The association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia

Abstract Background The effect of antidiabetic medication on cognitive function is unclear. We analyzed the association between five antidiabetic drugs and change in Mini-Mental State Examination (MMSE) scores in patients with diabetes and dementia. Methods Using the Swedish Dementia Registry and fo...

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Autores principales:	Juraj Secnik, Hong Xu, Emilia Schwertner, Niklas Hammar, Michael Alvarsson, Bengt Winblad, Maria Eriksdotter, Sara Garcia-Ptacek, Dorota Religa
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Diabetes Dementia Antidiabetics Metformin DPP-4i MMSE Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/a05a37f9003142baa4f3a1fad344943b
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spelling	oai:doaj.org-article:a05a37f9003142baa4f3a1fad344943b2021-12-05T12:24:33ZThe association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia10.1186/s13195-021-00934-01758-9193https://doaj.org/article/a05a37f9003142baa4f3a1fad344943b2021-12-01T00:00:00Zhttps://doi.org/10.1186/s13195-021-00934-0https://doaj.org/toc/1758-9193Abstract Background The effect of antidiabetic medication on cognitive function is unclear. We analyzed the association between five antidiabetic drugs and change in Mini-Mental State Examination (MMSE) scores in patients with diabetes and dementia. Methods Using the Swedish Dementia Registry and four supplementary Swedish registers/databases, we identified 1873 patients (4732 observations) with diagnosis of type 2 diabetes (diabetes) and Alzheimer’s disease or mixed-pathology dementia who were followed up at least once after dementia diagnosis. Use of metformin, insulin, sulfonylurea, thiazolidinediones (TZD), and dipeptidyl-peptidase-4 inhibitors (DPP-4i) was identified at baseline. Prevalent-user, incident-user, and drug-drug cohorts were sampled, and propensity-score matching was used to analyze comparable subjects. Beta coefficients with 95% confidence intervals (CI) from the random intercept and slope linear mixed-effects models determined the association between the use of antidiabetic medications and decline in MMSE score points between the follow-ups. Inverse-probability weighting was used to account for patient dropout. Results Compared to non-users, prevalent users of metformin (beta 0.89, 95% CI 0.44; 1.33) and DPP-4i (0.72, 0.06; 1.37) experienced a slower cognitive decline with time. Secondly, compared to DPP-4i, the use of insulin (−1.00, −1.95; −0.04) and sulfonylureas (−1.19; −2.33; −0.04) was associated with larger point-wise decrements in MMSE with annual intervals. Conclusions In this large cohort of patients with diabetes and dementia, the use of metformin and DPP-4i was associated with a slower decline in MMSE scores. Further examination of the cognitive effects of metformin and incretin-based medications is warranted.Juraj SecnikHong XuEmilia SchwertnerNiklas HammarMichael AlvarssonBengt WinbladMaria EriksdotterSara Garcia-PtacekDorota ReligaBMCarticleDiabetesDementiaAntidiabeticsMetforminDPP-4iMMSENeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENAlzheimer’s Research & Therapy, Vol 13, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diabetes Dementia Antidiabetics Metformin DPP-4i MMSE Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Diabetes Dementia Antidiabetics Metformin DPP-4i MMSE Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Juraj Secnik Hong Xu Emilia Schwertner Niklas Hammar Michael Alvarsson Bengt Winblad Maria Eriksdotter Sara Garcia-Ptacek Dorota Religa The association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia
description	Abstract Background The effect of antidiabetic medication on cognitive function is unclear. We analyzed the association between five antidiabetic drugs and change in Mini-Mental State Examination (MMSE) scores in patients with diabetes and dementia. Methods Using the Swedish Dementia Registry and four supplementary Swedish registers/databases, we identified 1873 patients (4732 observations) with diagnosis of type 2 diabetes (diabetes) and Alzheimer’s disease or mixed-pathology dementia who were followed up at least once after dementia diagnosis. Use of metformin, insulin, sulfonylurea, thiazolidinediones (TZD), and dipeptidyl-peptidase-4 inhibitors (DPP-4i) was identified at baseline. Prevalent-user, incident-user, and drug-drug cohorts were sampled, and propensity-score matching was used to analyze comparable subjects. Beta coefficients with 95% confidence intervals (CI) from the random intercept and slope linear mixed-effects models determined the association between the use of antidiabetic medications and decline in MMSE score points between the follow-ups. Inverse-probability weighting was used to account for patient dropout. Results Compared to non-users, prevalent users of metformin (beta 0.89, 95% CI 0.44; 1.33) and DPP-4i (0.72, 0.06; 1.37) experienced a slower cognitive decline with time. Secondly, compared to DPP-4i, the use of insulin (−1.00, −1.95; −0.04) and sulfonylureas (−1.19; −2.33; −0.04) was associated with larger point-wise decrements in MMSE with annual intervals. Conclusions In this large cohort of patients with diabetes and dementia, the use of metformin and DPP-4i was associated with a slower decline in MMSE scores. Further examination of the cognitive effects of metformin and incretin-based medications is warranted.
format	article
author	Juraj Secnik Hong Xu Emilia Schwertner Niklas Hammar Michael Alvarsson Bengt Winblad Maria Eriksdotter Sara Garcia-Ptacek Dorota Religa
author_facet	Juraj Secnik Hong Xu Emilia Schwertner Niklas Hammar Michael Alvarsson Bengt Winblad Maria Eriksdotter Sara Garcia-Ptacek Dorota Religa
author_sort	Juraj Secnik
title	The association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia
title_short	The association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia
title_full	The association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia
title_fullStr	The association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia
title_full_unstemmed	The association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia
title_sort	association of antidiabetic medications and mini-mental state examination scores in patients with diabetes and dementia
publisher	BMC
publishDate	2021
url	https://doaj.org/article/a05a37f9003142baa4f3a1fad344943b
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The association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia

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