ArticlesRisk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study
Introduction
The rising prevalence of type 2 diabetes is of great public health concern, especially because this disease can lead to complications in several organ systems. Over the past decades, patients with type 2 diabetes have been living longer because of major improvements in treatment and demographic trends.1 This improved longevity is, however, accompanied by an increased risk of health complications associated with ageing, including cognitive impairment and dementia.2 Adults with type 2 diabetes have a roughly doubled risk of dementia—both Alzheimer's disease and vascular dementia—compared with those who do not have type 2 diabetes.3
Despite substantial efforts, there is no effective treatment to cure or prevent dementia. In recent years, attention has focused on early intervention strategies at a stage when there is still time and potential to modify disease progression.4, 5 Nevertheless, the findings of prevention trials have not yet shown the desired effect. To increase the success of future trials, enrichment of study cohorts through risk stratification has been recommended.4 A similar approach in which risk scores are used for selection of people for targeted treatment has been used successfully for cardiovascular diseases.6, 7 Recently, several risk scores for prediction of the risk of dementia have been reported.8, 9, 10, 11 However, none of these scoring systems account for diabetes-specific dementia predictors, such as diabetes duration, glucose lowering treatment, and severe hypoglycaemic episodes.12, 13, 14, 15, 16, 17, 18 Because people with type 2 diabetes are particularly susceptible to dementia, identification of those at high risk in early stages of the dementia process when symptoms are still subclinical is crucial in this population. Our aim in this study was to develop and validate a score that can be easily implemented in daily clinical care to predict the 10 year dementia risk in older individuals with type 2 diabetes.
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Patients and study design
For the development of the risk score, we evaluated data for 29 961 patients (aged ≥60 years) with type 2 diabetes from the Kaiser Permanente Northern California (KPNC) Diabetes Registry, Oakland, CA, USA. The data for this well characterised cohort of patients with type 2 diabetes have been used in several epidemiological and health services studies18, 19, 20, 21 since 1994, as part of the Diabetes and Aging Study.19 KPNC is a large, integrated health-care delivery system providing
Results
Table 1 shows the baseline characteristics; the mean age of the development cohort (n=29 961) was 70·6 years (SD 6·8), 46% were women, and 45% of individuals were educated to college or higher level. The highest educational level was college or higher. The population was ethnically diverse, with 37% non-white patients. Mean diabetes duration at baseline was 11·6 years (9·5). 5173 (17%) patients received a diagnosis of dementia during 6·6 years (3·4) of follow-up. During follow-up 14 366 (48%)
Discussion
The DSDRS presented in this report is predictive of an individual's absolute risk of developing dementia within the subsequent decade based on the predictors diabetes-related comorbidities and complications, age, and education. The predictive accuracy of the DSDRS in the development and validation cohort was similar. The DSDRS stratifies individuals into 14 categories from −1 to 12–19, showing a 15 times difference in dementia risk between the lowest and the highest sum scores; it performs well
References (31)
- et al.
Risk of dementia in diabetes mellitus: a systematic review
Lancet Neurol
(2006) The European dementia prevention initiative
Lancet Neurol
(2013)- et al.
Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study
Lancet Neurol
(2006) - et al.
Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry
Am J Med
(2001) Intensive glucose lowering and cognition in type 2 diabetes
Lancet Neurol
(2011)- et al.
Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy
Lancet Neurol
(2011) - et al.
Life expectancy in a large cohort of type 2 diabetes patients treated in primary care (ZODIAC-10)
PLoS One
(2009) - et al.
Cognitive function, dementia and type 2 diabetes mellitus in the elderly
Nat Rev Endocrinol
(2011) - et al.
Can we prevent Alzheimer's disease? Secondary “prevention” trials in Alzheimer's disease
Alzheimers Dement
(2013) - et al.
Prediction of coronary heart disease using risk factor categories
Circulation
(1998)
Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin
Circulation
Predicting risk of dementia in older adults: The late-life dementia risk index
Neurology
Prediction of dementia in primary care patients
PLoS One
A summary risk score for the prediction of Alzheimer disease in elderly persons
Arch Neurol
Predictors of cognitive decline in older individuals with diabetes
Diabetes Care
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