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P4‐418: PLASMA ENDOTOXEMIA, INFLAMMATION AND LONG‐TERM RISK OF ALZHEIMER'S DISEASE AMONG ELDERLY COMMUNITY‐DWELLERS
Author(s) -
André Perrine,
Samieri Cécilia,
Buisson Charline,
Dartigues Jean-François,
Helmer Catherine,
Laugerette Fabienne,
Féart Catherine
Publication year - 2019
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.2019.06.4090
Subject(s) - medicine , odds ratio , systemic inflammation , immunology , inflammation , disease , dementia , pathogenesis , dysbiosis , confounding , gut flora , lipopolysaccharide , case control study , trem2 , cohort , microglia
Background: Although diabetes has been linked to stroke, the effect of diabetes on post-stroke dementia remains controversial. We aimed to examine the association of diabetes with stroke and post-stroke dementia. Methods: In a Swedish population-based cohort study of dementia-free participants aged 60, a strokefree cohort (n1⁄42510) and a stroke cohort (n1⁄4145) were identified at baseline and followed up to 12 years to detect incident stroke and/or dementia cases. Stroke was identified based on the national patient registry. Dementia was clinically diagnosed by physicians based on standard criteria. Post-stroke dementia was defined when dementia occurred at least 3 months after index stroke. Diabetes was ascertained based on medical history, medication use, medical records or glycated hemoglobin (HbA1c) 6.5%. Prediabetes was ascertained by HbA1c>5.7% in diabetes-free participants. Results: During the follow-up, in the stroke-free cohort, 248 people developed ischemic stroke, of them 48 patients developed dementia. Diabetes led to a multi-adjusted hazard ratios (HRs) of 1.83 (95% CI 1.22-2.57) for ischemic stroke, 4.17 (95% CI 1.76-9.88) for dementia with stroke, and 1.28 (95% 0.94-2.69) for dementia without stroke. Among the incident stroke cases, diabetes was related to higher risk of dementia (HR 4.11; 95%CI 1.908.48), and accelerated the progression from stroke to dementia by 1.5 years. In the stroke cohort, 35 persons developed dementia, and the HR of dementia related to diabetes was 3.17 (95% CI 1.31-7.65). Prediabetes was not statistically related to ischemic stroke or post-stroke dementia. Conclusions: Diabetes, not prediabetes, is associated with an increased risk of ischemic stroke and post-stroke dementia. Diabetes may anticipate dementia occurrence by 1.5 years in patients with stroke.