Abstract INTRODUCTION Hypertension and diabetes are common cardiovascular risk factors that increase Alzheimer's disease (AD) risk. However, it is unclear whether AD risk differs in hypertensive individuals with and without diabetes. METHODS Cognitively normal individuals (N = 11,074) from the National Alzheimer's Coordinating Center (NACC) were categorized as having (1) hypertension with diabetes (HTN+/DM+), (2) hypertension without diabetes (HTN+/DM‐), or (3) neither (HTN‐/DM‐). AD risk in HTN+/DM+ and HTN+/DM‐ was compared to HTN‐/DM‐. This risk was then investigated in those with AD neuropathology (ADNP), cerebral amyloid angiopathy (CAA), cerebrovascular neuropathology (CVNP), arteriolosclerosis, and atherosclerosis. Finally, AD risk in HTN‐/DM+ was compared to HTN‐/DM‐. RESULTS Seven percent (N = 830) of individuals developed AD. HTN+/DM+ (hazard ratio [HR] = 1.31 [1.19–1.44]) and HTN+/DM‐ (HR = 1.24 [1.17–1.32]) increased AD risk compared to HTN‐/DM‐. AD risk was greater in HTN+/DM+ with ADNP (HR = 2.10 [1.16–3.79]) and CAA (HR = 1.52 [1.09–2.12]), and in HTN+/DM‐ with CVNP (HR = 1.54 [1.17–2.03]). HTN‐/DM+ also increased AD risk (HR = 1.88 [1.30–2.72]) compared to HTN‐/DM‐. DISCUSSION HTN+/DM+ and HTN+/DM‐ increased AD risk compared to HTN‐/DM‐, but pathological differences between groups suggest targeted therapies may be warranted based on cardiovascular risk profiles. Highlights AD risk was studied in hypertensive (HTN+) individuals with/without diabetes (DM+/‐). HTN+/DM+ and HTN+/DM‐ both had an increased risk of AD compared to HTN‐/DM‐. Post mortem analysis identified neuropathological differences between HTN+/DM+ and HTN+/DM‐. In HTN+/DM+, AD risk was greater in those with AD neuropathology and CAA. In HTN+/DM‐, AD risk was greater in those with cerebrovascular neuropathology.

Investigating the impact of hypertension with and without diabetes on Alzheimer's disease risk: A clinico‐pathological study


 
 While diabetes, hypertension, and hyperlipidemia each are associated with increased risk of cognitive decline, little is known regarding how nonadherence to medications for these conditions is associated with cognitive decline risk.
 
 
 
 We identified patients enrolled in a Medicare Advantage Prescription Drug plan who were eligible for inclusion in the CMS Star Medication Adherence quality measures for diabetes, hypertension, and hyperlipidemia in 2018, 2019, and 2020. To achieve an adherence quality measure, patients had to meet 80% of the proportion of days for the medication. We used propensity score with inverse probability of treatment weighting to balance outcomes for baseline characteristics and logistic regression models to compare odds of cognitive decline outcomes across patient groups.
 
 
 
 The study population of 99,774 individuals had a mean age of 71.0 years and was 49.1% female, 73.9% White, and 17.8% Black, with 62.0% living in an urban setting. Compared with patients who missed zero adherence measures, those who missed one measure had 23%–33% increased odds of cognitive decline (any decline OR = 1.23; dementia OR = 1.33; Alzheimer's disease OR = 1.27; all P values <0.01). Patients who missed 2–3 measures had 37%–96% increased odds of cognitive decline (any decline OR = 1.37; dementia OR = 1.58; Alzheimer's disease OR = 1.96; all P values <0.01). Patients who missed ≥4 adherence measures had the greatest odds of cognitive decline (any decline OR = 1.64; dementia OR = 2.05; Alzheimer's disease OR = 2.48; all P values <0.01).
 
 
 
 Not achieving CMS Star Medication Adherence quality measures for diabetes, hypertension, and hyperlipidemia therapies was associated with increased risk of cognitive decline outcomes.


Association of medication adherence quality measures for diabetes, hypertension, and hyperlipidemia with cognitive decline

Aim. To assess awareness of biobanking among patients and healthcare professionals, and to identify factors influencing willingness to become donors and participate in the collection of biological material.Material and methods. A qualitative study was conducted based on semi-structured interviews of doctors (n=11) and patients (n=11) of Tomsk medical organizations. The results obtained were processed using lexical and comparative analysis techniques.Results. The experience of participation in biobanking was extremely limited among both patients and doctors, but those who had previous experience evaluated it positively. Patients and doctors had not received information about biobanks from official sources, but intuitively understood their functions and roles in biomedical research. Patients were willing to donate biomaterials, while doctors were willing to collect them, but both parties emphasized the importance of understanding the purpose and future use of the biomaterials. Patients wanted to ensure the safety of the collection procedures and the confidentiality of their personal data. The main motives for donating biomaterial were contribution to scientific development, potential attractiveness for the descendants of donors, social origin and material reward.Conclusion. Popularizing biobanking and increasing the awareness of donors and healthcare professionals about the regulatory framework governing biobanking activities can help establish trust and enhance readiness for donation, even regarding invasive biomaterial collection procedures.

