Prediabetes, intervening diabetes and subsequent risk of dementia: the Atherosclerosis Risk in Communities (ARIC) study

Hu, Jiaqi; Fang, Michael; Pike, James R; Lutsey, Pamela L.; Sharrett, A. Richey; Wagenknecht, Lynne E.; Hughes, Timothy M.; Seegmiller, Jesse C.; Gottesman, Rebecca F.; Mosley, Thomas H.; Coresh, Josef; Selvin, Elizabeth

doi:10.1007/s00125-023-05930-7

Cited by 9 publications

(4 citation statements)

References 34 publications

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“…This result, however, needs to be weighed against the evidence emerging from other studies showing a positive association between diabetes and late-onset dementia, and a higher risk of developing dementia when individuals were affected at a young age, regardless of its subtype. More specifically, research suggests that an earlier onset of diabetes is linked with a higher risk of dementia [56], and that the risk of AD is higher among people with diabetes than in the general population, irrespective of the age of onset [57]. Concerning diabetes, various studies have suggested that it has a role in increasing the risk of developing vascular dementia and AD, perhaps due to direct effects of the intrinsic metabolic conditions in diabetes (e.g., hyperglycemia and hyperinsulinemia) or through the mediating effect of other disorders [58].…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Other Cardiovascular Factors and the Risk of Dementia: An Italian Case–Control Study

Mazzoli,

Chiari,

Vitolo

et al. 2024

IJERPH

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Dementia is a major neurologic syndrome characterized by severe cognitive decline, and it has a detrimental impact on overall physical health, leading to conditions such as frailty, changes in gait, and fall risk. Depending on whether symptoms occur before or after the age of 65, it can be classified as early-onset (EOD) or late-onset (LOD) dementia. The present study is aimed at investigating the role of cardiovascular factors on EOD and LOD risk in an Italian population. Using a case–control study design, EOD and LOD cases were recruited at the Modena Cognitive Neurology Centers in 2016–2019. Controls were recruited among caregivers of all the dementia cases. Information about their demographics, lifestyles, and medical history were collected through a tailored questionnaire. We used the odds ratio (OR) and 95% confidence interval (CI) to estimate the EOD and LOD risk associated with the investigated factors after adjusting for potential confounders. Of the final 146 participants, 58 were diagnosed with EOD, 34 with LOD, and 54 were controls. According to their medical history, atrial fibrillation was associated with increased disease risk (ORs 1.90; 95% CI 0.32–11.28, and 3.64; 95% CI 0.32–41.39 for EOD and LOD, respectively). Dyslipidemia and diabetes showed a positive association with EOD, while the association was negative for LOD. We could not evaluate the association between myocardial infarction and EOD, while increased risk was observed for LOD. No clear association emerged for carotid artery stenosis or valvular heart disease. In this study, despite the limited number of exposed subjects and the high imprecision of the estimates, we found positive associations between cardiovascular disease, particularly dyslipidemia, diabetes, and atrial fibrillation, and EOD.

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Other Cardiovascular Factors and the Risk of Dementia: An Italian Case–Control Study

Mazzoli,

Chiari,

Vitolo

et al. 2024

IJERPH

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“…In another review of published studies on diabetic patients with MCI, their reduced rate of cognitive decline was clearly shown as being due to the treatment of diabetes since the RR in four studies was 0.53 when individuals taking medications were compared with those not taking them [ 16 ]. It is notable that prediabetes, defined as HbA1c 5.7–6.4%, did not predict subsequent dementia for the 11,656 participants of the Atherosclerosis Risk in Communities (ARIC) study [ 17 ]. In that study, an earlier age of onset of diabetes had the strongest association with dementia as follows: for onset before 60 years, HR 2.92; for onset at 60–69 years, HR 1.73; and for onset at 70–79 years, HR 1.23.…”

