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Association of Dipeptidyl Peptidase-4 Inhibitor Use and Amyloid Burden in Patients With Diabetes and AD-Related Cognitive Impairment

 Seong Ho Jeong  ;  Hye Ryun Kim  ;  Jeonghun Kim  ;  Hankyeol Kim  ;  Namki Hong  ;  Jin Ho Jung  ;  Kyoungwon Baik  ;  Hanna Cho  ;  Chul Hyoung Lyoo  ;  Byoung Seok Ye  ;  Young H Sohn  ;  Joon-Kyung Seong  ;  Phil Hyu Lee 
 NEUROLOGY, Vol.97(11) : e1110-e1122, 2021-09 
Journal Title
Issue Date
Aged ; Alzheimer Disease / complications ; Alzheimer Disease / pathology* ; Amyloid beta-Peptides / metabolism* ; Cognitive Dysfunction / complications ; Cognitive Dysfunction / pathology* ; Diabetes Complications / complications ; Diabetes Complications / drug therapy ; Diabetes Complications / pathology* ; Dipeptidyl-Peptidase IV Inhibitors / administration & dosage* ; Female ; Humans ; Hypoglycemic Agents / administration & dosage* ; Male ; Neuroprotective Agents / administration & dosage ; Retrospective Studies ; Treatment Outcome
Background and objective: To investigate whether dipeptidyl peptidase-4 inhibitors (DPP-4i) have beneficial effects on amyloid aggregation and longitudinal cognitive outcome in diabetic Alzheimer disease-related cognitive impairment (ADCI). Methods: We retrospectively reviewed 282 patients with ADCI with positive 18F-florbetaben amyloid PET images. Patients were classified into 3 groups according to prior diagnosis of diabetes and DPP-4i use: diabetic patients being treated with (ADCI-DPP-4i+, n = 70) or without DPP-4i (ADCI-DPP-4i-, n = 71) and nondiabetic patients (n = 141). Multiple linear regression analyses were performed to determine intergroup differences in global and regional amyloid retention using standardized uptake value ratios calculated from cortical areas. We assessed longitudinal changes in Mini-Mental State Examination (MMSE) score using a linear mixed model. Results: The ADCI-DPP-4i+ group had lower global amyloid burden than the ADCI-DPP-4i- group (β = 0.075, SE = 0.024, p = 0.002) and the nondiabetic ADCI group (β = 0.054, SE = 0.021, p = 0.010) after adjusting for age, sex, education, cognitive status, and APOE ε4 carrier status. The ADCI-DPP-4i+ group had lower regional amyloid burden in temporo-parietal areas than either the ADCI-DPP-4i- group or the nondiabetic ADCI group. The ADCI-DPP-4i+ group showed a slower longitudinal decrease in MMSE score (β = 0.772, SE = 0.272, p = 0.005) and memory recall subscore (β = 0.291, SE = 0.116, p = 0.012) than the ADCI-DPP-4i- group. Discussion: These findings suggest that DPP-4i use is associated with low amyloid burden and favorable long-term cognitive outcome in diabetic patients with ADCI.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Han kyeol(김한결) ORCID logo https://orcid.org/0000-0002-7650-6708
Lyoo, Chul Hyoung(류철형) ORCID logo https://orcid.org/0000-0003-2231-672X
Baik, Kyoungwon(백경원) ORCID logo https://orcid.org/0000-0001-7215-375X
Sohn, Young Ho(손영호) ORCID logo https://orcid.org/0000-0001-6533-2610
Ye, Byoung Seok(예병석) ORCID logo https://orcid.org/0000-0003-0187-8440
Lee, Phil Hyu(이필휴) ORCID logo https://orcid.org/0000-0001-9931-8462
Cho, Hanna(조한나) ORCID logo https://orcid.org/0000-0001-5936-1546
Hong, Nam Ki(홍남기) ORCID logo https://orcid.org/0000-0002-8246-1956
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