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P2‐189: Peripherial arterial disease and long‐term risk of dementia: The role of vascular injury in diabetes
Author(s) -
Exalto Lieza,
Biessels Geert Jan,
Quesenberry Charles,
Whitmer Rachel
Publication year - 2012
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.2012.05.895
Subject(s) - medicine , dementia , diabetes mellitus , vascular dementia , vascular disease , population , hazard ratio , cohort , disease , surgery , endocrinology , confidence interval , environmental health
Background: Peripheral arterial disease (PAD) is an important vascular complication of diabetes. Previous studies have found that PAD defined as a low ankle-brachial index is a risk factor for dementia in the general population; however the association between the clinical diagnosis of PAD and incident dementia risk in people with diabetes is unknown. Methods: We conducted a prospective cohort study of 26,221 members of the Kaiser Permanente of Northern California Diabetes Registry; a well characterized group of patients with type 2 diabetes mellitus established in 1994. PAD was identified between 1/1/96-1/1/98 ("baseline") via ICD-9 codes for the following inpatient diagnoses: atherosclerosis and aneurysms of the arteries of the abdomen and extremities. Initial dementia diagnoses were collected from primary care and neurology visits between 1/1/98-1/1/08 (Alzheimer’s Disease, vascular dementia, senile dementia uncomplicated & dementia not otherwise specified). The association between PAD and time to dementia diagnosis was assessed with Cox proportional hazard models (age as timescale) with censoring for mortality or membership lags. The models were adjusted for age, gender, race, education and in addition separately for medical utilization, several diabetes mellitus (DM) associated factors (duration, HbA1c, treatment, hyperglycemia, hypoglycaemia) and several vascular factors (hypertension, hyperlipidemia, BMI, smoking, cerebrovascular disease, peripheral arterial disease). Results: 1842 (7.0%) patients had PAD at baseline and 4492 (17.1%) were diagnosed with dementia during the 10 year follow-up period. Patients with PAD had a 72% increase in risk of dementia compared to patients without PAD (sociodemographics and medical utilization adjusted hazards ratio (HR)1⁄4 1.72, 95% confidence intervals (CI) 1.541.92). Further adjustments for DM associated factors show similar results (HR1⁄4 1.58, CI 1.40-1.79), whereas further adjustments for vascular factors shows a slight attenuation of the association (HR1⁄4 1.40, CI 1.23-1.59). Sociademographics, medical utilization and cerebrovascular disease adjusted HR was 1.52 with a CI 1.36-1.70. Conclusions: Elderly diabetic patients with PAD have a large increase in risk of incident dementia, independent of sociodemographic factors and DM associated factors. Other vascular comorbidities, especially cerebrovascular disease attenuated the association.The association between dementia risk and PAD in DM may reflect a potential etiological role of vascular injury in dementia in diabetes.