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Is glycaemia associated with poorer brain health and risk of dementia? Cross sectional and follow-up analysis of the UK Biobank

Garfield, V.; Farmaki, A.-E.; Eastwood, S. V.; Mathur, R.; Rentsch, C. T.; Bhaskaran, K.; Smeeth, L.; Chaturvedi, N.

2020-02-20 epidemiology
10.1101/2020.02.18.20024471 medRxiv
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INTRODUCTIONTo understand the relationship across the glycaemic spectrum, with brain health. METHODSUK Biobank participants. HbA1c and diabetes diagnosis define baseline glycaemic categories. Outcomes: incident vascular dementia (VD), Alzheimers dementia (AD), hippocampal volume (HV), white matter hyperintensity (WMH) volume, cognitive function and decline. Reference group: normoglycaemic individuals (HbA1c 35-<42 mmol/mol). RESULTSPre- and known diabetes increased incident VD, (HR 1.54, 95%CI=1.04;2.28 and 2.97, 95%CI=2.26;3.90). Known diabetes increased AD risk (HR 1.84, 95%CI=1.44;2.36). Pre- and known diabetes elevated risks of cognitive decline (OR 1.42, 1.48;2.96 and 1.39, 1.04;1.75). Pre-diabetes, undiagnosed and known diabetes conferred higher WMH volumes (4%, 26%, 5%,) and lower HV (22.4mm3, 15.2mm3, 62.2mm3). Low-normal HbA1c had 2% lower WMH volume and 13.6mm3 greater HV. DISCUSSIONPre and known diabetes increase VD risks; known diabetes increases AD risk. Low-normal HbA1c associates with favourable neuroimaging outcomes. Our findings may have implications for cardiovascular medication in hyperglycaemia for brain health.

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