Awareness of biobanking among patients and doctors: experience of the Tomsk Oblast

Metabolic disease is an epidemic phenomenon that affects both men and women from various ages, ethnic, and socio-economic groups. The term metabolic disease itself is an umbrella term that includes, among others: hypertension, type 2 diabetes mellitus, hyperlipidemia, obesity, and non-alcoholic fatty liver disease. Lifestyles such as poor nutrition, physical activity, and habits are risk factors that can increase the incidence of metabolic disease. Therefore, prevention of metabolic diseases is necessary, including for ordinary people. Metabolic disease, namely hypertension, is in 3rd place and diabetes is in 10th place, the most common disease suffered by residents of Singotrunan Village, Banyuwangi. In this regard, it is important to make efforts to prevent metabolic disease and even death due to complications from metabolic disease. This community service program is designed to create a fit village as a sustainable healthy lifestyle, initiated through health checks for screening, exercise training, education and discussions as encouragement to do regular exercise. The participants' pre-test and post-test results showed a significant increase in their level of knowledge (p=0.01). The results of the participant satisfaction test showed that 80.9% of participants said they were very satisfied and the rest (19.1%) said they were satisfied. It is hoped that the PKM activity to initiate a fit village in Singotrunan Village, Banyuwangi will provide motivation for residents to exercise regularly and can become a model village for residents of other areas. 

Initiation of the formation of fit village as an effort to prevent metabolic diseases in singotrunan village, banyuwangi

Hospitalizations for diabetes and dementia can impose a significant health and economic toll on older adults in the United States. This study sought to examine differences in hospitalization characteristics and outcomes associated with diabetes and dementia, separately and together, using 2019–2021 discharge record data from the California Department of Health Care Access and Information. The sampled group were residents of Los Angeles County who were aged 50+ at the time of the study. The multivariable linear regression analysis showed that compared to those with no diabetes or dementia, patients with diabetes alone exhibited the highest total charges, while those with comorbid diabetes and dementia exhibited lower charges (p < 0.05). The multinomial logistic regression found that patients with comorbid diabetes and dementia had the highest odds of having a length of stay of 7+ days (Adjusted Odds Ratio = 1.49; 95% Confidence Interval (CI) = 1.44–1.53). A matched case–control analysis revealed that comorbid diabetes and dementia were associated with significantly lower odds of hypertensive disease than diabetes alone (Matched Odds Ratio = 0.81; 95% CI = 0.67–0.97). Collectively, these results highlight the complex factors that may influence the variable hospitalization outcomes that are common occurrences in these three distinct disease profiles. Study findings suggest a need to consider these complexities when developing policies or strategies to improve hospitalization outcomes for these conditions.

Comorbidity of Type 2 Diabetes and Dementia among Hospitalized Patients in Los Angeles County: Hospitalization Outcomes and Costs, 2019–2021

Abstract The World Health Organization recently defined hypertension and type 2 diabetes (T2D) as modifiable comorbidities leading to dementia and Alzheimer’s disease. In the United States (US), hypertension and T2D are health disparities, with higher prevalence seen for Black and Hispanic minority groups compared to the majority White population. We hypothesized that elevated prevalence of hypertension and T2D risk factors in Black and Hispanic groups may be associated with dementia disparities. We interrogated this hypothesis using a cross-sectional analysis of participant data from the All of Us (AoU) Research Program, a large observational cohort study of US residents. The specific objectives of our study were: (1) to compare the prevalence of dementia, hypertension, and T2D in the AoU cohort to previously reported prevalence values for the US population, (2) to investigate the association of hypertension, T2D, and race/ethnicity with dementia, and (3) to investigate whether race/ethnicity modify the association of hypertension and T2D with dementia. AoU participants were recruited from 2018 to 2019 as part of the initial project cohort (R2019Q4R3). Participants aged 40–80 with electronic health records and demographic data (age, sex, race, and ethnicity) were included for analysis, yielding a final cohort of 125,637 individuals. AoU participants show similar prevalence of hypertension (32.1%) and T2D (13.9%) compared to the US population (32.0% and 10.5%, respectively); however, the prevalence of dementia for AoU participants (0.44%) is an order of magnitude lower than seen for the US population (5%). AoU participants with dementia show a higher prevalence of hypertension (81.6% vs. 31.9%) and T2D (45.9% vs. 11.4%) compared to non-dementia participants. Dominance analysis of a multivariable logistic regression model with dementia as the outcome shows that hypertension, age, and T2D have the strongest associations with dementia. Hispanic was the only race/ethnicity group that showed a significant association with dementia, and the association of sex with dementia was non-significant. The association of T2D with dementia is likely explained by concurrent hypertension, since &gt; 90% of participants with T2D also had hypertension. Black race and Hispanic ethnicity interact with hypertension, but not T2D, to increase the odds of dementia. This study underscores the utility of the AoU participant cohort to study disease prevalence and risk factors. We do notice a lower participation of aged minorities and participants with dementia, revealing an opportunity for targeted engagement. Our results indicate that targeting hypertension should be a priority for risk factor modifications to reduce dementia incidence. 

/pdf/investigation-of-hypertension-and-type-2-diabetes-as-risk-2uzlx1n5.pdf

Investigation of hypertension and type 2 diabetes as risk factors for dementia in the All of Us cohort

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Investigation of hypertension and type 2 diabetes as risk factors for dementia in the All of Us cohort