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Diabetes: Scoring system predicts dementia risk
21st August 2013 - A new tool to help doctors accurately predict the risk of dementia in people aged over 60 with type 2 diabetes has been developed in the US.
Researchers say the scoring system will allow those patients at the highest risk to get early treatment if needed.
Diabetes rates have been soaring in recent years with around 3 million people diagnosed in the UK. Improvements in treatment have meant that patients are living longer, exposing them to health problems specific to ageing, such as mental impairment.
Adults with type 2 diabetes are at approximately twice the risk of developing Alzheimer's and vascular dementia as those who do not have the disease.
Several methods of scoring for dementia risk in the general population have emerged, but the team from the Kaiser Permanente Division of Research in California says they have based theirs on specific dementia risk factors for people with diabetes, such as how long they have had the disease, their glucose lowering treatment and whether they have severe hypoglycaemic or hyperglycaemic episodes.
The scientists analysed the medical records of 27,512 people from California aged 60 and over with type 2 diabetes. They recorded whether patients were diagnosed with dementia within 10 years of their entry into the study, and found that nearly one in five (17%) of the participants developed dementia during this period.
Identifying risk factors
They then identified 45 possible risk factors for dementia, with age, lower educational attainment, and 6 different diabetes-related health complications emerging as the most important. These are:
- Acute metabolic event (e.g. severe hypoglycaemic and severe hyperglycaemic events)
- Microvascular disease (disease of the smaller blood vessels) )
- Diabetic foot
- Cerebrovascular disease (damage to blood vessels supplying the brain with blood)
- Heart disease
The scores allow patients to be allocated to one of 14 categories, with the lowest score (-1) indicating the lowest risk of dementia, and the highest scores (12 - 19) indicating the highest risk.
Patients with the highest score were 37 times more likely to develop dementia within 10 years than those with the lowest score, and patients with higher scores also developed dementia more quickly than those with lower scores.
The researchers then tested the scoring system against an unrelated group of older patients with type 2 diabetes and report that it accurately predicts patients’ risk of developing dementia.
The study is published in The Lancet Diabetes and Endocrinology.
'Public health crisis'
Lead author Rachel Whitmer says in a statement: "Unfortunately, there is an epidemic of both type 2 diabetes and dementia, and the link between these two illnesses portends a possible public health crisis.
"Our model shows that in two large populations of patients with type 2 diabetes a combination of diabetes-associated complications, education and age is highly predictive of the likelihood of dementia within the next decade."