Diabetes is associated with a slower rate of cognitive decline in Alzheimer disease.
BACKGROUND
Previous epidemiologic studies indicate that diabetes mellitus (DM) is associated with cognitive decline and an increased risk of developing Alzheimer disease (AD) in people who do not have dementia. However, little is known about the effect of DM on the rate of cognitive decline in established AD. Our objective was to determine whether DM influences the rate of cognitive decline in patients with AD.


METHODS
A total of 608 patients with a probable diagnosis of AD and a Mini-Mental State Examination (MMSE) score between 10 and 26 were enrolled in a prospective multicenter study. Participants were followed up to 52 (mean 26) months. DM was assessed at baseline (history of DM or antidiabetic medication use). Cognitive function was assessed twice yearly with the MMSE.


RESULTS
Sixty-three participants (10.4%) had DM at baseline. In a mixed model adjusted for sex, age, educational level, dementia severity, cholinesterase inhibitor use, and vascular factors (hypertension, atrial fibrillation, coronary heart disease, and hypercholesterolemia), there were no differences between the groups in MMSE baseline scores (-0.75, p = 0.20), but cognitive decline was slower in the group with DM (0.38, p = 0.01).


CONCLUSIONS
In a cohort of community-dwelling patients with Alzheimer disease (AD), the presence of diabetes mellitus (DM) was associated with a lower rate of cognitive decline. Future studies will need to address the potential impact of DM in the cerebral aging process and to assess the neuropathologic variations in patients with AD with DM.
Sanz
C
C
INSERM U558, 37 allées Jules Guesde, 31073 Toulouse, France. carolinesanz@hotmail.fr
Andrieu
S
S
Sinclair
A
A
Hanaire
H
H
Vellas
B
B
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D009483:Neuropsychological Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D007004:Hypoglycemic Agents