Introduction
Insulin resistance (IR) has been associated with cognitive decline and cortical vascular cognitive impairment. While IR has been linked to white matter abnormalities in population-based studies, few studies have examined the impact of IR in a clinical population.
The aim was to investigate the association between baseline Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and the risk of progression to the subcortical small vessel type of dementia (SSVD) or Alzheimer's disease (AD) in a memory clinic cohort.
Methods
A total of 352 patients with subjective cognitive impairment (SCI) or mild cognitive impairment (MCI) were followed for up to six years (mean follow-up: 4.1 years). Cox proportional hazards regression models were used to assess the association between baseline HOMA-IR and the risk of SSVD or AD with adjustment for relevant covariates.
Results
During the follow-up, 24% (n=83) of the SCI/MCI patients converted to dementia (SSVD, n = 28; AD, n = 55). Higher HOMA-IR levels were significantly associated with increased risk of progression to SSVD (adjusted hazard ratio [HR] = 1.42, 95% CI: 1.17–1.73, p < 0.001), but not with the risk of AD. Patients in the highest HOMA-IR quintile (Q5) had a markedly elevated risk of SSVD compared to those in the lowest quintile, Q1 (adjusted HR = 6.60, 95% CI: 1.02 – 42.54, p < 0.05). No significant association was observed between HOMA-IR and the risk of AD.
Conclusions
Insulin resistance is an independent predictor of conversion to SSVD, but not of the risk of AD, among patients with SCI or MCI. These findings highlight the potential role of metabolic dysfunction in the pathogenesis of SSVD and suggest that HOMA-IR could be useful both in the identification and prevention of progression to SSVD in a memory clinic population.
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