Dementia

Posted on Dementia, Diabetes

Earlier diabetes diagnosis linked to dementia risk

Adults diagnosed with type 2 diabetes in mid-life—before age 50—more likely to develop dementia
Adults diagnosed with type 2 diabetes in mid-life—before age 50—are more likely to develop dementia.

Individuals diagnosed with type 2 diabetes at a younger age face a greater risk of developing dementia compared to those diagnosed later in life, according to research conducted by experts at the NYU Rory Meyers College of Nursing.

“Our study indicates that early-onset type 2 diabetes may have cognitive consequences. It highlights the need for prevention strategies for dementia that take both diabetes and obesity into account,” said Xiang Qi, assistant professor at NYU Meyers and the study’s lead author.

Type 2 diabetes is a recognized risk factor for dementia. While the exact mechanisms behind this connection are not completely understood, researchers believe that certain characteristics of diabetes—such as high blood sugar levels, insulin resistance, and inflammation—may contribute to the onset of dementia in the brain.

Type 2 diabetes, once common among older adults, is now increasingly seen in younger individuals. Currently, one in five people with type 2 diabetes globally is under 40 years old.

To investigate how the timing of a type 2 diabetes diagnosis is associated with the risk of developing dementia, a research team analyzed data from the Health and Retirement Study, conducted by the University of Michigan Institute for Social Research. The study, published in PLOS ONE, included 1,213 U.S. adults aged 50 and older who had type 2 diabetes confirmed by blood tests and did not have dementia when they entered the study. The participants were followed for up to 14 years, during which 216 individuals (17.8%) developed dementia, as determined by follow-up telephone interviews.

The researchers found that adults diagnosed with type 2 diabetes at younger ages were at increased risk for developing dementia compared to those diagnosed at 70 years or older. Adults diagnosed with diabetes before age 50 were 1.9 times as likely to develop dementia as those diagnosed at 70 and older, while those diagnosed between 50-59 years were 1.72 times as likely and those diagnosed between 60-69 years were 1.7 times as likely.

Using linear trend tests, the researchers found a graded association between age at diagnosis and dementia risk: for each year younger a person is at the time of their type 2 diabetes diagnosis, their risk for developing dementia increases by 1.9%.

“While we do not know for sure why an earlier diabetes diagnosis would increase the risk for dementia, prior studies show that people diagnosed with type 2 diabetes in mid-life may experience more vascular complications, poor blood sugar control, and insulin resistance—all of which are known risk factors for cognitive impairment,” said Bei Wu, the Dean’s Professor in Global Health and vice dean for research at NYU Meyers and the study’s senior author.

In addition, obesity appeared to influence the relationship between type 2 diabetes and dementia. Individuals with obesity who were diagnosed with type 2 diabetes before age 50 had the highest dementia risk in the study.

The researchers note that this greater understanding of the connection between diabetes onset, obesity, and dementia may help inform targeted interventions to prevent dementia.

“Our study highlights the importance of one’s age at diabetes diagnosis and suggests that specifically targeting obesity—whether through diet and exercise or perhaps medication—may play a role in staving off dementia in younger adults with diabetes,” said Wu.

Posted on Cognitive dysfunction, Dementia, Diabetes, Diet, Obesity

Restricting sugar consumption in utero and in early childhood significantly reduces risk of midlife chronic disease

New research shows combined use of sodium glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) is likely to offer additional protection against heart and kidney disease in patients with diabetes

A new study has found that a low-sugar diet in utero and in the first two years of life can meaningfully reduce the risk of chronic diseases in adulthood. This provides compelling new evidence of the lifelong health effects of early-life sugar consumption.

A study published in the journal Science reveals that children who had sugar restrictions during their first 1,000 days after conception faced up to a 35% lower risk of developing Type 2 diabetes and a 20% reduced risk of hypertension in adulthood. The research indicates that low sugar intake by mothers during pregnancy was sufficient to lower these health risks, and maintaining sugar restrictions after birth further enhanced the benefits.

