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New York Consortium for Alzheimer Research and Education
The New York Consortium for Alzheimer Research and Education (N.Y.C.A.R.E.) is the joint effort of
the Alzheimer’s Association New York City Chapter and the Education and Information Cores of the
Alzheimer’s Centers — Columbia University, College of Physicians and Surgeons; Mount Sinai Medical Center; and New York University School of Medicine funded by the National Institute on Aging.
The Link Between Alzheimer’s and Diabetes
Memory disorders such as Alzheimer’s disease
(AD) are very common in older people. In
fact, the likelihood of dementia in patients
over 65 is about 13%, accounting for about one in eight
persons over the age of 65. Diabetes, especially type II
diabetes, is also common among the elderly and among
patients with Alzheimer’s disease. According to the
American Diabetes Association, over 18% of Americans
over the age of 60 are affected by diabetes. Interestingly,
these two conditions seem to have an impact on one
another. Diabetes has been associated with changes
in cognition, such as impaired learning and memory,
slowed mental speed and diminished mental flexibility.
Moreover, patients with Alzheimer’s disease are more
vulnerable to certain forms of diabetes.
The association between diabetes and Alzheimer’s
disease is strong among patients who carry the ApoE
4 allele, an inherited risk factor for the development of
AD. The association between these two diseases is also
strong in diabetic patients treated with insulin, a common
medication used to control blood sugar levels. In addition,
loss of brain tissue — something also seen in patients with
AD — seems to be more severe in elderly patients treated
with insulin. There seems to be something about high
levels of insulin that puts patients at risk for developing
AD, as the “hyperinsulinemic state” typical of some forms
of diabetes doubles the risk of Alzheimer’s disease. This is
a condition that many diabetic patients experience when
their bodies produce too much insulin because their cells
have become less responsive to normal levels of insulin.
It has been shown that this “hyperinsulinemic state”
may increase inflammation and affect the processing of
molecules that lead to Alzheimer’s disease, potentially
promoting memory impairment and AD. Interestingly,
therapies that target this state show promise in improving
cognition in patients with AD.
Other relationships between diabetes and memory
loss have been found. The Rancho Bernardo Study
demonstrated a fourfold increase in cognitive decline in
women with diabetes. This effect was not seen in men.
In addition, improving control of blood sugar could
actually reduce this risk in women. In the California
SALSA (Sacramento Area Latino Study on Aging) study
patients of both sexes with diabetes were less likely to
develop cognitive and physical symptoms if they were
taking diabetes medications. Despite the work that has
been done so far, this area of research is still in its early
stages.
The presence of memory loss and other cognitive
impairments can interfere with almost every area of
elderly patients’ medical care. This is especially so for
individuals with diabetes, as patients with this condition
must monitor their blood sugar levels, understand complex
medication regimens, and adapt to complicated dietary
changes and lifestyle modifications. Patients’ rapidly
changing treatment plans, many of them carrying the
potential for dangerous adverse effects, further complicate
the management of patients with diabetes and concurrent
cognitive deficits. Although researchers have begun
clarifying the links between diabetes and Alzheimer’s
disease, much is still not understood about how they
may affect one another. Given the apparent associations
between the two diseases, it is of particular interest to
understand the molecular mechanisms underlying these
interactions, as well as ways of preventing or ameliorating
the effect of diabetes on memory. With an increasing
percentage of America’s elderly population being affected
by both diabetes and AD, better understanding of the
relationship between these illnesses may have significant
implications for the prevention and treatment of AD.
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