For people with Type 2 diabetes, there is an additional incentive for keeping the disease under management. Research shows a possible link between diabetes and cognitive decline, including increased risk for Alzheimer’s disease and vascular dementia.
The scientific reason behind the link between diabetes and brain health is complex. Some scientists believe people with diabetes may also have insulin resistance or insulin deficiency that could damage brain cells enough to cause memory loss. Studies are underway to understand why 80 percent of people with Alzheimer’s disease also have some form of diabetes or disturbed glucose metabolism. However, so far, longitudinal research has not produced a consensus view regarding the link between blood glucose levels and cognitive impairment.
Meanwhile, in South Florida, medical professionals are working with diabetic patients to minimize the risk of cognitive decline through a variety of methods that include lifestyle, medical and mental-health components.
“Our message to diabetics is that the better people can control their diabetes, the more they can reduce risk of other conditions,” said Dr. Marc Agronin, director of the memory center and clinical research program at Miami Jewish Health. “Of course, that requires a lot of education and close attention.”
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On the lifestyle front, Agronin urges diabetics to exercise, maintain a healthy diet, lose weight if necessary and avoid being sedentary. “They need to adopt a brain-healthy lifestyle.”
On the medical front, medical professionals are considering how early detection and glycemic control can prevent cognitive decline (memory loss). They also are considering how certain foods, supplements and medications can help diabetics with brain health.
“If you have diabetes and you notice changes, you need to go to a memory center and get a workup to see your baseline,” Agronin said.
Research shows some medications are promising. A 2015 pilot study published in the Journal of Alzheimer’s Disease found specific doses of nasal insulin—which bypassed the blood/brain barrier—significantly improved memory in people with early Alzheimer’s disease and mild cognitive impairment. A larger trial is underway. Some studies also have shown that the longer a patient used Metformin (a drug diabetics use to control blood glucose), the lower the individual’s chances of developing Alzheimer’s disease and other types of dementia and cognitive impairment.
At Palmetto General Hospital in Hialeah, Dr. Monica Mejia Acosta, director of neurology, has found many of her patients with diabetes have had tiny strokes that eventually led to vascular dementia.
“If you control the diabetes, you decrease the risk for those tiny strokes significantly,” she said. While there isn’t any medication to reverse vascular dementia, “you can prevent it from worsening by controlling your glucose levels” she said.
When Mejia Acosta detects mini strokes, she recommends patients take a daily dose of aspirin. She also puts dementia patients on medications that she finds effective in slowing progression. “Usually two medicines work better than one, but I start them on one at a time,” she said.
Along with medication, there are natural supplements such as coconut oil, rosemary and certain vitamins that some medical experts believe can have positive effects on brain health. In addition, a group of doctors is looking at ways that stem cells can help. Kristin Comella, chief scientific officer at US Stem Cell, Inc. in Sunrise, said stem-cell therapy and regenerative medicine are novel treatments for diabetes and Alzheimer’s. Comella said stem cells have been shown to improve the function of the overworked pancreas in diabetes patients.
On the mental health front, Dale Pianko, a cognitive behavioral therapist and founder of the Aventura Memory Center, believes coping skills factor into memory decline.
“Anxiety around a diabetes diagnosis exacerbates the mental health and could affect memory loss if it’s not addressed in an interventional manner,” Pianko said. She works with patients to create an individual memory plan, and has found that individuals who self-monitor their diabetes, stick to their plan, and control their glucose levels have sharper memories. “Medication doesn’t do anything without the right behavior modification,” she said.
According to the American Diabetes Association, 27 percent of people 65 and older have developed diabetes. With scientists finding more evidence that links Type 2 diabetes with Alzheimer’s disease and cognitive decline, medical experts are finding early detection and effective ongoing management of diabetes may be more important than initially realized.