Using an unintended “natural experiment” from World War II, researchers at the USC Dornsife College of Letters, Arts and Sciences, McGill University in Montreal, and the University of California, Berkeley, examined how sugar rationing during the war influenced long-term health outcomes.

The United Kingdom introduced limits on sugar distribution in 1942 as part of its wartime food rationing program. Rationing ended in September 1953.

The researchers used contemporary data from the U.K. Biobank, a database of medical histories and genetic, lifestyle and other disease risk factors, to study the effect of those early-life sugar restrictions on health outcomes of adults conceived in the U.K. just before and after the end of wartime sugar rationing.

“Studying the long-term effects of added sugar on health presents challenges,” explains Tadeja Gracner, a senior economist at the USC Dornsife Center for Economic and Social Research and the study’s corresponding author. “It is difficult to identify situations where individuals are randomly exposed to different nutritional environments early in life and tracked over a span of 50 to 60 years. The end of rationing provided us with a unique natural experiment that helped us overcome these obstacles.”

On average, during rationing, sugar intake was about 8 teaspoons (40 grams) per day. When rationing ended, sugar and sweets consumption skyrocketed to about 16 teaspoons (80 grams) per day. 

Notably, rationing did not involve extreme food deprivation overall. Diets generally appeared to have been within today’s guidelines set by the U.S. Department of Agriculture and the World Health Organization, which recommend no added sugars for children under two and no more than 12 teaspoons (50g) of added sugar daily for adults. 

The immediate and large increase in sugar consumption but no other foods after rationing ended created an interesting natural experiment: Individuals were exposed to varying levels of sugar intake early in life, depending on whether they were conceived or born before or after September 1953. Those conceived or born just before the end of rationing experienced sugar-scarce conditions compared to those born just after who were born into a more sugar-rich environment.

The researchers then identified those born in the U.K. Biobank data collected over 50 years later. Using a very tight birth window around the end of sugar rationing allowed the authors to compare midlife health outcomes of otherwise similar birth cohorts.  

While living through the period of sugar restriction during the first 1,000 days of life substantially lowered the risk of developing diabetes and hypertension, for those later diagnosed with either of those conditions, the onset of disease was delayed by four years and two years, respectively. 

Notably, exposure to sugar restrictions in utero alone was enough to lower risks, but disease protection increased postnatally once solids were likely introduced. 

The researchers say the magnitude of this effect is meaningful as it can save costs, extend life expectancy, and, perhaps more importantly, improve quality of life.

In the United States, individuals with diabetes face average annual medical expenses of approximately $12,000. Additionally, an earlier diagnosis of diabetes is associated with a significantly reduced life expectancy; specifically, for each decade that diagnosis occurs earlier, life expectancy decreases by three to four years.

The researchers note that these numbers underscore the value of early interventions that could delay or prevent this disease.

Experts continue to raise concerns about children’s long-term health as they consume excessive amounts of added sugars during their early life, a critical period of development. Adjusting child sugar consumption, however, is not easy—added sugar is everywhere, even in baby and toddler foods, and children are bombarded with TV ads for sugary snacks, say the researchers.

“Parents need information about what works, and this study provides some of the first causal evidence that reducing added sugar early in life is a powerful step towards improving children’s health over their lifetimes,” says study co-author Claire Boone of McGill University and University of Chicago.  

Co-author Paul Gertler of UC Berkeley and the National Bureau of Economics Research adds: “Sugar early in life is the new tobacco, and we should treat it as such by holding food companies accountable to reformulate baby foods with healthier options and regulate the marketing and tax sugary foods targeted at kids.” 

This study is the first of a larger research effort exploring how early-life sugar restrictions affected a broader set of economic and health outcomes in later adulthood, including education, wealth, and chronic inflammation, cognitive function and dementia. 

