Type 1 Diabetes Linked to Increased Dementia Risk
August 30, 2016
Woman using glucometer for diabetes

Older patients with type 1 diabetes (T1D) have more than an 80% increased risk for dementia compared with those without diabetes, a new study suggests.

Previous research showed that older people with type 2 diabetes (T2D) have about a two-fold greater risk for dementia compared with people without diabetes, but the current study is the first to look at dementia risk in elderly adults with T1D.

“There has been a paucity of work in type 1 diabetes because only recently have they been living longer, and living long enough to be at risk for an age-related neurocognitive dysfunction,” Rachel Whitmer, PhD, senior scientist, Division of Research, Kaiser Permanente, Oakland, California, told Medscape Medical News.

Dr Whitmer presented the results here at the Alzheimer’s Association International Conference (AAIC) 2015.

Living Longer

The study included 490,344 persons aged 60 years and older who were members of Kaiser Permanente Northern California, none of whom had dementia. Of these, 334 had T1D.

Over a 12-year period, 16% of the patients with T1D were diagnosed with dementia compared with 12% of those without T1D.

Compared with participants without T1D, those with T1D were 83% more likely to get dementia (hazard ratio

, 1.83; 95% confidence interval [CI], 1.3 – 2.5) after adjustment for differences in age, sex, race, and vascular risk factors. After adjustments for stroke, peripheral artery disease, and hypertension, the HR was 1.61.

Another analysis excluded participants with T2D, which resulted in a somewhat larger dementia risk for those with T1D (HR, 1.93; 95% CI, 1.3 – 2.6). This fell to an HR of 1.73 (95% CI, 1.2 – 2.3) when fully adjusted.

Patients with T1D are now living longer, in large part because of changes in standard of care that were introduced in the 1990s. At that time, it became clear that tight glycemic control reduced complications of diabetes.

Older patients with T1D represent a unique population that has been little studied. “When these people reach old age or an age where they might be at risk of dementia, they have been living with this disease for an average of 40 years,” said Dr Whitmer.

T1D is different from other types of the disease in that it’s usually juvenile onset and requires insulin right away, so some participants in the study have been taking insulin for decades, according to Dr Whitmer. Patients with T1D tend to have more microvascular risk factors than those with T2D and have less adiposity, she said.

In contrast, patients with T2D are more likely to have macrovascular risk factors, such as end-stage renal disease or retinopathy, and a relatively high risk for stroke.

“Even though type 1 diabetes is a rare disease,” said Dr Whitmer, studying both diseases will help to understand how and why they are associated with dementia.

Another factor separating diabetes types is that even if the patients generally have taken good care of themselves, those with T1D are three times more likely to have had had hypoglycemic episodes, said Dr Whitmer.

“Part of taking good care of yourself is that you walk this tightrope between trying not to be hyperglycemic and trying not to be hypoglycemic, and we know from work we have done in type 2 diabetes that hypoglycemia, in particular very severe episodes that land you in the hospital emergency room, are strongly associated with dementia.”

Studying dementia risk in T1D may also shed new light on possible glycemic and vascular mechanisms for brain aging, she said.

Among the next steps for the researchers is to “figure out what is driving this,” said Dr Whitmer. “Is it hypoglycemia; is it microvascular risk factors; is it depression?”

Future work, she said, will “try to tease apart” dementia risk factors as well as any protective factors. Another research direction might be to determine the neuropathology — whether it’s Alzheimer’s disease or other forms of dementia that is raised in patients with T1D.

This work is becoming increasingly relevant as the incidence of both T1D (as well as other autoimmune disorders) and T2D is also increasing. For T2D, it’s likely driven by rising rates of obesity, but for T1D, it could be somehow related to lack of immune system stimulation.

According to anecdotal reports, the prevalence of a gene closely linked to T1D is the same in Finland and nearby Russia, but Finland has a much higher rate of T1D. The difference, said Dr Whitmer, could be that Russia has a higher infection rate and therefore the immune system of residents may be sufficiently stimulated.

Hypoglycemia the Culprit?

Asked to comment, Suzanne Craft, PhD, professor, Gerontology and Geriatric Medicine, Wake Forrest School of Medicine, Winston-Salem, North Carolina, and a member of the Alzheimer’s Association Medical and Scientific Advisory Council, said the connection between T1D and dementia risk may lie in the fact that this population is more likely to have hypoglycemia.

