Risk factors for dementia with type 2 diabetes mellitus among elderly people in China

Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China.
Age and Ageing (Impact Factor: 3.64). 01/2013; 42(3). DOI: 10.1093/ageing/afs188
Source: PubMed


to investigate the prevalence and risk factors of diabetes to dementia and its subtypes such as Alzheimer disease (AD) and vascular dementia (VD) among the Chinese elderly population.

among 8,213 Chinese people aged 65 years and older, 1,109 subjects with type 2 diabetes millitus (T2DM) were ascertained by interview and direct glucose testing. All diabetic subjects were initially screened with the "DSM-IV criteria" for dementia and its subtypes. We compared the prevalence of dementia in diabetic patients with that in ordinary subjects, and analyzed the association of the status of diabetes with dementia including AD and VD. Logistic regression was used to assess OR of dementia and its subtypes with T2DM.

after a comprehensive geriatric and cognitive assessment, 132 diabetic subjects were diagnosed with all-cause dementia. The prevalence rate for dementia with T2DM was 1.61%. Of demented subjects, 37 subjects had AD, 30 subjects had VD. The prevalence rates for AD with T2DM and VD with T2DM were 4.51% and 3.65%, respectively. In the univariate analyses, among all diabetic subjects, compared with cognitive intactly subjects, the demented subjects, including AD and VD subjects, were older, more female had higher percentage of current smoking, had a greater duration of diabetes, took more frequent use of diabetes medications, and stronger effect of APOE ε4 status. In multivariate logistic regression analyses, variables including age, APOE ε4 allele, duration from onset of diabetes, using oral hypoglycemic agents, HMG-CoA reductase (statins) were significantly associated with increased risk for dementia with T2DM (all P < 0.05).

the present study shows that T2DM is associated with dementia and its subtypes amongst elderly people in the Chinese population.

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    • "Recent studies have reported associations between diabetes, obesity and dementia amongst the older people in China [18] [19]. An association between meat consumption and higher risk of dementia in low-and middle-income countries has been reported [20]. "
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    ABSTRACT: Background: Western diets are associated with obesity, vascular diseases, and metabolic syndrome and might increase dementia risk in later life. If these associations are causal, those low- and middle-income countries experiencing major changes in diet might also see an increasing prevalence of dementia. Objective: To investigate the relationship of dietary supply and the prevalence of dementia in mainland China, Hong Kong, and Taiwan over time using existing data and taking diagnostic criteria into account. Methods: Estimated total energy supply and animal fat from the United Nations was linked to the 70 prevalence studies in mainland China, Hong Kong, and Taiwan from 1980 to 2012 according to the current, 10 years, and 20 years before starting year of investigation. Studies using newer and older diagnostic criteria were separated into two groups. Spearman's rank correlation was calculated to investigate whether trends in total energy, animal fat supply, and prevalence of dementia were monotonically related. Results: The supply of total energy and animal fat per capita per day in China increased considerably over the last 50 years. The original positive relationship of dietary supply and dementia prevalence disappeared after stratifying by newer and older diagnostic criteria and there was no clear time lag effect. Conclusion: Taking diagnostic criteria into account, there is no cross-sectional or time lag relationship between the dietary trends and changes in dementia prevalence. It may be too early to detect any such changes because current cohorts of older people did not experience these dietary changes in their early to mid-life.
    Journal of Alzheimer's disease: JAD 11/2014; 44(4). DOI:10.3233/JAD-141926 · 4.15 Impact Factor
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    • "There were 2 previous studies that examined statin use and dementia in T2DM cohort. Fei et al. [24] reported that statin use was associated with decreased risk of all cause dementia including Alzheimer's dementia and vascular dementia in a group of Chinese elderly diabetes subjects. By using a national cohort of beneficiaries of the Department of Veterans Affairs, Johnson et al [25] also reported that statin use can reduce risk of dementia in their diabetic cohort in additional to certain antihypertensive medications. "
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    ABSTRACT: Patients with Type 2 diabetes (T2DM) are prone to develop dementia. Results from a recent study indicated that statin users had lower chance of developing incident dementia. However there is little information on the potential benefits of statin use on dementia in patients with T2DM cohort. A population-based retrospective study using a nationwide cohort of National Health Insurance Research Database in Taiwan was performed. T2DM cohort with regular use of statins was followed up to 8 years. Multivariate cox-proportional hazards regression model was used to estimate the association between statin use and incidence of dementia including Alzheimer's disease and non-Alzheimer dementia after adjusting for several potential confounders. Among 28,321 patients diagnosed with T2DM age above 50 and without history of dementia before 2000/1/1, 15,770 patients who had never used statin and 2,400 patients who regularly used statin drugs were enrolled. After adjusting for age group, gender, CCI (Charlson-Deyo comorbidity index) group, stroke types and anti-diabetic drugs, regular statin use was associated with a decreased risk of developing incident Alzheimer's disease dementia (adjusted HR: 0.48, 95% CI 0.30 - 0.76, p<0.001), but not in non-Alzheimer dementia (adjusted HR: 1.07, 95% CI 0.54-2.12 p = 0.844) in patients with T2DM. Further analysis showed significant protective effects of the use of atorvastatin and simvastatin. Regular use of statins might decrease the risk of developing Alzheimer's disease in patients with T2DM while no benefit was observed in non-Alzheimer dementia. Among statins, both atorvastatin and simvastatin showed significant benefits.
    PLoS ONE 02/2014; 9(2):e88434. DOI:10.1371/journal.pone.0088434 · 3.23 Impact Factor
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    ABSTRACT: The prevalence of Alzheimer's disease (AD) is higher among type 2 diabetes mellitus (T2DM) patients. In T2DM patients, the progression of AD is more rapid. Furthermore, several pathophysiological pathways are common to AD and T2DM. Humanin is a recently introduced, mitochondrial-derived peptide with neuroprotective effects. Humanin can alter the mechanisms involved in AD and T2DM pathogenesis. Insulin resistance as well as oxidative stress has been shown to be associated with increased amyloid deposition in brain neurons and islet beta cells. Moreover, advanced glycation end products and lipid metabolism disorders are common pathways of oxidative stress and low-grade systemic inflammation in AD and T2DM. These common pathways may explain AD and T2DM pathogenesis and suggest common treatments for both diseases. Treatments for T2DM and AD attempt to slow cognitive decline, and recent investigations have focused on agents that may alter pathways common to AD and T2DM pathogenesis. Non-steroidal anti-inflammatory drugs, such as interleukin-1 antagonists and statins, are possible drug candidates for both AD and T2DM.
    CNS & neurological disorders drug targets 12/2013; 13(3). DOI:10.2174/1871527312666131223110147 · 2.63 Impact Factor
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