Abbatecola AM, Lattanzio F, Molinari AM, Cioffi M, Mansi L, Rambaldi P, Dicioccio L, Cacciapuoti F, Canonico R, Paolisso G.
Italian National Research Center on Aging (I.N.R.C.A.), Ancona, Italy.
Objective. Studies have suggested that insulin resistance(IR) plays a role on cognitive impairment in individuals with type 2 diabetes. We aimed to determine whether an improvement in IR could explain cognitive performance variations over a 36weeks in older persons with mild cognitive impairment (MCI) and type 2 diabetes. Research design and Methods. 97 older persons (mean age:76 +/- 6yrs) that recently (< 2 months) started an anti-diabetic treatment of: metformin (MF) (500mgtwice a day)(n=30) or metformin (500mg/day)+rosiglitazone (4mg/day) (MF/Rosi) (n=32) or using a diet (n=35) volunteered. The neuropsychological battery consisted of: Mini Mental State Examination(MMSE), Rey Verbal Auditory Learning total recall(RAVLT), Trail Making Tests (TMTA,TMTB,DIFFBA) performed at baseline and every 12 weeks for 36-weeks along with clinical testing. Results. Baseline: No significant differences were found between groups in clinical or neuropsychological parameter. Mean values in the entire population were: HbA(1c)=7.5+/-0.5%, FPG=8.6+/-1.3mmol/l, FPI=148+/-74pmol/l, MMSE=24.9+/-2.4, TMTA=61.6+/-42.0, TMTB=162.8+/-78.7, DIFFBA=101.2+/-58.1, RAVLT=24.3+/-2.1. Follow-up: ANOVA-models tested changes in metabolic control parameters (fasting plasma insulin(FPI), fasting plasma glucose (FPG),HbA(1c)). Such parameters improved in MF and MF/Rosi groups (p-for-trend<0.05 in both groups).ANCOVA-repeated models showed that MF/Rosi group maintained stable on all neuropsychological tests, the diet group on the MMSE and TMT-A tests, while declined in TMT-B (p for trend=0.024), executive efficiency (DIFFBA)(p for trend= 0.026) and RAVLT memory test(p for trend=0.011), MF group maintained stable on MMSE and TMTs but declined on RAVLT(p for trend=0.011).Using linear-mixed-effects-models, interaction term, FPI*time, correlated with cognitive stability on the RAVLT in the MF/Rosi group (beta=-1.899;p=0.009). Conclusions. Rosiglitazone may protect against cognitive decline in older persons with type 2 diabetes and MCI.
PMID: 20435794
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