD had five times the risk of developing dementia.…”

Section: Discussionmentioning

confidence: 93%

“…This disparity may be explained by the small numbers of AD cases limiting statistical power in the present study. Risk factors for PAD in diabetes include hypertension, hyperglycaemia, dyslipidaemia and smoking [23,33]; hence, atherosclerosis may explain the relationship between cardiovascular risk factors and dementia in diabetes [8,9]. An important clinical implication is the possibility that the risk of dementia can be reduced by intensive risk factor management.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebrovascular disease is likely to be relevant given the significant role it plays in the development of Alzheimer's disease (AD) and vascular dementia [4]. Cardiovascular risk factors and atherosclerosis are also associated with dementia and AD [5][6][7] and the combination of diabetes and hypertension confers a high risk of dementia [8,9]. In addition, non-vascular mechanisms may also contribute to dementia in diabetes [10], including excess formation of advanced glycation endproducts [11] and/or disturbed neuronal insulin signalling that may promote cerebral amyloidosis [12].…”

Section: Introductionmentioning

confidence: 99%

“…However, these studies have a number of limitations that include adopting methods to diagnose diabetes subject to significant false negative rates [8,9,15,16], incomplete or absent assessments of glycaemic control [5,8,9,[14][15][16] and lack of assessment of microvascular complications [5,8,9,[14][15][16]. In type 2 diabetes, glycaemic control, diabetic complications and the need for insulin treatment are strongly interrelated and in addition they are each related to the duration of diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…We distinguished participants with cognitive impairment who were not demented in the sample to increase analytical precision, and we distinguished dementia due to AD, given the controversy about whether diabetes increases the risk of AD [5,8].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of cognitive impairment and dementia in older people with diabetes

et al. 2007

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Aims/hypothesis Diabetes is associated with an increased risk of dementia but the reasons for this association are unclear because there are many potential mechanisms. We explored the relative contribution of diabetes-related variables as predictors of dementia in older individuals with diabetes. Methods Survivors, aged ≥70 or more, were recruited from an existing observational cohort study 7.6±1.0 years after baseline, when they underwent a comprehensive assessment of diabetes, complications and cardiovascular risk factors. Dementia, probable Alzheimer's disease and cognitive impairment without dementia were diagnosed clinically. Logistic regression modelling determined independent predictors of cognitive diagnoses. Results Of 302 participants, aged 75.7±4.6 years, 28 (9.3%) had dementia (16 with probable Alzheimer's disease) and 60 (19.9%) had cognitive impairment without dementia. The major independent longitudinal predictors of dementia were older age (per decade; odds ratio 4.0, 95% CI 1.59-10.10), diabetes duration (for each 5 years; odds ratio 1.69, 95% CI 1.24-2.32), peripheral arterial disease (odds ratio 5.35, 95% CI 2.08-13.72) and exercise (which was protective; odds ratio 0.26, 95% CI 0.09-0.73). For Alzheimer's disease, diabetes duration was an independent predictor in addition to age and diastolic blood pressure. The results of the cross-sectional analyses were similar with respect to diabetes duration and peripheral arterial disease. Conclusions/interpretation Peripheral arterial disease is a strong independent risk factor for dementia in diabetes. After adjustment for a wide range of potential risk factors, diabetes duration remains independently associated with dementia and probable Alzheimer's disease, indicating that factors not measured in this study may be important in the pathogenesis of dementia in diabetes.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of cognitive impairment and dementia in older people with diabetes

et al. 2007

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Heart Failure and Risk of Dementia and Alzheimer Disease

Qiu

Winblad²,

Marengoni³

et al. 2006

Arch Intern Med

346

283

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Background: Heart failure has been linked to cognitive impairment in several previous studies, but to our knowledge, no investigations have explored the relationship between heart failure and the risk of dementia. We sought to examine the hypothesis that heart failure is a risk factor for dementia and Alzheimer disease.Methods: A community-based cohort of 1301 individuals 75 years or older and without dementia in Stockholm, Sweden, was examined 3 times over a 9-year period to detect patients with dementia and Alzheimer disease using the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Heart failure was defined according to the guidelines of the Task Force on Heart Failure of the European Society of Cardiology by integrating clinical symptoms and signs with inpatient register entries and use of cardiac medications. Data were analyzed using Cox proportional hazards models with adjustment for major potential confounders.Results: During the 6534 person-years of follow-up (mean,5.02 years per person), 440 subjects were diagnosed as having dementia, including 333 with Alzheimer disease. At baseline, heart failure was identified in 205 subjects. Heart failure was associated with a multiadjusted hazard ratio (HR) of 1.84 (95% confidence interval [CI], 1.35-2.51) for dementia and 1.80 (95% CI, 1.25-2.61) for Alzheimer disease. Use of antihypertensive drugs (83% of which are diuretics) seemed to reduce dementia risk due to heart failure (HR, 1.38; 95% CI, 0.99-1.94). Heart failure and low diastolic pressure (Ͻ70 mm Hg) had an additive effect on the risk for dementia (HR, 3.07; 95% CI, 1.67-5.61).Conclusions: Heart failure is associated with an increased risk of dementia and Alzheimer disease in older adults. Antihypertensive drug therapy may partially counteract the risk effect of heart failure on dementia disorders.

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