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D2 – Dementia and Diabetes

Uncontrolled blood glucose seems to increase the risk of brain troubles.

Forgetfulness, bewilderment, problems with day-to-day tasks are a few hallmark signs of dementia. The repercussions of dementia being part of a person’s life can be both emotionally and physically taxing not only for the patient, but loved ones as well. Dementia distresses the way the brain routinely functions, and the onset of the illness can negatively affect an individual’s speech, memory, and aptitude to effectively complete daily responsibilities.

Particularly in the elderly, Alzheimer’s disease is typically the most common form of dementia; however, other factors greatly contribute to development of the condition. Dementia may strike individuals with inadequately managed diabetes, high blood pressure, high cholesterol and heart disease even harder, as these ailments increase the risk for ‘vascular dementia’—caused by a series of small strokes that severely injure or destroy brain tissue and inhibit oxygen from reaching the brain. Due to its rapid development and potential to trigger a stroke, symptoms of vascular dementia may develop unexpectedly or without warning, then stay constant for a period of time, and then abruptly become worse. Individuals with vascular dementia may even seem to get better for short intervals, only to get worse after the occurrence of one or more supplementary strokes. It is also probable for an individual to suffer from both vascular dementia and Alzheimer’s disease concurrently, creating opportunity for life-threatening complications.

Studies have consistently shown that individuals who have type 2 diabetes are more likely to develop dementia in comparison to those without. Being one of the most common metabolic disorders, type 2 diabetes allots for multiple pathological complications, which affect numerous organs, including the brain. Comparable to diabetes, glucose is not utilized appropriately in the brains of people with Alzheimer’s disease. This may be triggered by nerve cell deaths, which decrease the brain’s capability to translate messages. When considering vascular dementia, brain cells expire due to a lack or shortage of oxygen, averting brain cells from communicating with one another. The buildup of beta amyloid plaques in people with Alzheimer’s disease has also shown to hinder insulin receptors in the brain from doing their usual tasks. This directly influences insulin production and causes brain cells to become sensitive to insulin. This decrease in, or insensitivity to, insulin is one of the primary focuses of current research since it implies that the brains of individuals with Alzheimer’s disease are in a diabetic state.

One large observational study performed at the Institute of Medicine at the University of Gothenburg (Sweden) pooled more than 353,000 patients with type 2 diabetes who were monitored for the development of dementia for a span of 4.8 years. The study population was separated into six groups “according to baseline HbA1c: <6% (n = 118,433); 6% to <7% (n = 117,397); 7% to <8% (n = 49,049); 8% to <9% (n = 23,143); 9% to <10% (n = 9,096); ≥10% (n = 8,354).” The average age was about 68 years, with over half the patient population being male and the period of diabetes varying from 4 to 10 years. With the consideration of other variables, the study found that patients with a HbA1c level of 10.5% or greater were 50 percent more likely to be diagnosed with dementia in comparison to people with HbA1c levels of 6.5 percent or less. Likewise, patients who had a history of stroke were 40 percent more likely to have an overall deterioration in memory and thinking capacities.

Though the study did manage to show an association between higher glycemic levels and an increased risk of dementia, it failed to demonstrate a cause-and-effect relationship between dementia and diabetes. The study clearly demonstrated that having a higher BMI, high cholesterol and high blood pressure were the most significant factors associated with developing dementia. The most beneficial habits that patients with diabetes should develop in order to avoid complications that would lead to the development of dementia include checking their blood sugar regularly and taking any medications as prescribed. Regular physical activity, maintaining a healthy and balanced diet rich in vegetables, fruits, and foods low in saturated fat, and staying away from an excess consumption of alcohol, are critical in managing the disease state.

Practice Pearls:

  • There is a positive relationship between HbA1c and the risk of dementia in the average type 2 diabetes population, indicating the prevention of dementia with improved blood sugar control.
  • HbA1c >10% increased the risk for dementia in the majority of patients.
  • Maintaining an active lifestyle and continuous monitoring of blood sugar are key in avoiding developing dementia.

Diabetologia. “Improving blood sugar control could help prevent dementia in patients with type 2 diabetes, study suggests.” Piela, Rita. “Type 2 Diabetes, APOE Gene, and the Risk for Dementia and Related Pathologies.”American Diabetes Association. N.p., n.d. Web. 12 Jan. 2016.

Researched and prepared by Javeria Fayyaz, Doctor of Pharmacy Candidate LECOM College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE