Diabetes Plus Alzheimer's Gene Ups Dementia Risk
NEW YORK (Reuters Health) - Among individuals who carry the gene mutation associated with an increased risk of Alzheimer's disease, the risk of dementia is increased for those who also have diabetes.
Wednesday, January 16, 2008
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NEW YORK (Reuters Health) - Among individuals who carry the gene mutation associated with an increased risk of Alzheimer's disease, the risk of dementia is increased for those who also have diabetes, according to a study reported in the Archives of Neurology.
The study included 2,547 subjects who were an average of 75 years old and without dementia when they entered the trial between 1992 and 1994. There were 320 subjects with diabetes and 602 subjects who were carriers of apolipoprotein E epsilon-4 allele (APOE e-4).
Senior investigator Dr. Lenore J. Launer at the National Institute on Aging in Bethesda, Maryland, and colleagues diagnosed 411 new cases of dementia during an average follow-up of 5.4 years, including 207 cases of Alzheimer's disease, 58 cases of vascular dementia, and 132 cases of Alzheimer's disease with vascular dementia (mixed Alzheimer's disease).
The risk of dementia was calculated after accounting for the possible influence of age, race, years of education, cardiovascular risk factors, depression and stroke.
For participants with diabetes, the risk of Alzheimer's disease was increased by 62 percent. For those with APOE e-4, the risk was increased by 2.5-fold. The corresponding risks of mixed Alzheimer's disease was about the same.
Diabetes or APOE e-4 did not affect the risk of vascular dementia.
"When comparing the risk in those who had both diabetes and APOE e-4 with those who had either risk factor, the results suggest a synergistic interaction between the two risk factors," Launer's group reports.
The risk of Alzheimer's disease or mixed Alzheimer's disease for subjects with both conditions was increased by 5-fold and 4.2-fold, respectively.
The authors suggest that high blood sugar levels or reduced blood flow to the brain may increase the production or deposition of the beta-amyloid, one of the hallmarks of Alzheimer's disease, and that large- and small-vessel damage in the brain caused by diabetes may impede the clearance of beta-amyloid.
Regardless of the underlying mechanism, the finding that older persons with diabetes are at increased risk of dementia should be considered in the care of elderly diabetics, the authors advise.
SOURCE: Archives of Neurology, January 2008.
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