title: Diabetes mellitus as a modulator of functional impairment and decline in Alzheimer's disease. The Real.FR cohort.
abstract: OBJECTIVE
  To determine whether diabetes mellitus influences functional status in patients with Alzheimer's disease.
  
  
  METHODS
  We studied 608 community-dwelling patients with Alzheimer's disease from a prospective multicenter cohort. Diabetes was assessed at baseline. Functional status was assessed twice yearly with the Activities of Daily Living scale. Each patient had a baseline functional disability if their Activities of Daily Living score was < 6. Progression of functional disability was defined by a decreased Activities of Daily Living score over 4 years of follow-up visits.
  
  
  RESULTS
  At baseline, diabetes was present in 63 participants (10.4%) and, compared with those without diabetes, was associated with functional impairment [age- and sex-adjusted OR = 2.73 (95% CI 1.41-5.28)]. After controlling for confounders, the association remained significant [OR = 2.04 (95% CI 1.02-4.11)]. Follow-up demonstrated a significant interaction between duration of Alzheimer's disease and diabetes, which was associated with progression of functional impairment in patients who had been diagnosed with Alzheimer's disease for less than 1 year [age- and sex-adjusted hazard ratio = 1.52 (95% CI 1.01-2.30), P = 0.048], but not in those who had been diagnosed with Alzheimer's disease for more than 1 year [age- and sex-adjusted hazard ratio = 0.78 (95% CI 0.47-1.28), P = 0.32]. Abnormal one-leg balance, polymedication and obesity seem to be important factors explaining the association between diabetes and functional status.
  
  
  CONCLUSIONS
  At baseline, the presence of diabetes significantly increases the risk of functional disability in patients with Alzheimer's disease; our longitudinal data confirm that in patients with a recent diagnosis of Alzheimer's disease (but not in those who have had Alzheimer's disease for longer than 1 year), diabetes continues to worsen functional status.
authors.affiliation: Department of Diabetology, Metabolic Diseases and Nutrition, CHU Toulouse, France. carolinesanz@hotmail.fr
authors.forename: C M
authors.initials: CM
authors.lastname: Sanz
authors.forename: H
authors.initials: H
authors.lastname: Hanaire
authors.forename: B J
authors.initials: BJ
authors.lastname: Vellas
authors.forename: A J
authors.initials: AJ
authors.lastname: Sinclair
authors.forename: S
authors.initials: S
authors.lastname: Andrieu
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000097:blood / Q000503:physiopathology*; D003071:Cognition; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009765:Obesity / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D004856:Postural Balance; D011446:Prospective Studies; D012307:Risk Factors