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F3‐01‐02: Type 2 diabetes and incidence of dementia and cognitive decline: what are the mechanisms?
Author(s) -
Haan Mary N.
Publication year - 2009
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.2009.05.390
Subject(s) - dementia , cognitive decline , blood pressure , medicine , diabetes mellitus , type 2 diabetes , obesity , stroke (engine) , subclinical infection , gerontology , endocrinology , disease , mechanical engineering , engineering
Background: Type 2 diabetes has been associated with higher rates of dementia and more rapid cognitive decline in a number of studies. Elevated central body obesity (CBO) and hypertension are potential mechanisms that may account for this association. CBO is known to increase insulin and related metabolites which may increase the risk of neurodegeneration. Hypertension has a direct effect on both subclinical and clinical stroke. Obesity is linked to increased risk of hypertension. A complex set of relationships exist between these factors and cognitive decline and dementia. Mexican Americans (MAs) experience a higher prevalence of obesity, type 2 diabetes and untreated hypertension than non Hispanic Whites so are at higher risk for dementia. Methods: In a cohort of 1789 older MAs followed over 12 years, this paper will examine how both obesity and blood pressure change over time and modify the effects of type 2 diabetes on dementia incidence and cognitive decline. Trajectories of change in both CBO and blood pressure will be modeled for their impact on cognitive function. Moderation of these effects by type 2 diabetes status will be examined. Results: Initial results suggest that those with an increase in BP or who maintain a high blood pressure, experience 50% more rapid decline over time. Type 2 diabetics with a high blood pressure or declining blood pressure over time experience a significantly greater rate of cognitive decline than non diabetics (P interaction between DM2 and blood pressure trajectory 1⁄4 0.008). Treatment with medication attenuates this association. Conclusions: These findings imply that effective hypertension treatment could prevent or mitigate cognitive impairments associated with type 2 diabetes.