Dementia Still a Risk for Diabetics Controlling Blood Pressure

Intensive blood pressure and cholesterol control therapies were not tied to lower risk of cognitive decline

(RxWiki News) Type 2 diabetes has been linked to dementia and cognitive decline in older adults. A recent study examined whether intensive blood pressure goals and fibrate therapy could help.

Type 2 diabetes is a condition in which the body becomes resistant to insulin, a natural substance that regulates blood sugar.

The researchers found in two study arms that intensive treatment goals for high blood pressure and adding a fibrate medication to statin treatment of high cholesterol did not prevent cognitive decline and brain volume loss in diabetes patients compared to standard treatment. 

"If you have diabetes, talk to your doctor about preventing dementia."

Jeff Williamson, MD, MHS, of the Roena B. Kulynych Center for Memory and Cognition Research in the Wake Forest School of Medicine, led the study.

According to the authors, more older people have developed type 2 diabetes in recent decades. Paired with high blood pressure or high cholesterol, type 2 diabetes can change the brain's structure and increase a person's risk of developing dementia or other forms of cognitive impairment.

This study investigated whether intensive therapy for high blood pressure or high cholesterol reduces type 2 diabetes patients' risk of cognitive impairment. 

Researchers recruited 2,977 older adults with type 2 diabetes to participate in a trial. One group of diabetes patients received treatment for high blood pressure and another received treatment for high cholesterol for 40 months. Researchers measured the patients' thinking abilities during follow-up visits, and some participants underwent brain scans.

A total of 1,439 patients had high blood pressure and were assigned to receive either intensive intervention — meant to reduce systolic blood pressure to 120 — or standard intervention to reduce systolic blood pressure to 140.

The other 1,538 patients were enrolled in the high cholesterol arm of the study. Of those participants, 782 received a statin, or cholesterol-lowering drug, and another drug, fenofibrate (brand name Triglide, Lipofen and Lofibra).

The other 756 patients received a statin and a placebo, or fake medicine.

Researchers assessed the participants' cognition when they started the study, then at 20 and 40 months into the study.

The cognitive tests measured the participants' memory skills, processing speeds and control of cognitive functions. Also, 503 participants received an MRI scan of the brain during their 40-month follow-up visit.

The researchers found that, although the treatments were effective in reducing blood pressure and cholesterol levels, cognitive ability still declined among the participants

Additionally, at the 40-month follow-ups, cognitive ability was similar between the intensive and standard blood pressure therapy groups and between the fenofibrate and placebo groups.

Among the participants who received MRIs, the patients receiving standard blood pressure intervention lost about 50 percent less brain volume than those receiving intensive intervention.

The researchers concluded that using intensive treatments to control high blood pressure or high cholesterol in patients with type 2 diabetes did not seem to reduce cognitive decline. They also noted that previous studies found that intensive blood sugar therapy is an effective way to prevent brain volume loss in diabetes patients.

The authors of the study also wrote that the findings do not negate the importance of controlling blood pressure and cholesterol levels to prevent stroke or heart disease.

The study was published in JAMA Internal Medicine on February 3.

Some of the researchers disclosed financial ties to pharmaceutical companies like GlaxoSmithKline, AstraZeneca and Merck.