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Diabetes May Be an Early Indicator of Alzheimer’s Disease

What do alcohol consumption, smoking, obesity, and diabetes have in common…

Previous studies have shown that cardiovascular risk factors are linked to cognitive decline leading to Alzheimer’s disease and dementia. However, we don’t currently have effective treatments for Alzheimer’s disease, so the focus is on prevention. Being able to understand and provide patients with information about how different risk factors may affect their brain health may affect the patient’s outcomes and improve patient’s understanding of brain diseases.

The purpose of this study was to determine in a large cohort the cardiovascular and genetic risk factors associated with smaller volume in the hippocampus, precuneus, and posterior cingulate, and their association with declining cognitive performance in patients younger and older than 50 years of age. The study consisted of 1,629 participants who were divided into two age groups: 805 participants in the under age 50 group and 824 in the age 50 and older group. The researchers evaluated the participant’s data from the initial baseline visit, which included laboratory and clinical analysis and the follow-up visit seven years later where they underwent brain magnetic resonance imaging with automated volumetry and cognitive assessment with the Montreal Cognitive Assessment (MoCA).

The study found that smaller total brain volume was associated with alcohol use (standardized estimate, -0.04; P = .039) and diabetes (standardized estimate, -0.03; P = < .002), while smoking (standardized estimate, -0.04; P = .048) and obesity were linked with reduced volumes of the posterior cingulate cortex, which is the area of the brain connected with memory retrieval as well as emotional and social behavior. Lower hippocampal mass was linked to both alcohol consumption and smoking, where alcohol use, obesity, and high fasting blood glucose correlated with reduced precuneus size. Regression analysis showed associations between risk factors and segmental volumes, and associations between these volumes with cognitive performance in participants younger and older than 50 years.

The results of this study confirmed that lower cognitive test scores correlated with lower brain volumes in each area and also suggests that diminished hippocampal and precuneus volumes may be risk indicators for cognitive decline in patients 50 years and older. Smaller posterior cingulate volumes are better predictors for patients under the age of 50.

Practice Pearls:

  • Current treatments for Alzheimer’s disease are not very effective, therefore education on prevention may affect patient’s outcome and improve patient’s understanding of brain disease.
  • Smaller total brain volume was associated with alcohol use and diabetes, while smoking and obesity were linked with reduced volumes of the posterior cingulate cortex, which is connected with brain memory retrieval as well as emotional and social behavior.
  • Alcohol use, obesity, and high fasting blood glucose correlated with reduced precuneus size.

Srinivasa RN, Rossetti HC, Gupta MK, et al. “Cardiovascular Risk Factors Associated with Smaller Brain Volumes in Regions Identified as Early Predictors of Cognitive Decline.” Radiology. 2015; 142488.