Article: Care Delivery
Diabetes mellitus as a modulator of functional impairment and decline in Alzheimer’s disease. The Real.FR cohort
Article first published online: 12 MAR 2012
© 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK
Volume 29, Issue 4, pages 541–548, April 2012
How to Cite
Sanz, C. M., Hanaire, H., Vellas, B. J., Sinclair, A. J., Andrieu, S. and for REAL.FR Study Group (2012), Diabetes mellitus as a modulator of functional impairment and decline in Alzheimer’s disease. The Real.FR cohort. Diabetic Medicine, 29: 541–548. doi: 10.1111/j.1464-5491.2011.03445.x
- Issue published online: 12 MAR 2012
- Article first published online: 12 MAR 2012
- Accepted manuscript online: 13 SEP 2011 04:15PM EST
- Accepted 1 September 2011
- Alzheimer’s disease;
Diabet. Med. 29, 541–548 (2012)
Aims To determine whether diabetes mellitus influences functional status in patients with Alzheimer’s disease.
Methods We studied 608 community-dwelling patients with Alzheimer’s disease from a prospective multicenter cohort. Diabetes was assessed at baseline. Functional status was assessed twice yearly with the Activities of Daily Living scale. Each patient had a baseline functional disability if their Activities of Daily Living score was < 6. Progression of functional disability was defined by a decreased Activities of Daily Living score over 4 years of follow-up visits.
Results At baseline, diabetes was present in 63 participants (10.4%) and, compared with those without diabetes, was associated with functional impairment [age- and sex-adjusted OR = 2.73 (95% CI 1.41–5.28)]. After controlling for confounders, the association remained significant [OR = 2.04 (95% CI 1.02–4.11)]. Follow-up demonstrated a significant interaction between duration of Alzheimer’s disease and diabetes, which was associated with progression of functional impairment in patients who had been diagnosed with Alzheimer’s disease for less than 1 year [age- and sex-adjusted hazard ratio = 1.52 (95% CI 1.01–2.30), P = 0.048], but not in those who had been diagnosed with Alzheimer’s disease for more than 1 year [age- and sex-adjusted hazard ratio = 0.78 (95% CI 0.47–1.28), P = 0.32]. Abnormal one-leg balance, polymedication and obesity seem to be important factors explaining the association between diabetes and functional status.
Conclusions At baseline, the presence of diabetes significantly increases the risk of functional disability in patients with Alzheimer’s disease; our longitudinal data confirm that in patients with a recent diagnosis of Alzheimer’s disease (but not in those who have had Alzheimer’s disease for longer than 1 year), diabetes continues to worsen functional status.