Video

The VA is conducting a limited lung cancer screening pilot at 8 VA hospitals to better understand how to implement screening nationwide. Through this pilot, VA is attempting to identify the right physicians to offer screening during the course of routine care; determine the uptake of screening and what resources will be needed to meet the demand; establish appropriate screening and follow-up with accuracy, efficiency, and safety; and answer whether the overall outcomes of patients with early-stage cancer (especially those who are older with comorbid conditions) benefit from early detection.
 
Among many of the World Health Organization’s screening principles, Michael J. Kelley, MD, called attention to the organization’s concern that the natural history of the condition should be adequately understood. “I think the key word there is adequately,” said Dr. Kelley. “When you look at the development of disease from precursor lesions, do we really understand what is going to become a cancer that causes disease as opposed to that which is a cancer only to the pathologist?”

The VA is conducting a limited lung cancer screening pilot at 8 VA hospitals to better understand how to implement screening nationwide. Through this pilot, VA is attempting to identify the right physicians to offer screening during the course of routine care; determine the uptake of screening and what resources will be needed to meet the demand; establish appropriate screening and follow-up with accuracy, efficiency, and safety; and answer whether the overall outcomes of patients with early-stage cancer (especially those who are older with comorbid conditions) benefit from early detection.
 
Among many of the World Health Organization’s screening principles, Michael J. Kelley, MD, called attention to the organization’s concern that the natural history of the condition should be adequately understood. “I think the key word there is adequately,” said Dr. Kelley. “When you look at the development of disease from precursor lesions, do we really understand what is going to become a cancer that causes disease as opposed to that which is a cancer only to the pathologist?”

The VA is conducting a limited lung cancer screening pilot at 8 VA hospitals to better understand how to implement screening nationwide. Through this pilot, VA is attempting to identify the right physicians to offer screening during the course of routine care; determine the uptake of screening and what resources will be needed to meet the demand; establish appropriate screening and follow-up with accuracy, efficiency, and safety; and answer whether the overall outcomes of patients with early-stage cancer (especially those who are older with comorbid conditions) benefit from early detection.
 
Among many of the World Health Organization’s screening principles, Michael J. Kelley, MD, called attention to the organization’s concern that the natural history of the condition should be adequately understood. “I think the key word there is adequately,” said Dr. Kelley. “When you look at the development of disease from precursor lesions, do we really understand what is going to become a cancer that causes disease as opposed to that which is a cancer only to the pathologist?”

WASHINGTON – Amyloid-beta has been the Alzheimer’s research darling for more than a decade, and finally, after many failures, some small successes may be appearing in antiamyloid trials.

Experts suggest that these encouraging early results may lead companies to retest failed drugs under new conditions – for example, by using patients who test positive for amyloid-beta on brain PET scans, who have prodromal disease, or who are asymptomatic.

But questions remain, and some are fundamental. The functional nature of amyloid remains unknown. There are still questions about which form is the most neurotoxic. Little is understood about the way it interacts with tau as symptoms emerge.

Will these lines of investigation fall to the wayside if companies and amyloid-centric researchers put too many eggs into the antiamyloid basket? Dr. Michael Wolfe, Ph.D., of Brigham and Women’s Hospital, Boston, discusses these issues in an interview.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

WASHINGTON – Amyloid-beta has been the Alzheimer’s research darling for more than a decade, and finally, after many failures, some small successes may be appearing in antiamyloid trials.

Experts suggest that these encouraging early results may lead companies to retest failed drugs under new conditions – for example, by using patients who test positive for amyloid-beta on brain PET scans, who have prodromal disease, or who are asymptomatic.

But questions remain, and some are fundamental. The functional nature of amyloid remains unknown. There are still questions about which form is the most neurotoxic. Little is understood about the way it interacts with tau as symptoms emerge.

Will these lines of investigation fall to the wayside if companies and amyloid-centric researchers put too many eggs into the antiamyloid basket? Dr. Michael Wolfe, Ph.D., of Brigham and Women’s Hospital, Boston, discusses these issues in an interview.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

WASHINGTON – Amyloid-beta has been the Alzheimer’s research darling for more than a decade, and finally, after many failures, some small successes may be appearing in antiamyloid trials.