Posted on Alzheimer's, Dementia, Diabetes, Parkinson's Disease

Some diabetes drugs tied to lower risk of dementia, Parkinson’s disease

A randomized, controlled trial led by Mass General Brigham researchers demonstrates that cognitive behavioral therapy can significantly reduce the impact of fibromyalgia pain

A study suggests that a certain class of drugs used to treat diabetes may be linked to a reduced risk of dementia and Parkinson’s disease.

The study examined SGLT2 inhibitors, also known as gliflozins, which lower blood sugar by prompting the kidneys to excrete sugar through urine.

“We are aware that neurodegenerative diseases such as dementia and Parkinson’s disease are becoming more prevalent as the population ages. People with diabetes are at a higher risk of cognitive impairment. It is encouraging to see that this category of drugs may offer some protection against dementia and Parkinson’s disease,” stated study author Minyoung Lee, MD, PhD, from Yonsei University College of Medicine in Seoul, South Korea.

The retrospective study examined individuals with type 2 diabetes who initiated diabetes medication from 2014 to 2019 in South Korea. Individuals using SGLT2 inhibitors were compared with those using other oral diabetes drugs, ensuring that the two groups had similar ages, other health conditions, and diabetes-related complications. The researchers then monitored the participants to determine whether they developed dementia or Parkinson’s disease. The individuals taking SGLT2 inhibitors were monitored for an average of two years, while those taking the other drugs were monitored for an average of four years.

Among the 358,862 participants with an average age of 58, 6,837 people developed dementia or Parkinson’s disease during the study. For Alzheimer’s disease, the incidence rate for people taking SGLT2 inhibitors was 39.7 cases per 10,000 person-years, compared to 63.7 cases for those taking other diabetes drugs. Person-years represent both the number of people in the study and the amount of time each person spends in the study. For vascular dementia, which is dementia caused by vascular disease, the incidence rate for people taking the SGLT2 drugs was 10.6 cases per 10,000, compared to 18.7 for those taking the other drugs. For Parkinson’s disease, the incidence rate for those taking the SGLT2 drugs was 9.3 cases per 10,000, compared to 13.7 for those taking the other drugs. After researchers adjusted for other factors that could affect the risk of dementia or Parkinson’s disease, such as complications from diabetes and medications, they found that SGLT2 inhibitor use was associated with a 20% reduced risk of Alzheimer’s disease and a 20% reduced risk of Parkinson’s disease. Those taking the drugs had a 30% reduced risk of developing vascular dementia.

Posted on Dementia, Diabetes

“A healthy lifestyle may help counteract the effects of ageing on the brain associated with diabetes.”

Type 2 diabetes and prediabetes are associated with accelerated brain ageing, according to a new study from Karolinska Institutet in Sweden published in the journal Diabetes Care. The good news is that this may be counteracted by a healthy lifestyle.
Type 2 diabetes and prediabetes are linked to accelerated brain aging, according to a recent study from Karolinska Institutet in Sweden, published in the journal Diabetes Care. The good news is that a healthy lifestyle may help counteract this effect.

It is known that type 2 diabetes is a risk factor for dementia, but the impact of diabetes and its early stages, known as prediabetes, on brain aging in individuals without dementia is unclear. A recent comprehensive brain imaging study indicates that both diabetes and prediabetes may be associated with accelerated brain aging.

The study involved over 31,000 individuals aged between 40 and 70 from the UK Biobank who had undergone a brain MRI scan (magnetic resonance imaging). The researchers utilized a machine learning approach to calculate the brain age in comparison to the individual’s actual age.

Sure! Here’s the revised text:People with prediabetes were found to have brains that appeared 0.5 years older than their actual age, while those with diabetes had brains that appeared 2.3 years older. For individuals with poorly controlled diabetes, their brains looked more than four years older than their actual age. The researchers also observed that the difference between brain age and actual age slightly increased over time for people with diabetes. However, these associations were less pronounced in individuals with high levels of physical activity who did not smoke or consume large amounts of alcohol.

“Having a brain that appears older than one’s chronological age can indicate a deviation from the normal aging process and may serve as an early warning sign for dementia,” says Abigail Dove, the lead author of the study and a PhD student at the Department of Neurobiology, Care Sciences and Society at the Karolinska Institutet. “On the positive side, it seems that individuals with diabetes may be able to positively influence their brain health through healthy living.”

