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From the Taub Institute for Research of Alzheimer’s Disease and the Aging Brain (Drs. Luchsinger, Tang, and Mayeux), Gertrude H. Sergievsky Center (Dr. Mayeux), and Departments of Biostatistics (Dr. Tang) and Epidemiology (Drs. Shea and Mayeux), Joseph P. Mailman School of Public Health, Columbia University, New York; and Division of General Medicine, Department of Medicine (Drs. Luchsinger and Shea), Department of Neurology (Dr. Mayeux), and Department of Psychiatry (Dr. Mayeux), Columbia University College of Physicians and Surgeons, New York, NY.
Address correspondence and reprint requests to Dr. Richard Mayeux, Gertrude H. Sergievsky Center, PH-19, 630 West 168th St., New York, NY 10032; e-mail: rpm2{at}columbia.edu
Objective: To explore the association between fasting insulin levels and dementia.
Methods: Fasting insulin levels were measured from frozen sera using solid-phase chemiluminescent enzyme immunoassay in a sample of elderly subjects chosen at random from a cohort of persons aged 65 years and older from northern Manhattan. Dementia was diagnosed using standard methods. Neuropsychiatric testing was available on all subjects at each follow-up interval.
Results: A total of 683 subjects without prevalent dementia were followed for 3,691 person-years and 149 persons developed dementia (137 Alzheimer disease [AD], 6 dementia associated with stroke, 6 other). The risk of AD doubled in the 39% of the sample with hyperinsulinemia (HR = 2.1; 95% CI: 1.5, 2.9) and was highest in people without diabetes. The HR relating presence of hyperinsulinemia or diabetes in 50% of our sample to AD was 2.2 (95% CI: 1.5, 3.1). The risk of AD attributable to the presence of hyperinsulinemia or diabetes was 39%. The HR of AD for the highest quartile of insulin compared to the lowest was 1.7 (95% CI: 1.0, 2.7; p for trend = 0.009). Hyperinsulinemia was also related to a significant decline in memory-related cognitive scores, but not to decline in other cognitive domains.
Conclusions: Hyperinsulinemia is associated with a higher risk of AD and decline in memory.
Received February 28, 2004. Accepted in final form June 4, 2004.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the October 12 issue to find the title link for this article.
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