Did you know that diabetes is a risk factor for dementia and cognitive decline? But effectively managing diabetes could actually improve long-term brain health.
In diabetes, blood glucose levels remain too high, either because the body does not make or becomes resistant to insulin. Over time, high glucose levels can have serious repercussions, such as heart disease and stroke. But lower them too much and you could face immediate and severe side effects including confusion and cognitive impairment and, possibly, an increased risk of long-term cognitive decline .
WHAT THE EVIDENCE SAYS
Diabetics have up to 73% increased risk of dementia and a 100% higher risk of developing vascular dementia than non-diabetics [4–6]. The association between diabetes and dementia risk is even stronger in people with the APOE4 gene . Diabetes can lead to subtle cognitive decline and, in patients with mild cognitive impairment ?, it increases the odds of progressing to dementia [7–9]. The side effects of diabetes can worsen confusion and cognitive impairment in people with dementia.
Type 2 diabetes and Alzheimer's disease share certain characteristics, including impaired insulin signaling and oxidative stress . Because of this, research is underway to evaluate whether some specific diabetes drugs including metformin , liraglutide , exenatide , and pioglitazone  can prevent or treat dementia even in patients without diabetes .
WHAT YOU CAN DO
Strong research from multiple meta-analyses indicates that preventing or effectively managing diabetes is one of the most important things you can do to reduce dementia risk and protect your brain from cognitive decline [15-17]. Healthy diet, exercise, and weight control are the first steps of diabetes management . Older adults with diabetes who are unable to exercise at the recommended levels benefit from even modest increases in physical activity .
For many patients, oral or injectable prescription drugs are often required to keep blood glucose levels in the target range. Such drugs are generally safe, but some side effects and drug interactions can occur . A consensus guideline for treating diabetes in older adults suggests that treatments should be simplified as much as possible . For diabetics with dementia, experts recommend less stringent targets for managing blood glucose . It's possible that the choice of drugs to manage diabetes can influence cognitive function or dementia risk, but more research is needed .
Yuko Hara, PhD, is Acting Director of Aging and Alzheimer's Prevention at the Alzheimer's Drug Discovery Foundation. Dr. Hara was previously an Assistant Professor in Neuroscience at the Icahn School of Medicine at Mount Sinai, where she remains an adjunct faculty member. Her research focused on brain aging, specifically how estrogens and reproductive aging influence the aging brain's synapses and mitochondria. She earned a doctorate in neurology and neuroscience at Weill Graduate School of Medical Sciences of Cornell University and a bachelor's degree in biology from Cornell University, with additional study at Keio University in Japan. Dr. Hara has authored numerous peer-reviewed publications, including articles in PNAS and Journal of Neuroscience.
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