20 Mar Diabetes Key Risk Factor for Cognitive Impairment in Late-Life

MedicalResearch.com Interview with:
Rosebud O Roberts, M.B., Ch.B.
Professor of Epidemiology
Professor of Neurology
Mayo Clinic

MedicalResearch.com: What are the main findings of the study?

Dr. Roberts: The onset of type two diabetes in midlife (before age 65 years)  is associated with brain pathology (subcortical brain infarctions, reduced hippocampal volume, reduced whole brain volume) in late-life. Early onset of diabetes also increases the risk of developing mild cognitive impairment  which is an intermediate stage between normal cognitive aging and dementia. Our findings suggest that loss of brain volumes may be an intermediate stage or a link between diabetes and cognitive impairment.

We also found that diabetes onset in late-life (after age 65 years), is also associated with brain pathology (cortical infarctions, reduced whole brain volume).

Finally, onset of hypertension in midlife, but not late-life, is associated with brain pathology in late- life.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Roberts: The association of late life onset of diabetes with brain pathology (infarctions and reduced whole brain volume) was unexpected. Since brain pathology that leads to cognitive impairment develops over several decades, there was a relatively shorter period of time between late-life onset of diabetes (compared to midlife onset) and when we determined brain pathology in late life. This suggests that the impact of diabetes on brain pathology is very important as we try to understand diseases that damage the brain.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Roberts: These findings suggest diabetes is a key risk factor for cognitive impairment in late-life. Strategic efforts should be made to prevent diabetes through healthy dietary habits and physical exercise, both of which reduce obesity and in turn reduce risk of diabetes.  Early detection through screening is very important for those at increased risk such as persons who are overweight or obese but have not yet been clinically diagnosed as having diabetes. These efforts should be made not only at the patient level by physicians, but also a the level of the general population including families, schools, communities.  Effective control of diabetes in patients who already have diabetes, will help reduce the severity of the disease, and thereby reduce the development of brain pathology, and prevent cognitive impairment in late life.

Citation:

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Roberts: To identify novel biomarkers that can help identify persons who are at increased risk of diabetes who may benefit from preventive efforts to reduce onset of diabetes, the development of brain pathology, and of subsequent cognitive impairment.

Association of type 2 diabetes with brain atrophy and cognitive impairment

Rosebud O. Roberts, MB, ChB, MS, David S. Knopman, MD, Scott A. Przybelski, BS, Michelle M. Mielke, PhD, Kejal Kantarci, MD, MS, Gregory M. Preboske, MS, Matthew L. Senjem, MS, Vernon S. Pankratz, PhD, Yonas E. Geda, MD, MSc, Bradley F. Boeve, MD, Robert J. Ivnik, PhD, Walter A. Rocca, MD, Ronald C. Petersen, MD, PhD and Clifford R. Jack Jr, MD

1. Published online before print March 19, 2014, doi: 10.1212/WNL.0000000000000269 Neurology 10.1212/WNL.0000000000000269

Last Updated on March 20, 2014 by Marie Benz MD FAAD