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P4‐077: Relationship between diabetes and dementia in a population‐based study
Author(s) -
Helmer Catherine
Publication year - 2008
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2008.05.2142
Subject(s) - dementia , medicine , diabetes mellitus , vascular dementia , cohort , cohort study , population , stroke (engine) , risk factor , disease , alzheimer's disease , gerontology , endocrinology , environmental health , mechanical engineering , engineering
Background: Diabetes has been shown to be a risk factor of dementia in several studies. However, the impact of diabetes control is still unclear. The objective of this study was to evaluate the impact of diabetes, as well as diabetes control, on Alzheimer’s disease and vascular dementia. Methods: This study takes place within the Three City (3C) study, a communitybased cohort including 9,294 people over 65 in three urban areas in France, followed-up over a four-year period. Cognitive performances and dementia were actively screened and diagnosed at baseline and at the two and four-year follows-up. Diabetes was evaluated on self-reported diagnosis of diabetes and/or used of anti-diabetic medications and/or fasting blood glucose level. Glucose control was evaluated using glycated haemoglobin (HbA1c) measured at baseline within a sub-sample of the cohort (case cohort design). Analyses were performed using a Cox model controlled for age, gender, educational level, stroke, cardio-vascular pathology, vascular risk factors (alcohol, tobacco, high blood pressure, hyperlipemia and BMI). Results: Over the 4-year follow-up 257 incident dementia were diagnosed, including 184 Alzheimer’s disease and 58 vascular dementia. Among the 861 subjects initially classified as diabetics, 42 developed dementia (4.9% versus 2.8% among non-diabetics). After controlling for age, gender, education and vascular factors, diabetes was significantly associated with dementia (Relative Risk 1.6; 95% CI [1.1-2.3]). However, when focusing on Alzheimer’s disease this relationship was no longer significant (RR 1.4 [0.85-2.3]). Among diabetic subjects, an increased HbA1C was associated with dementia when controlled for socio-demographic characteristics and ApoE4 (RR 1.5 [1.08-2.2]; p 0.018). This association was unchanged and borderline significant after controlling for vascular factors (RR 1.6 [0.99-2.4]; p 0.0506) but was no longer significant after adjustment for wine consumption (RR 1.4 [0.82-2.3]). Conclusions: These results confirm an association between diabetes and dementia but not with Alzheimer’s disease. This study also suggests a potential benefit of glycaemic control among elderly diabetic to delay dementia.