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Dementia Risk in Type 2 Diabetes: Assessing Racial & Ethnic Differences

Dementia Risk in Type 2 Diabetes: Assessing Racial & Ethnic Differences

Published research has shown that type 2 diabetes is associated with about a twofold greater risk of dementia among older adults, but it is unclear if the risk of dementia for people with diabetes varies across racial and ethnic groups. “Over the last 10 years, much has been learned about the connection between type 2 diabetes and dementia risk,” says Rachel A. Whitmer, PhD. “Rates of both of these conditions continue to rise as the population ages and as there continues to be growing ethnic diversity among older patients. Because type 2 diabetes increases the risk of dementia, it’s important to understand the risk of dementia among older adults with type 2 diabetes who are from diverse racial and ethnic backgrounds.” A national public health goal has been set forth to eliminate health disparities. This makes it increasingly important to understand racial and ethnic differences in diabetes-related complications, including dementia, among older adults. Studies have reported that the prevalence of dementia is higher among African Americans and Caribbean Hispanics, lower among Japanese Americans, and similar among Native Americans and Mexican Americans when compared with Caucasians. However, knowledge about racial and ethnic differences in dementia risk has not been thoroughly investigated among people with type 2 diabetes. Exploring Racial & Ethnic Differences In Diabetes Care, Dr. Whitmer and colleagues had a study published that examined if there are racial and ethnic differences in the 10-year incidence of dementia among individuals with type 2 diabetes. The study analyzed more than 22,000 culturally diverse patients with diabetes aged 60 and older who did not have preexisting dementia and were part of the...
Linking Vitamin D to Dementia

Linking Vitamin D to Dementia

Adults who were moderately deficient or severely deficient in vitamin D had a 53% and 125% increased risk of developing dementia, respectively, in the largest study examining the link between low vitamin D levels and dementia published this month in Neurology. Similar results were found for the occurrence of Alzheimer’s disease, with the moderately deficient group 68% more likely to develop dementia and increasing to 122% for those who were severely deficient. The study, part-funded by the Alzheimer’s Association, examined over 1,600 adults aged 65 and over who were free from dementia, cardiovascular disease, and stroke—and were physically able to walk unaided. They were then followed for 6 years to determine who went on to develop dementia. Vitamin D levels above 50 nmol/L were most strongly associated with good brain health. Researchers were expecting to find an association between low vitamin D levels and the risk of Alzheimer’s and dementia, they were surprised when they found it was twice as strong as they anticipated. While their findings are insightful, they are cautious to claim that low vitamin D levels cause dementia. Currently, there are 44 million of dementia worldwide—a number expected to triple by 2050. Large scale clinical trials are required to determine if increasing vitamin D in patients with deficiencies can help prevent dementia from developing. Source: Neurology. Download Full Text (PDF) Video: Low Vitamin D Levels Might be Linked to Dementia Source: Newsy...
Recognizing & Treating Caregiver Burden

Recognizing & Treating Caregiver Burden

Research has shown that unpaid family or informal caregivers provide as much as 90% of the in-home long-term care that is needed by adults. A 2009 study estimated that 65.7 million people in the United States served as unpaid family caregivers to an adult or child, two-thirds of whom provided care for an adult aged 50 or older. “The burden of caring for others is increasing because of our aging population, an increase in the number of people living with chronic disease, and a lack of formal support for caregivers,” says Ronald D. Adelman, MD. In addition to providing assistance with basic and instrumental activities of daily living and medical support, caregivers also provide emotional support and comfort. The economic burden of informal caregiving is substantial, with a recent study estimating that the cost of informal dementia caregiving was $56,290 annually per patient. Furthermore, many caregivers have little choice in taking on a caregiving role, and many report feeling ill prepared to take on these responsibilities. “Many caregivers are unaware of the toll that caregiving takes on them, making them more vulnerable to other serious health problems,” Dr. Adelman says. “In addition, caregivers often receive inadequate support from health professionals and frequently feel abandoned and unrecognized by the healthcare system.” Diagnosis & Assessment of Caregiver Burden In a recent issue of JAMA, Dr. Adelman and colleagues reviewed cohort studies and other analyses to provide strategies to diagnose, assess, and intervene for caregiver burden. Several risk factors for caregiver burden were identified, including female sex, low educational attainment, and residing with care recipients. Depression, social isolation, financial stress, a higher...

Managing Cognitive Decline in Older Adults With Diabetes

This Physician’s Weekly feature on managing cognitive decline in older adults with diabetes was completed in cooperation with the experts at the American Diabetes Association. More than 25% of Ameri­cans aged 65 and older has diabetes, and the aging of the overall population has been identified as a significant driver of the diabetes epidemic. “Diabetes in older adults is associated with higher mortality, reduced cogni­tive and functional status, and increased risk of institutionaliza­tion,” explains Hermes Florez, MD, PhD, MPH. “Importantly, diabetes has been linked to sig­nificantly higher risks of cogni­tive impairment, a greater rate of cognitive decline, and increased risk of dementia.” While various complications of diabetes are well known and well researched, the effect diabetes has on the brain has historically received relatively little attention. “The risk of both diabetes and cognitive impairment increases with age,” Dr. Florez says. “The presentation of cognitive impairment in people with diabetes can vary, ranging from subtle executive dysfunction to overt dementia and memory loss. We’re starting to see links between diabetes and dementia and Alzheimer’s disease, but researchers are still conducting analyses to further increase our knowledge on these associations.”  Consensus Report on Diabetes in Older Adults In the December 2012 issue of Diabetes Care, the American Diabetes Association released a consensus report on diabetes and older adults. Dr. Florez, who was on the writing group that developed the report, says that an important component to managing older adults with diabetes is the role of cognitive impairment. “For older patients with diabetes, treatments will need to be simplified whenever possible, and caregivers should be involved during consultations. The presence of cognitive...
Delirium Among Hospitalized AD Patients: The Long-Term Impact

Delirium Among Hospitalized AD Patients: The Long-Term Impact

Recent studies show that patients with Alzheimer’s Disease (AD) who are hospitalized are at increased risk for further cognitive decline, institutionalization, and death in the year following their hospital stay. These risks are highest among those who develop delirium while being hospitalized. Little attention has been paid to the consequences of delirium on cognitive deterioration among patients with AD. Most studies have focused on short-term cognitive outcomes, but few have addressed whether these changes result in enduring problems in cognitive function. Examining Long-Term Changes Following Delirium In the August 20, 2012 online issue of the Archives of Internal Medicine, a study by senior investigator Sharon K. Inouye, MD, MPH, myself, and other colleagues explored the long-term trajectory of cognitive decline among older adults with AD who experienced delirium while they were hospitalized. The rate of cognitive deterioration was monitored for up to 5 years before and 5 years after hospitalization. Delirium in patients with AD was independently associated with cognitive deterioration for up to 5 years after hospitalization; the rate was roughly twice that of patients with AD who did not develop delirium while hospitalized. Delirium is a Medical Emergency In our analysis, delirium developed in 56% of the study group. Unfortunately, research suggests that delirium is recognized by physicians in fewer than 30% of hospital patients. Our study serves as an alarm to the long-term dangers of delirium on the development and progression of long-term cognitive impairment. Physicians should handle delirium cases among AD patients as they would a true medical emergency. Strategies to Prevent Delirium Efforts are needed to incorporate delirium prevention routinely into standard practices for...
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