Experts suggest that these encouraging early results may lead companies to retest failed drugs under new conditions – for example, by using patients who test positive for amyloid-beta on brain PET scans, who have prodromal disease, or who are asymptomatic.

But questions remain, and some are fundamental. The functional nature of amyloid remains unknown. There are still questions about which form is the most neurotoxic. Little is understood about the way it interacts with tau as symptoms emerge.

Will these lines of investigation fall to the wayside if companies and amyloid-centric researchers put too many eggs into the antiamyloid basket? Dr. Michael Wolfe, Ph.D., of Brigham and Women’s Hospital, Boston, discusses these issues in an interview.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

WASHINGTON – Finding a drug therapy for patients with Alzheimer’s disease that not only improves symptoms but also slows or stops the underlying disease process and results in disease modification will be a major challenge.

Disease modification “indicates the drug is attacking the underlying biology of the disease. The medications we have now affect only symptoms and are palliative,” Dr. David S. Knopman said in an interview during the Alzheimer’s Association International Conference 2015.

Designing trials capable of identifying disease-modifying drugs “turns out to be very challenging. In principle, a drug with disease-modifying effects would have bigger and more enduring effects, could be started earlier in the disease, and would ultimately be of greater benefit to patients and to society,” said Dr. Knopman, a professor of neurology at the Mayo Clinic in Rochester, Minn. He participated in a session at the meeting focused on the potential design of trials that could test a drug’s disease-modifying effect.

The most likely design that researchers seem ready to use is a “delayed-start” trial, in which placebo-treated patients who serve as controls in the initial, blinded, and randomized phase of an efficacy trial then cross over to open-label treatment once the first segment primary-endpoint stage is finished. In most trials “the open-label, long-term extension will occur anyway,” so adding a delayed-start element following the end of an efficacy trial “does not add a lot of complication to the design,” he said.

Two factors make a delayed-start analysis challenging. First, the drug needs to show efficacy during the initial, double-blinded phase. “Only if you see both a cognitive and some sort of functional-outcome benefit can you engage in the delayed-start analysis, to see if the effect is enduring,” Dr. Knopman said. The second limitation is patient drop out. “An open-label, long-term extension over another 1, 2, 3 years will invariably lead to subjects dropping out because of health issues or social matters and that makes the statistical analysis more complicated.” During one trial that was discussed in depth at the session, about 40% of patients who entered the delayed-start phase had left the study by the time this stage finished 2 years later.

Despite these issues, adding a delayed-start phase to drug trials likely will become increasingly common, Dr. Knopman predicted. Drug developers “will probably include this as a secondary analysis because it doesn’t add much expense or added burden on participants, so it seems like a win-win.” Plus, representatives from the Food and Drug Administration who participated in the session seemed to endorse the general concept, he noted. But the most important caveat remains, he stressed: “You have to first show primary-outcome results. Only then you can talk about disease modification.”

The delayed-start trial design was developed by Eli Lilly. Dr. Knopman received an honorarium from Lilly for chairing the data and safety-monitoring committee for two of their trials through 2012, but since then he has not had a financial relationship with the company. He currently is an investigator in a trial sponsored by Lilly. He said he has no other disclosures.

mzoler@frontlinemedcom.com

On Twitter@mitchelzoler

WASHINGTON – Finding a drug therapy for patients with Alzheimer’s disease that not only improves symptoms but also slows or stops the underlying disease process and results in disease modification will be a major challenge.

Disease modification “indicates the drug is attacking the underlying biology of the disease. The medications we have now affect only symptoms and are palliative,” Dr. David S. Knopman said in an interview during the Alzheimer’s Association International Conference 2015.

Designing trials capable of identifying disease-modifying drugs “turns out to be very challenging. In principle, a drug with disease-modifying effects would have bigger and more enduring effects, could be started earlier in the disease, and would ultimately be of greater benefit to patients and to society,” said Dr. Knopman, a professor of neurology at the Mayo Clinic in Rochester, Minn. He participated in a session at the meeting focused on the potential design of trials that could test a drug’s disease-modifying effect.

