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Alzheimer’s and Low Blood Sugar Can Trigger a Vicious Cycle

Low blood sugar episodes can increase the incidence of developing dementia, while dementia may increase the risk of having low blood sugar, creating a vicious cycle….

In a study composed of 783 diabetic patients, researchers found that elderly patients who were hospitalized for episodes of extreme hypoglycemia were twice as likely to develop dementia. Correspondingly, the diabetic patients with dementia were twice as likely to have a severe hypoglycemia episode. Essentially, both dementia and hypoglycemia increase one another. "This cycle leads to a decline in health," says Kristine Yaffe, MD of San Francisco Veterans Affair Medical Center.

The records of patients from a Memphis and Pittsburg hospital were studied. The age of participants in this study ranged from 70-79 years old at the time of enrollment and all patients were diagnosed with diabetes. These patients were followed for an average of12 years and occasionally were put through cognitive functioning tests. "Individuals with dementia or even those with milder forms of cognitive impairment may be less able to effectively manage complex treatment regimens for diabetes and less able to recognize the symptoms of hypoglycemia and to respond appropriately, increasing their risk of severe hypoglycemia," says Yaffe.

This means that physicians should seriously consider cognitive function with deciding what medications to prescribe in diabetic patients, especially in elderly individuals. Medications such as insulin secretagogues and sulfonylureas are known to have an increased risk for causing hypoglycemia. According to these studies, it would beneficial for elderly patients to avoid taking these medications so that hypoglycemic events can be avoided as best as possible.

Kristine Yaffe et al. Association Between Hypoglycemia and Dementia in a Biracial Cohort of Older Adults With Diabetes MellitusHypoglycemia and Dementia in Older Adults With DM. JAMA Internal Medicine, 2013; 1 DOI: 10.1001/jamainternmed.2013.6176