Diabetes mellitus as a modulator of functional impairment and decline in Alzheimers disease. The Real.FR cohort
Diabetic Medicine, 04/05/2012
Sanz CM et al. – At baseline, the presence of diabetes significantly increases the risk of functional disability in patients with Alzheimer's disease; the longitudinal data confirm that in patients with a recent diagnosis of Alzheimer's disease (but not in those who have had Alzheimer's disease for longer than 1 year), diabetes continues to worsen functional status.Methods
- The authors studied 608 community–dwelling patients with Alzheimer's disease from a prospective multicenter cohort.
- Diabetes was assessed at baseline.
- Functional status was assessed twice yearly with the Activities of Daily Living scale.
- Each patient had a baseline functional disability if their Activities of Daily Living score was <6.
- Progression of functional disability was defined by a decreased Activities of Daily Living score over 4years of follow–up visits.
- At baseline, diabetes was present in 63 participants (10.4%) and, compared with those without diabetes, was associated with functional impairment [age– and sex–adjusted OR=2.73 (95%CI 1.41–5.28)].
- After controlling for confounders, the association remained significant [OR=2.04 (95%CI 1.02–4.11)].
- Follow–up demonstrated a significant interaction between duration of Alzheimer's disease and diabetes, which was associated with progression of functional impairment in patients who had been diagnosed with Alzheimer's disease for less than 1year [age– and sex–adjusted hazard ratio=1.52 (95%CI 1.01–2.30), P=0.048], but not in those who had been diagnosed with Alzheimer's disease for more than 1year [age– and sex–adjusted hazard ratio=0.78 (95%CI 0.47–1.28), P=0.32].
- Abnormal one–leg balance, polymedication and obesity seem to be important factors explaining the association between diabetes and functional status.