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Diabetes, Alzheimer disease, and vascular dementia: a population-based neuropathologic study.

Abstract

OBJECTIVE

To investigate the relation of diabetes to dementia, Alzheimer disease (AD), and vascular dementia (VaD), through analyses of incidence, mortality, and neuropathologic outcomes in a prospective population-based study of the oldest old.

METHODS

The Vantaa 85+ study included 553 residents living in the city of Vantaa, Finland, and aged ≥85 years on April 1, 1991. Survivors were reexamined in 1994, 1996, 1999, and 2001. Autopsies were performed in 291 persons who died during the follow-up (48% of total population). Diabetes was assessed according to self-report, medical record of physician-diagnosed diabetes, or use of antidiabetic medication. Macroscopic infarcts were identified from 1-cm coronal slices of cerebral hemispheres, 5-mm transverse brainstem slices, and sagittal cerebellum slices. Methenamine silver staining was used for β-amyloid, methenamine silver-Bodian staining for neurofibrillary tangles, and modified Bielschowsky method for neuritic plaques. Cox proportional hazards and multiple logistic regression models were used to analyze the association of diabetes with dementia and neuropathology, respectively.

RESULTS

Diabetes at baseline doubled the incidence of dementia, AD, and VaD, and increased mortality. Individuals with diabetes were less likely to have β-amyloid (hazard ratio [HR] [95% confidence interval (CI)] was 0.48 [0.23-0.98]) and tangles (HR [95% CI] 0.72 [0.39-1.33]) but more likely to have cerebral infarcts (HR [95% CI] 1.88 [1.06-3.34]) after all adjustments.

CONCLUSION

Elderly patients with diabetes develop more extensive vascular pathology, which alone or together with AD-type pathology (particularly in APOE ε4 carriers) results in increased dementia risk.

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  • Authors+Show Affiliations

    ,

    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. satu.ahtiluoto@thl.fi

    , , , , , ,

    Source

    Neurology 75:13 2010 Sep 28 pg 1195-202

    MeSH

    Aged
    Aged, 80 and over
    Alzheimer Disease
    Amyloid beta-Peptides
    Apolipoproteins E
    Brain
    Community Health Planning
    Dementia, Vascular
    Diabetes Mellitus
    Female
    Humans
    Incidence
    Logistic Models
    Male
    Proportional Hazards Models
    Prospective Studies

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    20739645

    Citation

    Ahtiluoto, S, et al. "Diabetes, Alzheimer Disease, and Vascular Dementia: a Population-based Neuropathologic Study." Neurology, vol. 75, no. 13, 2010, pp. 1195-202.
    Ahtiluoto S, Polvikoski T, Peltonen M, et al. Diabetes, Alzheimer disease, and vascular dementia: a population-based neuropathologic study. Neurology. 2010;75(13):1195-202.
    Ahtiluoto, S., Polvikoski, T., Peltonen, M., Solomon, A., Tuomilehto, J., Winblad, B., ... Kivipelto, M. (2010). Diabetes, Alzheimer disease, and vascular dementia: a population-based neuropathologic study. Neurology, 75(13), pp. 1195-202. doi:10.1212/WNL.0b013e3181f4d7f8.
    Ahtiluoto S, et al. Diabetes, Alzheimer Disease, and Vascular Dementia: a Population-based Neuropathologic Study. Neurology. 2010 Sep 28;75(13):1195-202. PubMed PMID: 20739645.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diabetes, Alzheimer disease, and vascular dementia: a population-based neuropathologic study. AU - Ahtiluoto,S, AU - Polvikoski,T, AU - Peltonen,M, AU - Solomon,A, AU - Tuomilehto,J, AU - Winblad,B, AU - Sulkava,R, AU - Kivipelto,M, Y1 - 2010/08/25/ PY - 2010/8/27/entrez PY - 2010/8/27/pubmed PY - 2010/10/19/medline SP - 1195 EP - 202 JF - Neurology JO - Neurology VL - 75 IS - 13 N2 - OBJECTIVE: To investigate the relation of diabetes to dementia, Alzheimer disease (AD), and vascular dementia (VaD), through analyses of incidence, mortality, and neuropathologic outcomes in a prospective population-based study of the oldest old. METHODS: The Vantaa 85+ study included 553 residents living in the city of Vantaa, Finland, and aged ≥85 years on April 1, 1991. Survivors were reexamined in 1994, 1996, 1999, and 2001. Autopsies were performed in 291 persons who died during the follow-up (48% of total population). Diabetes was assessed according to self-report, medical record of physician-diagnosed diabetes, or use of antidiabetic medication. Macroscopic infarcts were identified from 1-cm coronal slices of cerebral hemispheres, 5-mm transverse brainstem slices, and sagittal cerebellum slices. Methenamine silver staining was used for β-amyloid, methenamine silver-Bodian staining for neurofibrillary tangles, and modified Bielschowsky method for neuritic plaques. Cox proportional hazards and multiple logistic regression models were used to analyze the association of diabetes with dementia and neuropathology, respectively. RESULTS: Diabetes at baseline doubled the incidence of dementia, AD, and VaD, and increased mortality. Individuals with diabetes were less likely to have β-amyloid (hazard ratio [HR] [95% confidence interval (CI)] was 0.48 [0.23-0.98]) and tangles (HR [95% CI] 0.72 [0.39-1.33]) but more likely to have cerebral infarcts (HR [95% CI] 1.88 [1.06-3.34]) after all adjustments. CONCLUSION: Elderly patients with diabetes develop more extensive vascular pathology, which alone or together with AD-type pathology (particularly in APOE ε4 carriers) results in increased dementia risk. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/20739645/Diabetes_Alzheimer_disease_and_vascular_dementia:_a_population_based_neuropathologic_study_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=20739645 DB - PRIME DP - Unbound Medicine ER -