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Diabetes Mellitus and Alzheimer Disease—Reply

Diabetes Mellitus and Alzheimer Disease—Reply In reply We thank Franco and Bronson for their interest in our article.1 They raise the possibility that depression may play a role in the relation of diabetes mellitus to risk of Alzheimer disease (AD) and to cognitive decline. To address this possibility, we repeated the analyses after excluding 11 persons with clinically diagnosed depression at the baseline evaluation and then following exclusion of 65 persons who had a clinical diagnosis of depression at any point in their lifetime. In both sets of analyses, the relation of diabetes mellitus to risk of AD (for both analyses: hazard ratio, 1.70 [95% confidence interval, 1.13-2.56]) and to decline in perceptual speed (P<.05) were unchanged, suggesting that clinical depression does not account for these associations. Whether the much more common mild depressive symptoms, which are related to AD,2 could be associated with diabetes mellitus requires further exploration. The biologic mechanisms linking diabetes mellitus to AD are unclear. While it is possible that cerebral infarctions account for this association, in prior research, neither measures of AD pathologic features nor cerebral infarctions accounted for the association of depression3,4 or stress5 with cognitive impairment. We agree with Franco and Bronson that other mechanisms will need to be explored, including the possibility that “stress-related cortisol secretion” could link endocrine, metabolic, and hemodynamic abnormalities, as well as obesity, to cognitive impairment. Back to top Article Information Correspondence: Dr Arvanitakis, Rush Alzheimer’s Disease Center, Rush University Medical Center, Armour Academic Center, 600 S Paulina St, Suite 1020E, Chicago, IL 60612. References 1. Arvanitakis ZWilson RSBienias JLEvans DABennett DA Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function. Arch Neurol 2004;61661- 666PubMedGoogle ScholarCrossref 2. Wilson RSBarnes LLMendes de Leon CF et al. Depressive symptoms, cognitive decline, and risk of AD in older persons. Neurology 2002;59364- 370PubMedGoogle ScholarCrossref 3. Wilson RSSchneider JABienias JLArnold SEEvans DABennett DA Depressive symptoms, clinical AD, and cortical plaques and tangles in older persons. Neurology 2003;611102- 1107PubMedGoogle ScholarCrossref 4. Bennett DAWilson RSSchneider JABienias JLArnold SE Cerebral infarctions and the relationship of depression symptoms to level of cognitive functioning in older persons. Am J Geriatr Psychiatry 2004;12211- 219PubMedGoogle ScholarCrossref 5. Wilson RSEvans DABienias JLMendes de Leon CFSchneider JABennett DA Proneness to psychological distress is associated with risk of Alzheimer's disease. Neurology 2003;611479- 1485PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Diabetes Mellitus and Alzheimer Disease—Reply

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Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.62.2.330-b
Publisher site
See Article on Publisher Site

Abstract

In reply We thank Franco and Bronson for their interest in our article.1 They raise the possibility that depression may play a role in the relation of diabetes mellitus to risk of Alzheimer disease (AD) and to cognitive decline. To address this possibility, we repeated the analyses after excluding 11 persons with clinically diagnosed depression at the baseline evaluation and then following exclusion of 65 persons who had a clinical diagnosis of depression at any point in their lifetime. In both sets of analyses, the relation of diabetes mellitus to risk of AD (for both analyses: hazard ratio, 1.70 [95% confidence interval, 1.13-2.56]) and to decline in perceptual speed (P<.05) were unchanged, suggesting that clinical depression does not account for these associations. Whether the much more common mild depressive symptoms, which are related to AD,2 could be associated with diabetes mellitus requires further exploration. The biologic mechanisms linking diabetes mellitus to AD are unclear. While it is possible that cerebral infarctions account for this association, in prior research, neither measures of AD pathologic features nor cerebral infarctions accounted for the association of depression3,4 or stress5 with cognitive impairment. We agree with Franco and Bronson that other mechanisms will need to be explored, including the possibility that “stress-related cortisol secretion” could link endocrine, metabolic, and hemodynamic abnormalities, as well as obesity, to cognitive impairment. Back to top Article Information Correspondence: Dr Arvanitakis, Rush Alzheimer’s Disease Center, Rush University Medical Center, Armour Academic Center, 600 S Paulina St, Suite 1020E, Chicago, IL 60612. References 1. Arvanitakis ZWilson RSBienias JLEvans DABennett DA Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function. Arch Neurol 2004;61661- 666PubMedGoogle ScholarCrossref 2. Wilson RSBarnes LLMendes de Leon CF et al. Depressive symptoms, cognitive decline, and risk of AD in older persons. Neurology 2002;59364- 370PubMedGoogle ScholarCrossref 3. Wilson RSSchneider JABienias JLArnold SEEvans DABennett DA Depressive symptoms, clinical AD, and cortical plaques and tangles in older persons. Neurology 2003;611102- 1107PubMedGoogle ScholarCrossref 4. Bennett DAWilson RSSchneider JABienias JLArnold SE Cerebral infarctions and the relationship of depression symptoms to level of cognitive functioning in older persons. Am J Geriatr Psychiatry 2004;12211- 219PubMedGoogle ScholarCrossref 5. Wilson RSEvans DABienias JLMendes de Leon CFSchneider JABennett DA Proneness to psychological distress is associated with risk of Alzheimer's disease. Neurology 2003;611479- 1485PubMedGoogle ScholarCrossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Feb 1, 2005

References