Background: The risk of dementia increases by 15–28% in patients with type 2 diabetes mellitus (DM). However, studies on dementia risk in type 1 DM have been neither comprehensive nor conclusive. Methods: We carried out a cohort study involving 1,077 patients registered to have type 1 DM from 1998 to 2009 and 32,310 matched non-DM controls who were selected from Taiwan National Health Insurance Claims. These participants were followed up from their first clinical appearance for type 1 DM treatment in 1998–2009 to the date of dementia diagnosis or the last day of 2011. The Cox proportional hazard model was employed to estimate the hazard ratio (HR) of dementia incidence. Results: The incidence rates of dementia reached 42.8 and 13.1 per 104 person-years for the type 1 DM and control groups respectively. The adjusted HR of dementia in patients with type 1 DM was estimated at 3.01 (95% CI 2.18–4.14) after adjustment for demographics, comorbidity, urbanization, monthly income, and annual frequency of ambulatory care visits. No significant difference in sex-specific HR was observed. Conclusions: The relative risk of developing dementia (118–314%) in patients with type 1 DM was much higher than the -previously reported relative risk (15–28%) associated with type 2 DM.

Keywords:
Cohort studies, Dementia, Incidence, Type 1 diabetes
1.
Chatterjee S, Peters SA, Woodward M, et al: Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes Care 2016; 39: 300–307.
2.
Smolina K, Wotton CJ, Goldacre MJ: Risk of dementia in patients hospitalised with type 1 and type 2 diabetes in England, 1998-2011: a retrospective national record linkage cohort study. Diabetologia 2015; 58: 942–950.
3.
Kuo SC, Lai SW, Hung HC, et al: Association between comorbidities and dementia in diabetes mellitus patients: population-based retrospective cohort study. J Diabetes Complications 2015; 29: 1071–1076.
4.
Jiang YD, Chang CH, Tai TY, Chen JF, Chuang LM: Incidence and prevalence rates of diabetes mellitus in Taiwan: analysis of the 2000-2009 Nationwide Health Insurance database. J Formos Med Assoc 2012; 111: 599–604.
5.
Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P: Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol 2006; 5: 64–74.
6.
Luchsinger JA, Tang MX, Shea S, Mayeux R: Hyperinsulinemia and risk of Alzheimer disease. Neurology 2004; 63: 1187–1192.
7.
Steen E, Terry BM, Rivera EJ, et al: Impaired insulin and insulin-like growth factor expression and signaling mechanisms in Alzheimer’s disease-is this type 3 diabetes? J Alzheimers Dis 2005; 7: 63–80.
8.
Sharp SI, Aarsland D, Day S, Sønnesyn H; Alzheimer’s Society Vascular Dementia Systematic Review Group, Ballard C: Hypertension is a potential risk factor for vascular dementia: systematic review. Int J Geriatr Psychiatry 2011; 26: 661–669.
9.
Chiu WC, Ho WC, Lin MH, et al: -Angiotension receptor blockers reduce the risk of -dementia. J Hypertens 2014; 32: 938–947.
10.
Rusanen M, Kivipelto M, Levälahti E, et al: Heart diseases and long-term risk of dementia and Alzheimer’s disease: a population-based CAIDE study. J Alzheimers Dis 2014; 42: 183–191.
11.
Adelborg K, Horváth-Puhó E, Ording A, Pedersen L, Toft Sørensen H, Henderson VW: Heart failure and risk of dementia: a Danish nationwide population-based cohort study. Eur J Heart Fail 2017; 19: 253–260.
12.
Sasaki Y, Marioni R, Kasai M, Ishii H, Yamaguchi S, Meguro K: Chronic kidney disease: a risk factor for dementia onset: a population-based study. The Osaki-Tajiri Project. J Am Geriatr Soc 2011; 59: 1175–1181.
13.
Berger I, Wu S, Masson P, et al: Cognition in chronic kidney disease: a systematic review and meta-analysis. BMC Med 2016; 14: 206.
14.
McCrimmon RJ, Ryan CM, Frier BM: Diabetes and cognitive dysfunction. Lancet 2012; 379: 2291–2299.
15.
Kim B, Backus C, Oh S, Feldman EL: Hyperglycemia-induced Tau cleavage in vitro and in vivo: a possible link between diabetes and Alzheimer’s disease. J Alzheimers Dis 2013; 34: 727–739.
16.
Combarros O, Llorca J, Sánchez-Juan P: Interaction between prion protein and interleukin-1A genes increases early-onset Alzheimer’s disease risk. J Neurol 2007; 254: 115–117.
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2018
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