Section: Diabetes Insulin Resistance and Admentioning

confidence: 99%

Formulating Treatment to Cure Alzheimer’s Dementia: Approach #2

Fessel

2024

IJMS

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There are two generic approaches to curing any medical condition. The first one treats every patient for all the known possible causes that contribute to pathogenesis; the second one individualizes potentially curative therapy by only identifying in each separate patient the components of pathogenesis that are actually operative and treating those. This article adopts the second approach for formulating a cure for Alzheimer’s dementia (AD). The components of AD’s pathogenesis are, in alphabetical order, as follows: circadian rhythm disturbances, depression, diabetes and insulin resistance, dyslipidemia, hypertension, inflammation, metabolic syndrome, mitochondrial dysfunction, nutritional deficiencies, TGF-β deficiency, underweight, vascular abnormalities, and Wnt/β-catenin deficiency. For each component, data are described that show the degree to which its prevalence is higher in patients with mild cognitive impairment (MCI) who did not revert to having normal cognition than in those who did because the former group is the pool of patients in which future AD may develop. Only addressing the components that are present in a particular individual potentially is a curative strategy. Published data indicate that curative therapy requires the number of such components that are addressed to be ≥3. Although structural brain changes cannot be directly addressed, the impaired neural tracts result from many of the reversible causal elements, so correcting them will benefit these tracts.

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“…It has been observed that the HR increases with higher glucose levels [ 122 ]. People diagnosed with diabetes before the age of 60 were found to have a threefold increased risk of dementia [ 123 ] and in adults with T2D aged 70 years or older using CGM, a higher time above range (TAR) was found associated with cognitive impairment of both executive and working memories [ 124 ]. Importantly, glycemic variability and time below range (TBR) were not found associated with any cognitive function [ 124 ].…”

Section: Key Topics Discussed During the 9th Cvot Summitmentioning

confidence: 99%

CVOT Summit Report 2023: new cardiovascular, kidney, and metabolic outcomes

Schnell,

Barnard-Kelly,

Battelino

et al. 2024

Cardiovasc Diabetol

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The 9th Cardiovascular Outcome Trial (CVOT) Summit: Congress on Cardiovascular, Kidney, and Metabolic Outcomes was held virtually on November 30-December 1, 2023. This reference congress served as a platform for in-depth discussions and exchange on recently completed outcomes trials including dapagliflozin (DAPA-MI), semaglutide (SELECT and STEP-HFpEF) and bempedoic acid (CLEAR Outcomes), and the advances they represent in reducing the risk of major adverse cardiovascular events (MACE), improving metabolic outcomes, and treating obesity-related heart failure with preserved ejection fraction (HFpEF). A broad audience of endocrinologists, diabetologists, cardiologists, nephrologists and primary care physicians participated in online discussions on guideline updates for the management of cardiovascular disease (CVD) in diabetes, heart failure (HF) and chronic kidney disease (CKD); advances in the management of type 1 diabetes (T1D) and its comorbidities; advances in the management of CKD with SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists (nsMRAs); and advances in the treatment of obesity with GLP-1 and dual GIP/GLP-1 receptor agonists. The association of diabetes and obesity with nonalcoholic steatohepatitis (NASH; metabolic dysfunction-associated steatohepatitis, MASH) and cancer and possible treatments for these complications were also explored. It is generally assumed that treatment of chronic diseases is equally effective for all patients. However, as discussed at the Summit, this assumption may not be true. Therefore, it is important to enroll patients from diverse racial and ethnic groups in clinical trials and to analyze patient-reported outcomes to assess treatment efficacy, and to develop innovative approaches to tailor medications to those who benefit most with minimal side effects. Other keys to a successful management of diabetes and comorbidities, including dementia, entail the use of continuous glucose monitoring (CGM) technology and the implementation of appropriate patient-physician communication strategies. The 10th Cardiovascular Outcome Trial Summit will be held virtually on December 5–6, 2024 (http://www.cvot.org).

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Prediabetes, intervening diabetes and subsequent risk of dementia: the Atherosclerosis Risk in Communities (ARIC) study

Cited by 9 publications

References 34 publications

Atrial Fibrillation and Other Cardiovascular Factors and the Risk of Dementia: An Italian Case–Control Study

Atrial Fibrillation and Other Cardiovascular Factors and the Risk of Dementia: An Italian Case–Control Study

Formulating Treatment to Cure Alzheimer’s Dementia: Approach #2

CVOT Summit Report 2023: new cardiovascular, kidney, and metabolic outcomes

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