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The Diabetes-Dementia Link

If you have blood sugar levels that aren’t quite high enough to get you a diabetes diagnosis, you might feel relieved. But more and more research shows that you’re not off the hook. Not only do you have to work to avoid crossing that line into diabetes, you need to lower your borderline blood sugar levels because you are already at risk for the repercussions of diabetes, which include heart disease and stroke and possibly dementia.

Studies have suggested that mental function is worse in people with diabetes, and new research published in the August 24th issue of Neurology shows that risk for dementia is twice as high in older women with diabetes and pre-diabetes as it is in older women with normal blood sugar levels. If confirmed by other studies, these results could have an impact on a huge number of people. While an estimated 17 million Americans are living with diabetes, about 41 million Americans fall into the pre-diabetes category, which means that they have blood sugar levels that are higher than normal but not at a diabetic level.

"Our results suggest that an accelerated decline in cognitive function might be yet another untoward consequence of having high blood sugar levels." says study author Alka Kanaya, MD, a professor of medicine at the University of California at San Francisco (UCSF).

The study investigators, led by Kristine Yaffe, MD, of UCSF and the San Francisco VA Center, analyzed data from approximately 7,000 women who had gone through menopause and were participating in another study on osteoporosis. The UCSF researchers identified 267 women with diabetes and 297 who had pre-diabetes and compared them to women with normal blood sugar levels.

Over the course of four years, about 12 percent of the women with diabetes and 10 percent of the women with pre-diabetes experienced a decline in mental function, compared to about 6 percent of women with normal blood sugar levels. The researchers measured cognition, or mental sharpness, with tests that evaluated memory and other intellectual capabilities. This decline reflects an increased risk of developing mild cognitive impairment (MCI), which is a mental state that often precedes dementia in which memory is affected but one can still live independently.

Although researchers aren’t sure exactly how high blood sugar levels affect the brain, they have some theories. Risk of dementia, including Alzheimer’s disease and vascular dementia, may be increased because people with diabetes and pre-diabetes are prone to strokes, high blood pressure and high cholesterol, all of which are associated with poor mental performance. It’s also possible that chronically high levels of blood sugar damage nerve cells in the brain, says Dr. Kanaya.

An ongoing trial of more than 10,000 people with diabetes called the Action to Control Cardiovascular Disease Risk in Diabetes (ACCORD) trial may explain why elevated blood sugar levels may raise dementia risk-and also shed light on the impact of high cholesterol and high blood pressure on the brain.

In the meantime, Dr. Kanaya advises people with diabetes and those with pre-diabetes to reign in their blood sugar with diet, exercise and medication, when necessary, to protect themselves from becoming one of the millions of Americans living with dementia.