Disclosures from Past Studies on Dementia in Geriatric Patients with Diabetes and Cardiovascular Comorbidities
Key Study Disclosures and Conflicts of Interest
The provided evidence does not contain explicit conflict of interest or funding disclosure statements from the individual studies referenced. However, several important methodological and contextual disclosures can be identified:
Study Design and Population Disclosures
Diabetes and Dementia Research Limitations
The ACCORD trial disclosed that intensive glucose control showed no difference in cognitive outcomes compared to standard glycemic control, despite finding that each 1% higher A1C level was associated with lower cognitive function in individuals with type 2 diabetes 1.
Studies examining intensive glycemic and blood pressure control to achieve specific targets disclosed they did not demonstrate reduction in brain function decline, representing an important negative finding that contradicts the hypothesis that aggressive glycemic control prevents dementia 2.
The ACCORD-MIND study specifically disclosed no benefit to brain structure or cognitive function with intensive glucose control, though there was significantly less decrement in total brain volume in the intensive arm 1, 2.
Cardiovascular Disease and Dementia Studies
Population-based cohort studies using UK Clinical Practice Research Datalink (CPRD) disclosed median follow-up periods of 6 years when examining cardiovascular comorbidities and dementia risk in 489,205 T2D patients 3.
The FinnGen nationwide study disclosed data from 218,192 individuals with last follow-up information available from October 2021, with mean age at end of follow-up being 61.7 ± 17.1 years and 53% women 4.
Hypoglycemia and Dementia Research
Studies disclosed a critical bidirectional relationship: cognitive decline increases hypoglycemia risk, while severe hypoglycemia increases dementia risk 2, 5.
Retrospective cohort studies using CPRD (1997-2016) disclosed they selected participants, intervention, and follow-up to mirror two hypothetical target randomized controlled trials when examining hypoglycemia effects in patients with dementia 5.
Medication-Specific Disclosures
Cholinesterase Inhibitor Studies
Clinical trials of donepezil disclosed that the mean age of enrolled patients was 73 years, with 80% between 65-84 years old and 49% at or above age 75 6.
Studies disclosed that approximately 20-35% of patients with mild to moderate Alzheimer's disease show a 7-point improvement on neuropsychological tests when treated with donepezil, equivalent to reversing one year's cognitive decline 7, 8.
Donepezil trials disclosed that patients weighing <55 kg reported more nausea, vomiting, and decreased weight than patients weighing ≥55 kg, with more withdrawals due to adverse reactions 6.
Statin Studies
A systematic review disclosed that data do not support an adverse effect of statins on cognition 1.
FDA post-marketing surveillance databases disclosed a low reporting rate for cognitive function-related adverse events with statin therapy, similar to rates seen with other commonly prescribed cardiovascular medications 1.
Incretin-Based Therapy Studies
- Studies of patients treated with incretin-based therapies disclosed that pancreatitis may occur more frequently with these medications, but results have been mixed and causality has not been established 1.
Epidemiological Disclosures
Risk Magnitude Disclosures
Meta-analyses of prospective observational studies disclosed that people with diabetes showed 73% increased risk of all-cause dementia, 56% increased risk of Alzheimer dementia, and 127% increased risk of vascular dementia compared with individuals without diabetes 1, 2.
Time-varying Cox regressions disclosed that T2D patients with stroke had the highest dementia risk (HR 1.64), followed by peripheral vascular disease (HR 1.37), atrial fibrillation (HR 1.26), heart failure (HR 1.15), and hypertension (HR 1.10) 3.
Nationwide studies disclosed that stroke was most strongly associated with dementia (HR 1.7), and CVD was more strongly associated with vascular dementia than with Alzheimer's disease 4.
Comorbidity Interaction Disclosures
Studies disclosed that the combination of diabetes and coronary artery disease is associated with substantially higher dementia risk (aHR 1.37 for all-cause dementia, aHR 2.03 for vascular dementia) compared to either condition alone 9.
Research disclosed that patients with diabetes alone (aHR 1.14) or CAD alone (aHR 1.11) had only modestly increased rates of all-cause dementia, suggesting the diabetes-related risk is partly mediated through concomitant atherosclerotic CVD 9.
Methodological Limitations Disclosed
Dietary Intervention Studies
- A Cochrane review disclosed insufficient evidence to recommend any specific dietary change for the prevention or treatment of cognitive dysfunction, despite one study showing adherence to Mediterranean diet correlated with improved cognitive function 1.
Treatment Duration Studies
- Studies disclosed that efficacy of donepezil is maintained for up to 4.9 years in patients with mild to moderate Alzheimer's disease, but treatment effects do not prevent disease progression and the illness continues to advance even during treatment 7, 8.
Clinical Trial Population Characteristics
Age and Frailty Considerations
Guidelines disclosed that fasting should be reconsidered for those with comorbidities, frailty, and impaired cognition, and for those age >70 years with no home support 1.
Studies disclosed that older adults with diabetes are at higher risk of cognitive decline and institutionalization, with presentation ranging from subtle executive dysfunction to memory loss and overt dementia 2.