The most likely design that researchers seem ready to use is a “delayed-start” trial, in which placebo-treated patients who serve as controls in the initial, blinded, and randomized phase of an efficacy trial then cross over to open-label treatment once the first segment primary-endpoint stage is finished. In most trials “the open-label, long-term extension will occur anyway,” so adding a delayed-start element following the end of an efficacy trial “does not add a lot of complication to the design,” he said.

Two factors make a delayed-start analysis challenging. First, the drug needs to show efficacy during the initial, double-blinded phase. “Only if you see both a cognitive and some sort of functional-outcome benefit can you engage in the delayed-start analysis, to see if the effect is enduring,” Dr. Knopman said. The second limitation is patient drop out. “An open-label, long-term extension over another 1, 2, 3 years will invariably lead to subjects dropping out because of health issues or social matters and that makes the statistical analysis more complicated.” During one trial that was discussed in depth at the session, about 40% of patients who entered the delayed-start phase had left the study by the time this stage finished 2 years later.

Despite these issues, adding a delayed-start phase to drug trials likely will become increasingly common, Dr. Knopman predicted. Drug developers “will probably include this as a secondary analysis because it doesn’t add much expense or added burden on participants, so it seems like a win-win.” Plus, representatives from the Food and Drug Administration who participated in the session seemed to endorse the general concept, he noted. But the most important caveat remains, he stressed: “You have to first show primary-outcome results. Only then you can talk about disease modification.”

The delayed-start trial design was developed by Eli Lilly. Dr. Knopman received an honorarium from Lilly for chairing the data and safety-monitoring committee for two of their trials through 2012, but since then he has not had a financial relationship with the company. He currently is an investigator in a trial sponsored by Lilly. He said he has no other disclosures.

mzoler@frontlinemedcom.com

On Twitter@mitchelzoler

WASHINGTON – Finding a drug therapy for patients with Alzheimer’s disease that not only improves symptoms but also slows or stops the underlying disease process and results in disease modification will be a major challenge.

Disease modification “indicates the drug is attacking the underlying biology of the disease. The medications we have now affect only symptoms and are palliative,” Dr. David S. Knopman said in an interview during the Alzheimer’s Association International Conference 2015.

Designing trials capable of identifying disease-modifying drugs “turns out to be very challenging. In principle, a drug with disease-modifying effects would have bigger and more enduring effects, could be started earlier in the disease, and would ultimately be of greater benefit to patients and to society,” said Dr. Knopman, a professor of neurology at the Mayo Clinic in Rochester, Minn. He participated in a session at the meeting focused on the potential design of trials that could test a drug’s disease-modifying effect.

The most likely design that researchers seem ready to use is a “delayed-start” trial, in which placebo-treated patients who serve as controls in the initial, blinded, and randomized phase of an efficacy trial then cross over to open-label treatment once the first segment primary-endpoint stage is finished. In most trials “the open-label, long-term extension will occur anyway,” so adding a delayed-start element following the end of an efficacy trial “does not add a lot of complication to the design,” he said.

Two factors make a delayed-start analysis challenging. First, the drug needs to show efficacy during the initial, double-blinded phase. “Only if you see both a cognitive and some sort of functional-outcome benefit can you engage in the delayed-start analysis, to see if the effect is enduring,” Dr. Knopman said. The second limitation is patient drop out. “An open-label, long-term extension over another 1, 2, 3 years will invariably lead to subjects dropping out because of health issues or social matters and that makes the statistical analysis more complicated.” During one trial that was discussed in depth at the session, about 40% of patients who entered the delayed-start phase had left the study by the time this stage finished 2 years later.

Despite these issues, adding a delayed-start phase to drug trials likely will become increasingly common, Dr. Knopman predicted. Drug developers “will probably include this as a secondary analysis because it doesn’t add much expense or added burden on participants, so it seems like a win-win.” Plus, representatives from the Food and Drug Administration who participated in the session seemed to endorse the general concept, he noted. But the most important caveat remains, he stressed: “You have to first show primary-outcome results. Only then you can talk about disease modification.”