Repeated MRI data were available for only a small percentage of the study participants. Follow-up MRI scans are ongoing, and researchers are now continuing to study the link between diabetes and brain aging over time.

“There’s a high and growing prevalence of type 2 diabetes in the population,” says Abigail Dove. “We hope that our research will help prevent cognitive impairment and dementia in people with diabetes and prediabetes.”

Posted on Alzheimer's, Dementia, Diabetes

“Diabetes drugs may help prevent dementia.”

Metformin highly effective in targeting diabetes and some cancers but potentially dangerous with others

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, which are used to treat type 2 diabetes, may have the potential to prevent dementia, offering increased benefits with prolonged use, according to a large study from Korea published by The BMJ.

As this study was observational, the researchers note that the effect size could have been overestimated. They say randomised controlled trials are now necessary to confirm these findings.

According to the World Health Organization, the global number of people with dementia is expected to reach 78 million by 2030, and there is an association between type 2 diabetes and a higher risk of developing dementia.

A recent study of individuals over 65 with type 2 diabetes suggested a lower risk of dementia associated with SGLT-2 inhibitors compared to another type of diabetes drug, dipeptidyl peptidase-4 (DPP-4) inhibitors. However, the impacts on younger individuals and specific types of dementia (such as Alzheimer’s disease and vascular dementia) are still not fully understood.

Researchers used the Korea National Health Insurance Service database to identify 110,885 pairs of adults aged 40-69 with type 2 diabetes. The adults were free of dementia and began taking either an SGLT-2 inhibitor or a DPP-4 inhibitor between 2013 and 2021.

All participants (with an average age of 62; 56% of whom were men) were matched by age, sex, use of the diabetes drug metformin, and baseline cardiovascular risk. They were followed up for an average of 670 days to determine the development of dementia.

Potentially influential factors, such as personal characteristics, income level, underlying risk factors for dementia, other conditions, and related medication use, were also considered.

During the follow-up period, a total of 1,172 participants who had been newly diagnosed with dementia were identified.

Dementia rates per 100 person-years were 0.22 for those using SGLT-2 inhibitors and 0.35 for those using DPP-4 inhibitors. This corresponds to a 35% reduced risk of dementia associated with the use of SGLT-2 inhibitors compared with DPP-4 inhibitors.

The researchers also found a 39% reduced risk for Alzheimer’s disease, and a 52% reduced risk for vascular dementia associated with SGLT-2 inhibitors compared with DPP-4 inhibitors.

What’s more, the effect of SGLT-2 inhibitors seemed more pronounced with longer treatment duration. A 48% reduced risk of dementia was seen for more than two years of treatment versus a 43% reduced risk for two years or less.

“This study is observational, so no definite conclusions can be made about cause and effect. The authors also mention that specific details about health behaviors (such as smoking and alcohol consumption) and the duration of type 2 diabetes were not fully available.”

However, the researchers emphasize that this was a significant study based on nationally representative data, which included relatively younger individuals with type 2 diabetes, and the results were highly consistent across subgroups.

As such, they say SGLT-2 inhibitors might prevent dementia, providing greater benefits with longer treatment, and they call for randomised controlled trials to confirm these findings.

Researchers from Taiwan stated in a connected editorial that this study presents encouraging results with significant implications for clinical practice and public health.

They agree that further trials are needed to confirm these findings, and suggest that studies are also needed “to explore the underlying mechanisms of any neuroprotective effects of SGLT-2 inhibitors.”

As no cure currently exists for dementia and few effective treatment options are available, strategies that can potentially prevent onset are critically important, they write. 

The substantial socioeconomic and public health burdens associated with both dementia and type 2 diabetes highlight the need for regular updates to clinical guidelines and healthcare policies. These updates should incorporate the latest evidence on the potential benefits of SGLT-2 inhibitors, including the reduced risk of dementia.