“The area of brain that supports memory — the hippocampus — is very dependent on having a constant supply of glucose and if that supply goes too low, it can cause damage to the cells in the hippocampus,” said Dr Craft. “I don’t think that the danger of low blood sugar is emphasized quite as much as it should be by physicians.”

It’s possible that younger patients with T1D today will be better managed than the participants in the current study. In that case, they may have fewer hypoglycemic episodes and possibly a better dementia risk profile.

On the other hand, hyperglycemia can cause inflammation and oxidative stress, which also negatively affect the hippocampus through a different pathway, said Dr Craft.

She also noted that T2D is increasing among children — a “scary fact,” she said — which raises the question about how this will affect their dementia risk in years to come.

Also contributing a comment was Maria Carrillo, PhD, chief science officer, Alzheimer’s Association. The study results raise the question about whether more vigilance is needed surrounding cognition in people with T1D as they age, said Dr Carrillo.

“Perhaps we should be doing more to ensure that their cognition is protected as much as possible; should they be engaging in more enrichment activities; should we be keeping an eye on their cognition from an earlier time point; should they perhaps get cognitive testing earlier, starting in their 40s and 50s in their primary care physician’s offices.”

Dr Whitmer receives funding from the National Institute on Aging.

Information source

New study finds dementia more common in African-Caribbean people
August 27, 2016

New study finds dementia more common in African-Caribbean people

RCPsych release

A UK study shows dementia is more common in older African-Caribbean people than in White people – and tends to affect African-Caribbean people at a younger age. The study, published online today by the British Journal of Psychiatry, is the largest study of dementia in the UK African-Caribbean population to date.


Researchers from UCL (University College London) studied 436 people over the age of 60 living in the north London borough of Haringey. Of these, 218 had migrated to the UK from a Caribbean island or Guyana. The remaining 218 participants were White and had been born in the UK.

All the study participants were screened to test if they showed signs of cognitive impairment. Those that did were invited for a longer interview, to see if they met the full diagnostic criteria for dementia.

The researchers found that the prevalence of dementia was significantly higher in the African-Caribbean group than the White group, when corrected for age and socioeconomic status. 9.6% of the people in the African-Caribbean Group (21 out of 218) were diagnosed with dementia, compared to only 6.9% (15 out of 218) of people in the White group. In addition, those African-Caribbean people who had dementia were nearly 8 years younger than those from the White group (they had a mean age of 79.1 years compared to 86.9 years).

The most common type of dementia among the participants was Alzheimer’s disease, which was diagnosed in 69% (25 out of the 36). 28% (10 out of the 36) had vascular dementia. Of the 10 people with vascular dementia, 9 were from the African-Caribbean population.

Lead researcher Dr Simon Adelman said: “Our study shows there is an increased prevalence of dementia in older people of African-Caribbean country of birth who are living in the UK. It also suggests that dementia affects African-Caribbean people at younger ages.”

Dr Adelman points out that their study does not explain why rates of dementia are higher in African-Caribbean people – further research is needed to investigate the risk factors. However, he believes the study does have important implications for how we provide care for people with dementia.

Dr Adelman said: “Older Black people in the UK are generally first-generation immigrants, and the largest of these groups are people of African-Caribbean descent. For the first time, many of this group have now reached retirement age. Healthcare staff working in both primary and secondary care need to be aware than dementia may occur more commonly, and at younger ages, in African-Caribbean people than White people. Our study also supports the move towards providing health and social care services based on people’s needs – not just on their age.”

Number of people with dementia in minority ethnic groups could rise seven fold by 2051
August 1, 2016

Number of people with dementia in minority ethnic groups could rise seven fold by 2051 and yet awareness and support is lacking

Estimated numbers of people with dementia in Black, Asian and Minority Ethnic (BAME) groups in England and Wales are far higher than previously thought yet their needs are often being overlooked.

This is according to a new report published today (Tuesday 2 July 2013). The All-Party Parliamentary Group on dementia’s inquiry ‘Dementia does not discriminate’ reports that there are nearly 25,000 people with dementia from BAME communities.

This number is set to increase seven-fold to over 170,000 by 2051. This is a significantly bigger leap than the two-fold increase expected amongst the rest of the population, as people who moved here between the 1950s and 1970s are reaching their 70s and 80s. Despite this increase, awareness of the condition in minority ethnic groups is low and current provision of appropriate support is lacking.