The delayed-start trial design was developed by Eli Lilly. Dr. Knopman received an honorarium from Lilly for chairing the data and safety-monitoring committee for two of their trials through 2012, but since then he has not had a financial relationship with the company. He currently is an investigator in a trial sponsored by Lilly. He said he has no other disclosures.

mzoler@frontlinemedcom.com

On Twitter@mitchelzoler

WASHINGTON – Postoperative cognitive decline, which occurs in roughly 20% of elderly patients who undergo major surgery, strikes older women with greater severity than it does similarly aged men, according to a retrospective analysis of data collected from 527 older Americans.

“We looked at the sex difference in postoperative cognitive decline and Alzheimer’s disease because of the sex difference in Alzheimer’s disease, where about two-thirds of patients are women,” Dr. Katie J. Schenning said in an interview during the Alzheimer’s Association International Conference 2015. “We know that a lot of the pathologic changes that happen to the brain after anesthesia and surgery are similar to the changes that happen in Alzheimer’s disease patients. But at this point that is all we can say about a link between the two. It is currently unknown whether there is a clear relationship between postoperative cognitive decline and Alzheimer’s disease,” said Dr. Schenning, an anesthesiologist at Oregon Health & Science University in Portland.

She and her associates studied data collected longitudinally from two cohorts, the Oregon Brain Aging Study and the Intelligent Systems for Assessment of Aging Changes. At baseline, the average age of the enrollees in the combined group was 83 years, and just under two-thirds were women. During follow-up, 182 of the participants underwent a total of 331 major surgeries, with some undergoing more than one surgery. The most common form of surgery was orthopedic, done in one-third of the patients, followed by general surgery, in a quarter.

The researchers running both studies collected data annually from participants using a battery of neuropsychological evaluations, brain MRIs, and information on their general health. Retrospective analysis of the data showed that following surgery, people showed evidence of statistically significant and clinically meaningful declines in several measures, compared with those who did not undergo surgery, including deficits measured by the Mini-Mental State Examination, instrumental activities of daily living, and logical memory delayed recall. The trajectory of these declines was significantly steeper in women following surgery, compared with men following surgery, Dr. Schenning reported in a poster at the meeting. In addition, the MRI scans showed ventricular enlargement in the postsurgical women but not in men, a change that is characteristic of neuropathology.

“Women who underwent surgery had a more rapid rate of decline in measures of cognition and function than women who did not have surgery, and it affected women in more categories than in men,” Dr. Schenning said.

The risk for postoperative cognitive decline “is one of the things that patients should take into consideration before undergoing elective surgery, especially if they are older or have pre-existing cognitive impairment,” Dr. Schenning suggested. The enhanced risk for postsurgical cognitive decline faced by older women and even the somewhat lesser risk that exists for older men “is certainly something that patients should discuss with their surgeon, anesthesiologist, and family members,” she said.

Dr. Schenning had no disclosures.

mzoler@frontlinemedcom.com

On Twitter @mitchelzoler

WASHINGTON – Postoperative cognitive decline, which occurs in roughly 20% of elderly patients who undergo major surgery, strikes older women with greater severity than it does similarly aged men, according to a retrospective analysis of data collected from 527 older Americans.

“We looked at the sex difference in postoperative cognitive decline and Alzheimer’s disease because of the sex difference in Alzheimer’s disease, where about two-thirds of patients are women,” Dr. Katie J. Schenning said in an interview during the Alzheimer’s Association International Conference 2015. “We know that a lot of the pathologic changes that happen to the brain after anesthesia and surgery are similar to the changes that happen in Alzheimer’s disease patients. But at this point that is all we can say about a link between the two. It is currently unknown whether there is a clear relationship between postoperative cognitive decline and Alzheimer’s disease,” said Dr. Schenning, an anesthesiologist at Oregon Health & Science University in Portland.

She and her associates studied data collected longitudinally from two cohorts, the Oregon Brain Aging Study and the Intelligent Systems for Assessment of Aging Changes. At baseline, the average age of the enrollees in the combined group was 83 years, and just under two-thirds were women. During follow-up, 182 of the participants underwent a total of 331 major surgeries, with some undergoing more than one surgery. The most common form of surgery was orthopedic, done in one-third of the patients, followed by general surgery, in a quarter.

