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The system -- which scores patients based on their age, health issues and education -- could help doctors closely monitor diabetes patients at the highest risk of dementia and begin early treatment if needed, said Dr. Rachel Whitmer and her colleagues at the Kaiser Permanente Division of Research in California.
The researchers created the scoring system by examining data from nearly 30,000 patients who were older than 60 and had type 2 diabetes. Nearly one in five (17 percent) of the patients developed dementia over a decade.
The researchers identified 45 risk factors for dementia, and used sophisticated statistical methods to analyze the patients' medical records and identify the risk factors that most strongly predicted the onset of dementia.
Age, education level and six different diabetes-related health complications (acute metabolic event, microvascular disease, diabetic foot, cerebrovascular disease, heart disease and depression) were determined to be the most important predictors of dementia.
The researchers incorporated these factors into an easy-to-use point system that places patients in one of 14 categories. The lowest score (-1) indicates the lowest risk of dementia and the highest scores (12 to 19) indicate the highest risk.
Patients with the highest scores were 37 times more likely to develop dementia within 10 years than those with the lowest scores, and patients with higher scores developed dementia more quickly than those with lower scores, according to an article published online Aug. 20 in the journal The Lancet Diabetes & Endocrinology.
The researchers then tested the scoring system in another group of older patients with type 2 diabetes, and found that it accurately predicted their risk of developing dementia.
Scoring systems have been developed to predict the risk of dementia in other groups of patients, but this is the first one to predict the risk of dementia in people with diabetes, the researchers said.
"Unfortunately, there is an epidemic of both type 2 diabetes and dementia, and the link between these two illnesses portends a possible public health crisis," Whitmer said in a journal news release.
"Generally, risk scores might be useful in the identification of individuals who should be monitored for disease symptoms, selection of high-risk individuals for clinical trials, targeting of preventive interventions toward those at greatest risk, and assessment of the effectiveness of an intervention at reducing the risk of future illness," Dr. Anna-Maija Tolppanen, of the University of Eastern Finland, wrote in an accompanying commentary.
"[This new scoring system] might be useful for clinicians for the first purpose, but clinical trial data on effective preventive interventions for dementia are currently lacking," Tolppanen said.
-- Robert Preidt
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