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NEUROLOGY 2009;73:1359-1366
© 2009 American Academy of Neurology

Diabetes is associated with a slower rate of cognitive decline in Alzheimer disease

C. Sanz, MD, S. Andrieu, MD, PhD, A. Sinclair, MD, FRCP, H. Hanaire, MD, PhD, B. Vellas, MD, PhD For the REAL.FR Study Group*

From the Department of Diabetology, Metabolic Diseases and Nutrition (C.S., H.H.), Department of Epidemiology and Public Health (S.A.), and Gerontopole, Department of Geriatric Medicine (S.A., B.V.), CHU Toulouse; INSERM U558 (C.S., S.A., B.V.), Toulouse; University Toulouse III (C.S., S.A., H.H., B.V.), Toulouse, France; and Institute of Diabetes for Older People (A.S.), Luton, UK.

Address correspondence and reprint requests to Dr. Caroline Sanz, INSERM U558, 37 allées Jules Guesde, 31073 Toulouse, France carolinesanz{at}hotmail.fr

Background: Previous epidemiologic studies indicate that diabetes mellitus (DM) is associated with cognitive decline and an increased risk of developing Alzheimer disease (AD) in people who do not have dementia. However, little is known about the effect of DM on the rate of cognitive decline in established AD. Our objective was to determine whether DM influences the rate of cognitive decline in patients with AD.

Methods: A total of 608 patients with a probable diagnosis of AD and a Mini-Mental State Examination (MMSE) score between 10 and 26 were enrolled in a prospective multicenter study. Participants were followed up to 52 (mean 26) months. DM was assessed at baseline (history of DM or antidiabetic medication use). Cognitive function was assessed twice yearly with the MMSE.

Results: Sixty-three participants (10.4%) had DM at baseline. In a mixed model adjusted for sex, age, educational level, dementia severity, cholinesterase inhibitor use, and vascular factors (hypertension, atrial fibrillation, coronary heart disease, and hypercholesterolemia), there were no differences between the groups in MMSE baseline scores (–0.75, p = 0.20), but cognitive decline was slower in the group with DM (0.38, p = 0.01).

Conclusions: In a cohort of community-dwelling patients with Alzheimer disease (AD), the presence of diabetes mellitus (DM) was associated with a lower rate of cognitive decline. Future studies will need to address the potential impact of DM in the cerebral aging process and to assess the neuropathologic variations in patients with AD with DM.

Abbreviations: AD = Alzheimer disease; BMI = body mass index; CI = confidence interval; DM = diabetes mellitus; HR = hazard ratio; MMSE = Mini-Mental State Examination; PC = potential confounders.

*See the appendix for a list of Group members.

Supported by a grant from the Clinical Research Hospital Program from the French Ministry of Health (PHRC 98-47N, PHRC 0101001).

Disclosure: Author disclosures are provided at the end of the article.

Received February 26, 2009. Accepted in final form July 20, 2009.






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