The researchers running both studies collected data annually from participants using a battery of neuropsychological evaluations, brain MRIs, and information on their general health. Retrospective analysis of the data showed that following surgery, people showed evidence of statistically significant and clinically meaningful declines in several measures, compared with those who did not undergo surgery, including deficits measured by the Mini-Mental State Examination, instrumental activities of daily living, and logical memory delayed recall. The trajectory of these declines was significantly steeper in women following surgery, compared with men following surgery, Dr. Schenning reported in a poster at the meeting. In addition, the MRI scans showed ventricular enlargement in the postsurgical women but not in men, a change that is characteristic of neuropathology.

“Women who underwent surgery had a more rapid rate of decline in measures of cognition and function than women who did not have surgery, and it affected women in more categories than in men,” Dr. Schenning said.

The risk for postoperative cognitive decline “is one of the things that patients should take into consideration before undergoing elective surgery, especially if they are older or have pre-existing cognitive impairment,” Dr. Schenning suggested. The enhanced risk for postsurgical cognitive decline faced by older women and even the somewhat lesser risk that exists for older men “is certainly something that patients should discuss with their surgeon, anesthesiologist, and family members,” she said.

Dr. Schenning had no disclosures.

mzoler@frontlinemedcom.com

On Twitter @mitchelzoler

WASHINGTON – Postoperative cognitive decline, which occurs in roughly 20% of elderly patients who undergo major surgery, strikes older women with greater severity than it does similarly aged men, according to a retrospective analysis of data collected from 527 older Americans.

“We looked at the sex difference in postoperative cognitive decline and Alzheimer’s disease because of the sex difference in Alzheimer’s disease, where about two-thirds of patients are women,” Dr. Katie J. Schenning said in an interview during the Alzheimer’s Association International Conference 2015. “We know that a lot of the pathologic changes that happen to the brain after anesthesia and surgery are similar to the changes that happen in Alzheimer’s disease patients. But at this point that is all we can say about a link between the two. It is currently unknown whether there is a clear relationship between postoperative cognitive decline and Alzheimer’s disease,” said Dr. Schenning, an anesthesiologist at Oregon Health & Science University in Portland.

She and her associates studied data collected longitudinally from two cohorts, the Oregon Brain Aging Study and the Intelligent Systems for Assessment of Aging Changes. At baseline, the average age of the enrollees in the combined group was 83 years, and just under two-thirds were women. During follow-up, 182 of the participants underwent a total of 331 major surgeries, with some undergoing more than one surgery. The most common form of surgery was orthopedic, done in one-third of the patients, followed by general surgery, in a quarter.

The researchers running both studies collected data annually from participants using a battery of neuropsychological evaluations, brain MRIs, and information on their general health. Retrospective analysis of the data showed that following surgery, people showed evidence of statistically significant and clinically meaningful declines in several measures, compared with those who did not undergo surgery, including deficits measured by the Mini-Mental State Examination, instrumental activities of daily living, and logical memory delayed recall. The trajectory of these declines was significantly steeper in women following surgery, compared with men following surgery, Dr. Schenning reported in a poster at the meeting. In addition, the MRI scans showed ventricular enlargement in the postsurgical women but not in men, a change that is characteristic of neuropathology.

“Women who underwent surgery had a more rapid rate of decline in measures of cognition and function than women who did not have surgery, and it affected women in more categories than in men,” Dr. Schenning said.

The risk for postoperative cognitive decline “is one of the things that patients should take into consideration before undergoing elective surgery, especially if they are older or have pre-existing cognitive impairment,” Dr. Schenning suggested. The enhanced risk for postsurgical cognitive decline faced by older women and even the somewhat lesser risk that exists for older men “is certainly something that patients should discuss with their surgeon, anesthesiologist, and family members,” she said.

Dr. Schenning had no disclosures.

mzoler@frontlinemedcom.com

On Twitter @mitchelzoler

WASHINGTON – Could a ubiquitous lipid – manufactured in the liver – be one of the root causes of Alzheimer’s disease? Plasmalogens are important in maintaining cell membrane permeability and effective neurotransmission. They also appear to influence the production of toxic forms of amyloid-beta by affecting the activity of alpha-secretase. What are they, and how strong could their influence in Alzheimer’s be? Dayan Goodenowe, Ph.D., explains at the Alzheimer’s Association International Conference 2015.

