- The Washington Times - Tuesday, March 17, 2009

Diabetes hurts your heart, your eyes, your kidneys. Now, new research indicates a more ominous link - that diabetes increases the risk of getting Alzheimer’s disease and may speed dementia once it strikes.

Doctors long suspected diabetes damaged blood vessels that supply the brain. It now seems even more insidious, that the damage may start before someone is diagnosed with full-blown diabetes, back when the body is gradually losing its ability to regulate blood sugar.

In fact, the lines are blurring between what specialists call “vascular dementia” and scarier classic Alzheimer’s disease. Whatever it’s labeled, there’s reason enough to safeguard your brain by fighting diabetes and heart-related risks.

“Right now we can’t do much about the Alzheimer’s disease pathology,” those sticky plaques that clog patients’ brains, said Dr. Yaakov Stern, an Alzheimer’s specialist at Columbia University Medical Center. But, “if you could control these vascular conditions, you might slow the course of the disease.”

The link has staggering societal implications: More than 5 million Americans have Alzheimer’s, and cases already are projected to skyrocket in the next two decades as the population ages. The question is how much the simultaneous obesity-fueled epidemic of Type 2 diabetes may worsen that toll.

There are about 18 million Type 2 diabetics who are considered to have at least two to three times a non-diabetic’s risk of developing Alzheimer’s. Still, Type 2 diabetes often leads to heart disease and other conditions that kill before Alzheimer’s typically strikes, in the 70s.

Don’t panic if you’re diabetic, said Dr. Ralph Nixon of New York University, vice chairman of the Alzheimer’s Association’s scientific advisory council. Genetics still are the prime risk factor for dementia.

“It by no means means that you’re going to develop Alzheimer’s disease, and certainly many people with Alzheimer’s don’t have diabetes,” he said.

But the latest research strengthens the link, and has scientists asking if diabetes and its related “metabolic syndrome” increase risk solely by spurring brain changes that underlie Alzheimer’s - or if they add an extra layer of injury to an already struggling brain, what Dr. Nixon calls “essentially a two-hit situation.”

Other factors, such as brain inflammation and cell-damaging oxidative stress, may play a role, too. But clearly more affected is a silent dysfunction of glucose control, not something that suddenly begins after diabetes is diagnosed.

“You want to think of it more as a continuum than just whether or not you have diabetes,” Dr. Stern said.

While scientists sort out exactly what’s going on, the research does point to some common-sense protections: If you have diabetes, closely follow your doctor’s advice for controlling it. Try to lower high cholesterol and blood pressure that can harm the brain’s blood supply and exacerbate memory problems.

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