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Using Retinal Imaging to Study Dementia
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Diabetes-Related Dementia.

Haruo Hanyu1

  • 1Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan. h-hanyu@tokyo-med.ac.jp.

Advances in Experimental Medicine and Biology
|May 8, 2019
PubMed
Summary

Type 2 diabetes may cause a distinct dementia, "diabetes-related dementia" (DrD), characterized by metabolic issues, not Alzheimer's pathology. Early identification and glycemic control are key for managing this potentially modifiable condition.

Keywords:
Alzheimer diseaseDiabetes mellitusDiabetes-related dementiaFrailtyGlycemic controlInsulin resistanceNeuroimagingVascular dementia

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Area of Science:

  • Neurology
  • Endocrinology
  • Geriatrics

Background:

  • Type 2 diabetes mellitus (DM) is linked to increased risk of cognitive decline and dementia.
  • A distinct dementia subgroup may arise from DM-related metabolic abnormalities, separate from Alzheimer disease (AD) or vascular dementia (VaD).

Purpose of the Study:

  • To characterize a specific dementia subgroup associated with type 2 diabetes, termed "diabetes-related dementia" (DrD).
  • To differentiate DrD from AD and VaD based on clinical, pathological, and imaging findings.
  • To explore potential therapeutic and preventive strategies for DrD.

Main Methods:

  • Clinical characterization of patients with DrD, including age, glycemic control (hemoglobin A1c), diabetes duration, insulin use, and apolipoprotein E4 status.
  • Neuroimaging (SPECT, MRI) and PET scans (11C-Pittsburgh compound-B) to assess brain perfusion, lesions, atrophy, and amyloid accumulation.
  • Assessment of cognitive functions (attention, executive function, word recall) and evaluation of frailty, sarcopenia, and dynapenia.

Main Results:

  • DrD presents with specific metabolic abnormalities, often negative amyloid PET scans, and distinct cognitive profiles (impaired attention/executive function, preserved word recall).
  • Patients with DrD show less medial temporal lobe atrophy and slower cognitive progression compared to AD.
  • Higher frequencies of frailty and sarcopenia/dynapenia are observed in DrD, suggesting the need for geriatric interventions.

Conclusions:

  • DrD is a distinct dementia entity associated with type 2 diabetes, characterized by metabolic dysregulation rather than typical AD or VaD pathology.
  • Glycemic control, management of insulin resistance, inflammation, oxidative stress, and advanced glycation end products are crucial for cognitive function in DrD.
  • DrD is a potentially controllable and modifiable dementia, necessitating specific diagnostic approaches and interventions, including geriatric care.