Journal
JOURNAL OF ALZHEIMERS DISEASE
Volume 71, Issue 4, Pages 1339-1350Publisher
IOS PRESS
DOI: 10.3233/JAD-190427
Keywords
Cohort studies; death; dementia; type 2 diabetes mellitus
Categories
Funding
- Caisse Nationale Maladie des Travailleurs Salaries
- Direction Generale de la Sante
- Mutuelle Generale de l'Education Nationale
- Institut de la Longevite
- Conseil Regionaux of Aquitaine
- Conseil Regionaux of Bourgogne
- Fondation de France
- Ministry of Research-INSERM Programme Cohortes et collections de donnees biologiques
- Fondation Plan Alzheimer (FCS 2009-2012)
- Caisse Nationale pour la Solidarit'e et l'Autonomie
- Agence Nationale de la Recherche ANR PNR 2006 [ANR/DEDD/PNRA/PROJ/200206-01-01]
- Longvie 2007 [LVIE-003-01]
- Fondation pour la Recherche Medicale
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Diabetes is associated with a higher dementia and mortality risk. However, few studies have accounted for death when estimating the association between diabetes and dementia. We estimated absolute and relative risks of all-cause dementia according to diabetes exposure status in older adults while accounting for competing risk of death using illness-death models. Effect modification by specific characteristics (age, gender, education, cardiovascular risk factors, body mass index, cardiovascular history, depressive symptomatology, impaired renal function, and APOE epsilon 4 genotype) was also investigated. We analyzed the Three-City study data, a French population-based cohort of adults aged 65 years and above who were followed up for 12 years from 1999-2001. Among 8,328 participants selected in the analytical sample (median age, 73.3 years; 60.3% women), 809 (9.3%) presented with diabetes at baseline. Over a median follow-up period of 8.3 years, 836 participants developed incident dementia. Baseline diabetes was associated with a higher risk of dementia: hazard ratio, 1.79 [95% confidence interval, 1.46-2.19]. No effect modification was shown. Diabetes was associated with a higher 12-year absolute risk of dementia and a lower dementia-free life expectancy (e.g., 14.5% [11.2-18.1] versus 8.7% [7.6-10.2], and 13.4 [12.7-14.1] years versus 16.5 [16.0-17.1] years, respectively, for a 70-year-old woman with the highest level of education). These findings support the potential impact of preventing diabetes on reducing dementia risk in older adults, with a 2-3-year higher dementia-free life expectancy for individuals without diabetes, and inform the design of future interventional trials.
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