Dr Margaret Gatz,a professor of psychology,gerontology and preventative medicine at the University of Southern California,conducts research on interventions that may reduce the risk of Alzheimers disease.
In a recent study,published in the January 2009 issue of Diabetes,Gatz and her team tracked rates of dementia and diabetes and discovered that developing Type 2 diabetes before the age of 65 was associated with a 125 per cent increased risk of developing Alzheimers disease.
How did you become interested in the relationship between diabetes and dementia?
Our research began with the question why some people develop dementia,especially Alzheimers disease,in old age,whereas others do not. Alzheimers disease is the most common type of dementia,followed by vascular dementia,which is generally caused by the same things that are risk factors for stroke.
Recently,a number of researchers have begun to show that vascular risk factors are important not only for increasing risk of vascular dementia but also for increasing risk of Alzheimers disease. This observation is particularly interesting because vascular risk factors are potentially modifiable. In other words,people might be able to reduce their risk of Alzheimers disease by attending to the kinds of health behaviours that reduce vascular risk,like controlling blood pressure,cholesterol and diabetes.
What is most surprising about your findings?
Two findings are particularly intriguing. One is that diabetes was a risk factor for both vascular dementia and Alzheimers disease,although the association was more robust for vascular dementia than for Alzheimers disease. The second is that diabetes that first occurred before age 65 was a far more important risk factor for dementia than diabetes that did not occur until after age 65.
While it is possible that long-term diabetes or its treatment may cause some sort of damage to the brain,it is also possible that the diabetes is not so much the cause of the dementia,but rather that diabetes and dementia each arise from the same environmental exposures and influences.
For example,the same adverse early childhood conditions that lead to higher rates of diabetes (such as a low birth weight) may also affect brain development. Thus,we concluded that a complex interplay of genetic factors and environmental exposures throughout life course affects ris of dementia.
Do you believe that an appropriate treatment for diabetes and good diabetes control could have an impact on lowering the likelihood of developing dementia?
Or are prolonged treatments a potential part of the problem?
In our study,we could not separate diabetes from its treatment or identify those with well-controlled versus poorly-controlled diabetes. The association between mid-life diabetes and dementia,however,was still significant after adjustment for diabetes duration. In other words,our results suggest that age of diabetes onset itself might be an important factor in later dementia risk,not so much how prolonged the diabetes treatment had been.
With rising rates of diabetes and longer life spans,do you suspect that there also will be a rise in dementia rates among the elderly?
Because dementia is age-related,with longer life spans the number of people with dementia can be expected to rise,unless we make real progress in identifying modifiable risk factors and treatments for dementia.