Medication may reduce dementia risk by 16%

Why are people with type 2 diabetes at increased risk of developing dementia?

according to Dr. Karen D. SullivanA board-certified neuropsychologist and owner of I CARE FOR YOUR BRAIN in Pinehurst, North Carolina, he says diabetes affects nearly every system in the body. brain.

“People with type 2 diabetes have a 50-60% higher risk of developing dementia compared to people without diabetes. This is one of the strongest modifiable risk factors for dementia,” she said. said. medical news today.

” insulin resistance seen in diabetes atherosclerosis and transform the energy metabolismwhich can lead to microvascular changes in the brain and ultimately to loss of blood flow to the network neuron,” she explained.

In addition, type 2 diabetes is interleukin-6 According to Dr. Sullivan, in the brain, inflammation and oxidative stress initiate the pathological process seen in Alzheimer’s diseasethe most common form of dementia in the elderly.

“Two prospective neuropathological cohort studies suggested that diabetes lowers neuronal mass thresholds. amyloid beta It is necessary for people with diabetes to develop Alzheimer’s disease,” she continued.

“The longer the duration of type 2 diabetes and the poorer control of the disease, the higher the risk of dementia.”
— Dr. Karen D. Sullivan

For this study, researchers National Korean Health Database Percentage of people newly diagnosed with type 2 diabetes without dementia. Over 91,000 participants were followed for an average of 10 years. Of that number, 3,467 were given the drug pioglitazone.

The analysis found that 8.3% of people who took pioglitazone developed dementia, compared to 10% of people with type 2 diabetes who did not take pioglitazone.

After considering certain lifestyle factors, scientists found that people with type 2 diabetes who took pioglitazone were 16% less likely to develop subsequent dementia.

The researchers noted the limitations of this study because it was based on information about insurance claims, so it’s possible that some people didn’t take pioglitazone even if they were prescribed it.

There is also no information in the study about the severity of illness in the participants blood sugar controlor the genetic risk of dementia.

When asked how pioglitazone reduces the risk of developing dementia in people with type 2 diabetes, Dr. Kim EosProfessor of Psychiatry, Yonsei University School of Medicine, Seoul, Republic of Korea, and the lead author of the study .

“But based on [the] The basic pharmacological actions of this drug and findings from previous studies may suggest some,” he said. medical news today.

“First, basically the control Blood glucose level Beneficial for brain function. And the drug improves the metabolic capacity of the cells, allowing them to use bioenergetics more efficiently – in other words, it improves insulin resistance in the brain.

“Second, some studies have shown that pioglitazone clears the brain of a toxic protein called beta-amyloid. Accumulation of β-amyloid It’s one of the main causes of Alzheimer’s disease,” he continued.

“Thirdly, the drug was found to be more effective in diabetic patients who have problems with blood circulation. heart We speculate that pioglitazone’s nootropic effects may be related to improved vascular health,” he added.

As for the heart, during the study Dr. Kim and his team found that the strongest dementia-protective effect of pioglitazone was ischemic stroke again ischemic heart disease.

Researchers found that people with a history of ischemic heart disease had a 54% reduced risk of developing dementia, and those who had an ischemic stroke had a 43% reduced risk.

Dr. Kim said he and his team were surprised by these results.

“It was an unexpected find,” he said.

“Ischemic heart or brain disease Another important risk factor for dementia, it seemed natural if pioglitazone was found to be less effective in people with such problems. The results defied this expectation,” he explained.

As a next step in this research, Dr. Kim said he is conducting research to see how it is being used today. antidiabetic drug Alternatively, drug candidates that improve cellular energy metabolism could curb the pathology of dementia through animal experiments.

“Clinical studies need prospective studies to confirm [the] Antidementia effects of this drug and the risk-benefit balance of using this drug. That is, [a] From a dementia prevention perspective, it’s about balancing the side effects and beneficial effects of long-term use of this drug,” he explained.

When asked what he would like to see next in this study, Dr. Sullivan said the next step for pioglitazone would be to assess its long-term safety in humans and maintain the observed benefits while reducing side effects. is to identify the optimal dose to

Pioglitazone is currently second line choice for the treatment of type 2 diabetes by safety concernsis known to increase the risk of fractureweight gain, and hospitalization heart failure.

Until then, Dr. Sullivan said the most important thing people with type 2 diabetes can do to lower their risk of dementia is to keep their blood sugar stable.hyperglycemia) and hypoglycemia (hypoglycemia) can damage blood vessels in the brain.

“We want our patients to avoid big highs and lows, and that’s when brain damage happens,” she said.

Tips for people with T2D

“Other evidence-based recommendations include: Aerobic 30 minutes daily, 5 days weekly, anti-inflammatory diet,Avoidance carbohydratesprioritize hydration,maintain healthy weightand management of other vascular risk factors high blood pressure, sleep apneaand high cholesterol”
— Dr. Karen D. Sullivan