Launer LJ, Miller ME, Williamson JD, Lazar RM, Gerstein HC, Murray AM, Sullivan M, Horowitz KR, Ding J, Marcovina S, Lovato LC, Lovato J, Margolis KL, O'Connor P, Lipkin EW, Hirsch J, Coker L, Maldjian J, Sunshine JL, Truwit C, Davatzikos C, Bryan RN, .
Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy.
Lancet Neurol. 2011 Nov;10(11):969-77.
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Alzforum should be commended for highlighting the ACCORD MIND study. At first glance, the findings from this study (an aggressive treatment to control diabetes did not improve cognition and in fact may be detrimental) seem to lack direct relevance to AD, but I see two important lessons for the field. First, this study shows a clear divergence between brain volume and cognition. Since the loss of cognition remains the most devastating aspect of AD, we should be cognizant of the danger of overly relying on a particular biomarker as a surrogate for cognition or brain function. Second, this study shows that aggressive treatment does not always bring about desirable outcomes.
This is especially important, since current thinking in the AD field is that we should treat patients before symptoms appear. AD research stands at a crossroads, and future directions are somewhat cloudy. I believe lessons from related fields can help navigate future steps and help us to formulate more realistic expectations for ongoing efforts in the AD field.