Dr. Goodenowe is the founder and CEO of Phenomenome Discoveries, which holds patents on measuring plasmalogen levels and is developing a plasmalogen therapeutic.

 msullivan@frontlinemedcom.com

On Twitter @alz_gal

WASHINGTON – Could a ubiquitous lipid – manufactured in the liver – be one of the root causes of Alzheimer’s disease? Plasmalogens are important in maintaining cell membrane permeability and effective neurotransmission. They also appear to influence the production of toxic forms of amyloid-beta by affecting the activity of alpha-secretase. What are they, and how strong could their influence in Alzheimer’s be? Dayan Goodenowe, Ph.D., explains at the Alzheimer’s Association International Conference 2015.

Dr. Goodenowe is the founder and CEO of Phenomenome Discoveries, which holds patents on measuring plasmalogen levels and is developing a plasmalogen therapeutic.

 msullivan@frontlinemedcom.com

On Twitter @alz_gal

WASHINGTON – Could a ubiquitous lipid – manufactured in the liver – be one of the root causes of Alzheimer’s disease? Plasmalogens are important in maintaining cell membrane permeability and effective neurotransmission. They also appear to influence the production of toxic forms of amyloid-beta by affecting the activity of alpha-secretase. What are they, and how strong could their influence in Alzheimer’s be? Dayan Goodenowe, Ph.D., explains at the Alzheimer’s Association International Conference 2015.

Dr. Goodenowe is the founder and CEO of Phenomenome Discoveries, which holds patents on measuring plasmalogen levels and is developing a plasmalogen therapeutic.

 msullivan@frontlinemedcom.com

On Twitter @alz_gal

WASHINGTON – Improved management of patients with type 1 diabetes and the resulting increased longevity it has fostered has produced a new medical concern that few patients faced in the past: their risk for developing dementia as they age into their 60s, 70s, and beyond.

That risk, which turns out to be nearly double that of people without diabetes, closely matches the higher risk faced by patients with type 2 diabetes, based on analysis of data collected during 2002-2014 from more than 490,000 people aged 60 years or older enrolled in the Kaiser Permanente Medical Care Program of Northern California, Rachel Whitmer, Ph.D. reported at the Alzheimer’s Association International Conference 2015.

Her study tracked the dementia incidence in 334 of these Kaiser Permanente enrollees with type 1 diabetes and no dementia at baseline and found the rate ran 73% higher when compared with controls without any type of diabetes in the cohort after adjustment for sex, race, and vascular complications such as hypertension, stroke, and peripheral vascular disease. The patients with type 1 diabetes averaged 71 years old at baseline and their follow-up averaged 7 years. This is the first study to look at the incidence of dementia in elderly patients with type 1 diabetes, Dr. Whitmer said in an interview during the meeting.

Physicians who care for patients with type 1 diabetes should be aware of this increased risk, be on the lookout for signs of developing dementia in these patients, and use the increased risk to help motivate type 1 diabetes patients to be vigilant in controlling their disease to help avoid the microvascular complications that likely contribute to their dementia risk. Patients with type 1 diabetes are especially vulnerable to the consequences of cognitive impairment as they must maintain complex self-management routines of blood glucose monitoring, insulin administration, and keeping close tabs on their diet and exercise, Dr. Whitmer noted.

In 2013, she and her associates published a simple and easy-to-use tool for clinicians to assess the dementia risk in individual patients with type 2 diabetes (Lancet Diabetes Endocrinol. 2013;3:183-90). Further study of the risk factors that contribute to dementia onset in patients with type 1 diabetes will hopefully lead to creation of a similar risk-assessment tool for use in type 1 patients, said Dr. Whitmer, an epidemiologist at the Kaiser Permanente Northern California Division of Research in Oakland.

Dr. Whitmer had no disclosures.

mzoler@frontlinemedcom.com

On Twitter @mitchelzoler

WASHINGTON – Improved management of patients with type 1 diabetes and the resulting increased longevity it has fostered has produced a new medical concern that few patients faced in the past: their risk for developing dementia as they age into their 60s, 70s, and beyond.

That risk, which turns out to be nearly double that of people without diabetes, closely matches the higher risk faced by patients with type 2 diabetes, based on analysis of data collected during 2002-2014 from more than 490,000 people aged 60 years or older enrolled in the Kaiser Permanente Medical Care Program of Northern California, Rachel Whitmer, Ph.D. reported at the Alzheimer’s Association International Conference 2015.

