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New risk score predicted 10-year dementia risk in diabetes
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Researchers have developed the diabetes-specific dementia risk score — a tool that can accurately predict the 10-year risk for dementia based on a patient’s diabetes-associated complications, education and age, according to recent study data published in Lancet Diabetes & Endocrinology.
“The risk score could be useful in the selection of high-risk patients for early intervention studies and for many applications of personalized medicine,” Geert Jan Biessels, MD, professor of neurology at the University Medical Centre Utrecht in the Netherlands, said in a press release. “Clinicians can use it to guide their decisions in terms of clinical attention to incipient cognitive impairment, which makes people vulnerable to dangerous side effects of diabetes treatment. The risk score will also help us understand the causes of diabetes-associated increased dementia risk because we can examine those at high risk in early stages of the dementia process.”
Risk score development
To create the diabetes-specific dementia risk score (DSDRS), researchers evaluated data from 29,961 patients aged at least 60 years with type 2 diabetes with 10 years of follow-up from the Kaiser Permanente Northern California diabetes registry.
According to researchers, the DSDRS was developed in three analytic steps: 1) evaluation of 45 candidate predictors using Cox proportional hazard models; 2) development of a point system for the risk score based on the size of the predictor’s beta-coefficient; and 3) model prediction tested for accuracy and discrimination.
Data indicate that 5,173 (17%) of patients received a diagnosis of dementia during 6.6 years of follow-up; 14,366 (48%) patients died; and 3,465 (24%) were diagnosed with dementia before death.
The strongest predictors of dementia included microvascular disease, diabetic foot disease, cerebrovascular disease, cardiovascular disease, acute metabolic events, depression, age and education. Findings also indicate that risk for dementia was 5.3% (95% CI, 4.2-6.3) for the lowest score (–1) and 73.3% (95% CI, 64.8-81.8) for the highest (12 to 19) sum scores, researchers wrote.
Looking ahead
In an accompanying comment, Anna-Maija Tolppanen, PhD, of the Center for Comparative Effectiveness and Patient Safety at the University of Finland, wrote that the development and validation of lifetime risk models are timely, particularly for research on dementia.
“Generally, risk scores might be useful in the identification of individuals who should be monitored for disease symptoms, selection of high-risk individuals for clinical trials, targeting of preventive interventions toward those at greatest risk, and assessment of the effectiveness of an intervention at reducing the risk of future illness,” Tolppanen wrote. “DSDRS might be useful for clinicians for the first purpose, but clinical trial data on effective preventive interventions for dementia are currently lacking.”
For more information:
Exalto LG. Lancet. 2013;doi:10.1016/S2213-8587(13)70048-2.
Tolppanen AM. Lancet. 2013;doi:10.1016/S2213-8587(13)70091-3.
Disclosure: Biessels reports research support from Boehringer Ingelheim and consultancy for Takeda. All other researchers report no relevant financial disclosures. Tolppanen reports no relevant financial disclosures.