title: Differential subtypes of diabetic older adults diagnosed with Alzheimer's disease.
abstract: OBJECTIVE
  The clinical management of diabetic elderly patients with Alzheimer's disease (AD) is hindered by several difficulties. The present study aimed to clarify the clinical characteristics and pathophysiological properties of AD in diabetic older adults.
  
  
  METHODS
  A total of 91 patients with type 2 diabetes mellitus and 161 non-diabetic individuals who were diagnosed with AD were recruited. Diabetic patients were classified into two groups with glycated hemoglobin (HbA1c) < 7.0% or ≥ 7.0%. The demographics, cognition, daily-life function, metabolic changes, treatment, and behavioral and psychological symptoms of dementia (BPSD), as well as brain pathophysiology, were compared among the three groups.
  
  
  RESULTS
  Patients with higher HbA1c had increased diabetic vascular complications and impaired activities of daily living with decreased levels of serum high-molecular-weight adiponectin and 25-hydroxyvitamin D. Although cognitive status was similar among the three groups, BPSD, including apathy, overeating and excessive daytime sleeping appeared to be increased in the patients with HbA1c ≥ 7.0%. The frequency of apolipoprotein E4 carriers and of posterior cerebral hypoperfusion (AD-pattern) on single-photon emission computed tomography in poorly controlled diabetic subjects was similar to that in non-diabetic AD patients, whereas diabetic patients with HbA1c <7.0% included fewer apolipoprotein E4 carriers and fewer patients with an AD pattern on single-photon emission computed tomography.
  
  
  CONCLUSIONS
  Subtypes of older diabetic patients with AD were identified based on clinical features and brain pathophysiology. Physical and psychological complications of dementia are prevalent in patients with higher HbA1c. It seems likely that difficulties in the management of diabetes with AD are due not only to non-adherence to diabetes treatment, but also several symptoms and pathophysiological characteristics of dementia.
authors.affiliation: Center for Comprehensive Care and Research on Memory Disorders.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakurai
authors.forename: Shuji
authors.initials: S
authors.lastname: Kawashima
authors.forename: Shosuke
authors.initials: S
authors.lastname: Satake
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Miura
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Tokuda
authors.forename: Kenji
authors.initials: K
authors.lastname: Toba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003071:Cognition / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D006442:Glycated Hemoglobin
keywords: Alzheimer's disease; behavioral and psychological symptoms of dementia; diabetes; glycemic control; pathophysiology