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ARTICLES: Glen L. Xiong, Brenda L. Plassman, Michael J. Helms, and David C. Steffens Vascular risk factors and cognitive decline among elderly male twins Neurology 2006; 67: 1586-1591 [Abstract] [Full text] [PDF]

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Vascular risk factors and cognitive decline among elderly male twins

Marc Gotkine   (1 February 2007)

Reply from the authors

Brenda L. Plassman, Glen L. Xiong, Michael J. Helms, David C. Steffens   (1 February 2007)

Vascular risk factors and cognitive decline among elderly male twins 1 February 2007
Marc Gotkine, Department of Neurology, Hadassah University Hospital Jerusalem, Israel Send Correspondence to journal: Re: Vascular risk factors and cognitive decline among elderly male twins marcgotkine{at}gmail.com Marc Gotkine	Xiong et al’s elegant study provides valuable data illustrating the damaging effects of diabetes on cognitive function while minimizing genetic and early environmental background noise. [1] Elucidating the mechanisms underlying the cognitive decline could be facilitated by examining available imaging data for some of the twin pairs discordant for diabetes. Addressing the issue of whether accelerated cognitive dysfunction in twin pairs is always correlated with the accumulation of brain infarcts on MRI would provide valuable insight into how diabetes exerts its deleterious effects on cognition. If non-vascular mechanisms such as direct glucose toxicity on neurons, enhanced amyloid deposition, or deranged neurotransmission are shown to play a prominent role in “diabetic dementia” these may be addressed by the early initiation of preventative therapies targeted at these factors. As aggressive glycemic control may be expected to slow cognitive decline by multiple mechanisms, it would be interesting to know whether there was data available which allowed this factor to be related to the rate of cognitive deterioration in this study. Further application of this twin assessment approach may provide information regarding the mechanisms underlying the cognitive decline in this prevalent and potentially disabling condition. Reference 1. Xiong GL, Plassman BL, Helms MJ, Steffens DC. Vascular risk factors and cognitive decline among elderly male twins Neurology 2006; 67: 1586-1591. Disclosure: The author reports no conflicts of interest.
Reply from the authors 1 February 2007
Brenda L. Plassman, Duke University Medical Center 905 W Main Street, Ste 25-D, Box 41, Durham, NC 27701, Glen L. Xiong, Michael J. Helms, David C. Steffens Send Correspondence to journal: Re: Reply from the authors bplassman{at}psych.duhs.duke.edu Brenda L. Plassman, et al.	We thank Dr. Gotkine for his comments about utilizing neuroimaging to clarify the mechanism underlying the observed association between diabetes and cognitive decline. Due to the financial costs of in-person assessments of individuals in this sample who reside throughout the continental US, much of the data on the NAS-NRC WWII Veteran Twin Registry was collected via telephone interviews or mail-out questionnaires. Unfortunately, this means that we typically do not have neuroimaging studies to assess cerebrovascular lesions. For this same reason, we do not have blood samples or detailed medical records available to assess the level of glycemic control among the diabetics. We agree that having sufficiently detailed medical information, blood glucose levels or an index of diabetes control such as hemoglobin A1C, and neuroimaging data--perhaps including PET--would be important for future studies. Disclosure: The authors report no conflicts of interest.