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Diabetes mellitus (DM) is an appalling disorder—quiet enough at onset, but with a toll on the body that is immense, causing damage to eyes, limbs, kidneys, and heart. Now Ott et al., in this issue of Neurology, provide compelling evidence that the brain too is damaged and that type 2 DM increases risk of dementia.1 Such has been suspected for some time. Case–control and prospective studies have suggested that cognition is impaired in patients with diabetes,2 and cross-sectional studies, including the earlier report from the Rotterdam group,3 have suggested that diabetes is a risk factor for dementia. What was needed was large, prospective, population-based studies examining diabetes as a risk factor for dementia. The study now reported fulfills these demanding epidemiologic criteria amply, following a population of over 6,000 for up to 6 years, and demonstrating that the risk of dementia is nearly doubled in those with diabetes.
If, as seems to be the case, diabetes is responsible for causing dementia, then what is the mechanism? One obvious explanation would be that it is not the diabetes per se but the vascular complications of diabetes that result in neurodegeneration. Some earlier studies have found that diabetes increases the risk of vascular dementia, although studies …
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