Scientists have created a simple scoring system that will allow clinicians to predict whether older people with type 2 diabetes are at risk of developing dementia, according to a study published in The Lancet Diabetes and Endocrinology.
Researchers from the Kaiser Permanente Division of Research in California say the new system, called the “diabetes-specific dementia risk score” (DSDRS), will mean doctors can closely monitor patients with type 2 diabetes who are at highest risk of dementia and enable early treatment to be given.
For the study, the research team analyzed medical records of 29,961 Kaiser Permanente patients over the age of 60 who had type 2 diabetes.
The researchers looked at whether the patients were diagnosed with dementia within the 10-year follow-up period. The analysis revealed that 17% of patients developed dementia during this time.
They built the DSDRS model with 45 candidate risk factors for dementia. Using “sophisticated statistical methods,” the researchers looked at patients’ medical records to determine the risk factors that most strongly predicted the onset of dementia within 10 years.
The following were identified as the most important predictive factors:
- Acute metabolic event
- Microvascular disease
- Diabetic foot
- Cerebrovascular disease
- Heart disease
The scoring system can divide patients into one of 14 categories. The lowest score is -1, which indicates the lowest risk of dementia, while the highest scores are between 12 and 19.
By using the diabetes-specific dementia risk score, results showed that, compared with those who had the lowest scores, patients with the highest were 37 times more likely to develop dementia within 10 years.
Additionally, patients with the highest scores developed dementia faster than those with the lowest.
The researchers tested the scoring system against a large group of people with type 2 diabetes who were unrelated to the study and found that it accurately predicted their risk of developing dementia.
Dr. Rachel Whitmer from Kaiser Permenante says:
“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.”
“Our model shows that in two large populations of patients with type 2 diabetes a combination of diabetes-associated complications, education, and age is highly predictive of the likelihood of dementia within the next decade.”
The study authors say that this is the first time scoring systems have been used to specifically predict dementia in patients with type 2 diabetes.
They add that the scoring system would prove beneficial to doctors in predicting the onset of dementia in type 2 diabetes patients, as it does not rely on expensive, complicated brain imaging or cognitive testing.
“Early detection of patients with type 2 diabetes who are at increased risk of dementia could help to develop and target preventive treatment,” says Dr. Whitmer.
“Our scoring system has the potential to change clinical care by giving clinicians a simple and accurate way of predicting the risk of dementia in older people with type 2 diabetes.”
But the study authors note that there are plans to conduct a second stage into the scoring system, which may involve some use of cognitive testing in order to improve accuracy.
In a comment piece following the study, Dr. Anna-Maija Tolppanen of the Center for Comparative Effectiveness and Patient Safety in Finland, says that although the diabetes-specific dementia risk score (DSDRS) could be beneficial for clinicians in determining dementia risk, the system may not be so useful in selecting patients for drug trials.
“Clinical trial data on effective preventive interventions for dementia are currently lacking,” says Dr. Tolppanen.
“Although [the researchers] state that DSDRS could be used to select candidates for trials, it should be noted that diabetes and many of the components of the score are often exclusion criteria for medication trials.”