Sweet memories: Diabetes and Alzheimer’s disease

Diabetes

Look around you and it seems as if the “healthy body, healthy mind” campaign is in full swing. Adherence to the latest health and fitness mantras may seem impossible to people coping with a sluggish economy, a confusing healthcare reform process and their own aches and pains. However, the latest epidemiology data from the International Diabetes Federation about this chronic disease [1] – which is linked to a host of other illnesses, including Alzheimer’s disease (AD) – may serve as an impetus to discard the fog of confusion in favor of pro-active health maintenance. An estimated total of 382 million people had diabetes in 2013 and this number is anticipated to rise to 592 million by 2035 [1]. Additionally, North America and the Caribbean lead other global regions in terms of money spent on the disease [1].

Having a healthy body and mind may empower diabetics awaiting solutions to the American healthcare paradox. The public-health specialists, Elizabeth Bradley and Lauren Taylor, have described the paradox as follows: “American per-capita spending on health far exceeds that of any other country on earth, the results achieved fall well short of other nations that spend much less. This includes such basic measures as life expectancy, maternal and infant mortality, and infant birth weight, for example.” For diabetics focused on also maintaining a healthy mind, these words may sound ominous as they grapple with a national fear of getting AD.

Alzheimer’s disease

A 4-minute captioned video depicting the brain changes characteristic of AD can be viewed at the National Institute on Aging's website. While the animation illustrates the advances that has been made in the understanding of AD progression, it does not address the complexities involved in accurately diagnosing the disease, especially within the context of comorbid illnesses such as diabetes. Scientific evidence is accumulating that suggests a link between Type 2 diabetes and AD, the most common form of dementia and the seventh leading cause of death in this country. The data pointing to an association between AD and low brain insulin levels has led some researchers to refer to this dementia sub-type as Type 3 diabetes.

A middle-aged or older diabetic  (≥40 years old) exhibiting one or more AD warning signs is likely to visit a primary care physician. In the absence of a lifelong relationship with a trusted clinician, any patient and family caregiver(s) will have to provide comprehensive medical histories to numerous doctors in order to facilitate optimal AD management in the context of diabetes. This task – usually assigned to caregivers – may be daunting, since recall bias or the presence of significant memory loss may hinder the collection of information. Nevertheless, ascertainment of complete medical histories will aid in the differential diagnosis of AD. Patients and members of their care team also need to remain vigilant about the potential for misdiagnosis and its accompanying excess costs [2].  

Reference

1.       International Diabetes Federation. IDF Diabetes Atlas, 6th edition. Brussels, Belgium: International Diabetes Federation, 2013. http://www.idf.org/diabetesatlas

2.       Jeffrey, S. The High Cost of Alzheimer's disease Misdiagnosis, 2013.  Medscape Medical News from the Alzheimer's Association International Conference (AAIC),  2013