The APPG is now calling for Public Health England to raise awareness of dementia amongst minority ethnic groups by funding a pilot awareness campaign to inform communities about the condition whilst challenging existing stigma. ‘Dementia does not discriminate’ also urges commissioners to ensure appropriate dementia support services are provided in minority ethnic communities.

The APPG commissioned Ethnos – specialist in minority ethnic research – to interview carers, people with dementia and service providers to create new evidence which explores the experiences of people with dementia from BAME communities. ‘Dementia does not discriminate’ found that many did not receive a diagnosis of dementia, preventing them from having access to support and treatments that could help them live well with the condition. In addition to this, stigma surrounding the condition meant people with dementia and their families face social isolation, feeling unable to reach out for support. Amongst those who did seek help, there is generally felt to be a lack of culturally-sensitive dementia services. One Indian carer talked about their negative experience of visiting a local support service, feeling like they couldn’t relate to the activities and were unable to talk to people because of language barriers.

Gloria Bailey who runs the Make a Difference African Caribbean support group in Streatham said:

‘Having cared for my own husband when he had dementia, I understand the need to support both the person with dementia as well as the carer. In my group, I show tenderness and sensitivity towards people in my community affected by the condition, it can often be difficult to talk about dementia, but I encourage people to brave, I hope that other people will take the plunge and get help with the condition so as to improve their standard of living.’

In order to raise awareness and improve existing services for people from minority ethnic groups, the report also recommends:

  • Commissioners ensure local services meet the needs of people with dementia from minority ethnic groups, ensuring that specially designed services are provided locally to suit people from a diverse range of backgrounds
  • Public Health England should lead preventative work to protect people from BAME communities who are at greater risk from developing dementia
  • It’s important for ethnic community groups and specialist dementia services to share knowledge and expertise to improve the quality of services

The APPG on Dementia sought evidence from a range of people, including those with dementia and their carers, health and social care providers and practitioners, and experts in dealing with challenges that can arise for people living in minority groups. Commissioners and providers of dementia support services gave examples of services that have been tailored for people in minority groups.

Baroness Sally Greengross Chair of the APPG on Dementia, said:

‘Ageing populations in BAME groups in the UK mean dementia is a growing challenge. It’s frightening to think that dementia is set to affect thousands more people from ethnic minorities and yet society isn’t geared up to deal with this.

‘Our focus now should be on ensuring high quality dementia support is available to all once they’ve received a formal diagnosis. Making sure more services are tailored to meet the needs of people with dementia from ethnic minorities is the key to helping them achieve the best possible quality of life.’

Meers Syal

Actress and comedienne Meera Syal, who recently became an Alzheimer’s Society ambassador, is supporting the report. She said:

‘It was a shock when I found out a loved one had dementia, but what really made that time difficult was finding such a lack of appropriate care and support that caters for the needs of people from Asian communities. It’s vital that services are tailored to be meaningful and effective for people from all walks of life. Everyone wants the person that they love to have access to support that works for them.’

For more information about the inquiry and to read the findings in full, visit here alzheimers.org.uk/appginquiry

How Far We’ve Come in Alzheimer’s Research
Developments in Alzheimer Research

A worldwide quest is under way to find new treatments to stop, slow or even prevent Alzheimer’s. Because new drugs take years to produce from concept to market—and because drugs that seem promising in early-stage studies may not work as hoped in large-scale trials—it is critical that Alzheimer’s and related dementias research continue to accelerate.

Currently, there are five FDA-approved Alzheimer’s drugs that treat the symptoms of Alzheimer’s — temporarily helping memory and thinking problems in about half of the people who take them. But these medications do not treat the underlying causes of Alzheimer’s.

In contrast, many of the new drugs in development aim to modify the disease process itself, by impacting one or more of the many wide-ranging brain changes that Alzheimer’s causes. These changes offer potential “targets” for new drugs to stop or slow the progress of the disease. Many researchers believe successful treatment will eventually involve a “cocktail” of medications aimed at several targets, similar to current state-of-the-art treatments for many cancers and AIDS.

In this video, past and present members of the Alzheimer’s Association Medical and Scientific Advisory Council explore the progress we’ve made since Dr. Alois Alzheimer first described the disease more than a century ago.

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