Her study tracked the dementia incidence in 334 of these Kaiser Permanente enrollees with type 1 diabetes and no dementia at baseline and found the rate ran 73% higher when compared with controls without any type of diabetes in the cohort after adjustment for sex, race, and vascular complications such as hypertension, stroke, and peripheral vascular disease. The patients with type 1 diabetes averaged 71 years old at baseline and their follow-up averaged 7 years. This is the first study to look at the incidence of dementia in elderly patients with type 1 diabetes, Dr. Whitmer said in an interview during the meeting.

Physicians who care for patients with type 1 diabetes should be aware of this increased risk, be on the lookout for signs of developing dementia in these patients, and use the increased risk to help motivate type 1 diabetes patients to be vigilant in controlling their disease to help avoid the microvascular complications that likely contribute to their dementia risk. Patients with type 1 diabetes are especially vulnerable to the consequences of cognitive impairment as they must maintain complex self-management routines of blood glucose monitoring, insulin administration, and keeping close tabs on their diet and exercise, Dr. Whitmer noted.

In 2013, she and her associates published a simple and easy-to-use tool for clinicians to assess the dementia risk in individual patients with type 2 diabetes (Lancet Diabetes Endocrinol. 2013;3:183-90). Further study of the risk factors that contribute to dementia onset in patients with type 1 diabetes will hopefully lead to creation of a similar risk-assessment tool for use in type 1 patients, said Dr. Whitmer, an epidemiologist at the Kaiser Permanente Northern California Division of Research in Oakland.

Dr. Whitmer had no disclosures.

mzoler@frontlinemedcom.com

On Twitter @mitchelzoler

WASHINGTON – Improved management of patients with type 1 diabetes and the resulting increased longevity it has fostered has produced a new medical concern that few patients faced in the past: their risk for developing dementia as they age into their 60s, 70s, and beyond.

That risk, which turns out to be nearly double that of people without diabetes, closely matches the higher risk faced by patients with type 2 diabetes, based on analysis of data collected during 2002-2014 from more than 490,000 people aged 60 years or older enrolled in the Kaiser Permanente Medical Care Program of Northern California, Rachel Whitmer, Ph.D. reported at the Alzheimer’s Association International Conference 2015.

Her study tracked the dementia incidence in 334 of these Kaiser Permanente enrollees with type 1 diabetes and no dementia at baseline and found the rate ran 73% higher when compared with controls without any type of diabetes in the cohort after adjustment for sex, race, and vascular complications such as hypertension, stroke, and peripheral vascular disease. The patients with type 1 diabetes averaged 71 years old at baseline and their follow-up averaged 7 years. This is the first study to look at the incidence of dementia in elderly patients with type 1 diabetes, Dr. Whitmer said in an interview during the meeting.

Physicians who care for patients with type 1 diabetes should be aware of this increased risk, be on the lookout for signs of developing dementia in these patients, and use the increased risk to help motivate type 1 diabetes patients to be vigilant in controlling their disease to help avoid the microvascular complications that likely contribute to their dementia risk. Patients with type 1 diabetes are especially vulnerable to the consequences of cognitive impairment as they must maintain complex self-management routines of blood glucose monitoring, insulin administration, and keeping close tabs on their diet and exercise, Dr. Whitmer noted.

In 2013, she and her associates published a simple and easy-to-use tool for clinicians to assess the dementia risk in individual patients with type 2 diabetes (Lancet Diabetes Endocrinol. 2013;3:183-90). Further study of the risk factors that contribute to dementia onset in patients with type 1 diabetes will hopefully lead to creation of a similar risk-assessment tool for use in type 1 patients, said Dr. Whitmer, an epidemiologist at the Kaiser Permanente Northern California Division of Research in Oakland.

Dr. Whitmer had no disclosures.

mzoler@frontlinemedcom.com

On Twitter @mitchelzoler

To read the supplement on the pivotal findings discussed in this video, click here.

To read the supplement on the pivotal findings discussed in this video, click here.

To read the supplement on the pivotal findings discussed in this video, click here.