Latest news with #BiancaGumina
Medscape
03-07-2025
- Health
- Medscape
Insulin Resistance Linked to Faster Cognitive Decline in AD
Insulin resistance, detected using a simple and readily available blood test, may flag cognitive decline in patients with early Alzheimer's disease (AD), preliminary results of a new study suggested. Using the triglyceride-glucose (TyG) index to measure insulin resistance, investigators found that cognitive decline was four times faster in individuals with mild cognitive impairment (MCI) due to AD who had the highest insulin resistance levels compared to those with lower levels. The findings underline the importance of risk stratification strategies and early interventions to change the trajectory of cognitive decline, lead author Bianca Gumina, MD, neurology resident, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, told Medscape Medical News. 'The results suggest that in MCI-AD, the brain seems to be more vulnerable to metabolic stress. By identifying and addressing modifiable risk factors like metabolic health, we can use the tools we already have to potentially slow the disease course,' Gumina said. The results were presented on June 23 at the Congress of the European Academy of Neurology (EAN) 2025 in Helsinki, Finland. A 'Practical Tool' While insulin resistance has been linked to AD onset and pathology, its role in how rapidly the condition progresses has remained unclear. The single-center retrospective study included 315 patients without diabetes who had a neurodegenerative disorder (NDD) detected through cerebrospinal fluid (CSF). Of these, 210 had AD (mean age, 71.51 years; 79% men), and 115 had another NDD, mostly Lewy body dementia or frontotemporal dementia (mean age, 69.19; 60% men). Baseline measurements included neurologic evaluations, the Mini-Mental State Examination (MMSE) to test cognition, CSF biomarkers (Abeta42 or pTau181), APOE4 genotyping, and blood-brain barrier (BBB) integrity (CSF/serum albumin ratio). Follow-up assessments involved cognitive testing, typically every 6 months, with most patients followed for 3 years. Cognitive decline was defined as a loss of more than 2.5 points per year on the MMSE. Investigators measured insulin resistance with the TyG index, a metabolic marker calculated from fasting triglycerides and fasting glucose levels. The index, which Gumina called a 'practical tool,' can be obtained from standard blood tests. Researchers stratified patients into tertiles (low, medium, or high) according to TyG index levels. Exacerbating Neuroinflammation After adjusting for age, sex, baseline MMSE, disease duration, AD therapy, and BMI, the study found high TyG was significantly associated with faster cognitive decline over 3 years in a subgroup of 161 subjects with MCI (77% men) compared to those with lower TyG levels (hazard ratio, 4.08; 95% CI, 1.06-15.73). Insulin resistance may accelerate AD progression by impairing brain glucose uptake, said Gumina. This could exacerbate neuroinflammation and disrupt the BBB, 'all of which accelerate neurodegeneration,' she added. The study did link high TyG to elevated BBB permeability, but only in patients with AD. 'This supports the hypothesis that metabolic dysfunction may worsen neurodegeneration via mechanisms specifically related to AD,' said Gumina. Researchers observed an association between TyG and conversion from MCI to dementia, although this trend was not significant. Insulin resistance did not affect clinical progression in those with a neurodegenerative disease other than AD, which again likely reflects a disease-specific mechanism, said Gumina. 'AD may be the most sensitive to metabolic stress due to its underlying pathology,' she said. The study found no significant interaction between TyG and APOE4 genotype on the rate of cognitive decline. Speeding Disease Progression These new results show that insulin resistance 'influences the speed of disease progression, especially in early stages, which could be the most vulnerable in modifying the trajectory,' said Gumina. The findings could lead to more prompt identification of high-risk patients. 'By using the TyG index, we can stratify MCI patients by risk of fast progression, enabling personalized follow-up and interventions when the brain is still more responsive,' said Gumina. She recommends more widespread use of the TyG test, especially in patients with MCI or early AD. 'It's already available through routine and simple blood tests, found in every lab, so it could be used to flag patients for closer monitoring or early intervention.' Such interventions could include targeted enrollment in anti-amyloid or anti-tau clinical trials and timely introduction of lifestyle modifications and perhaps medications to improve insulin sensitivity. 'Lifestyle changes like regular exercise, a healthy diet, weight control, and managing blood pressure and cholesterol are all effective,' said Gumina. 'Some medications that modify insulin resistance are also under investigation.' The research team is investigating whether the TyG index correlates with neuroimaging biomarkers and integrating it with genetic and imaging data to improve prediction models. Important Puzzle Piece Commenting on the findings for Medscape Medical News , Sebastiaan Engelborghs, MD, PhD, professor and chair of Neurology, Vrije University Brussels, Brussels, Belgium, said the study 'adds an important piece to the Alzheimer's puzzle . ' The results highlighted how a routine metabolic marker such as the TyG index could help identify patients most likely to benefit from early, targeted interventions, said Engelborghs, who co-chaired the EAN panel on dementia and was not part of the research. And with precision neurology becoming ever more relevant, 'such noninvasive and low-cost tools could become critical in tailoring care and optimizing clinical trial design,' he added. Engelborghs agreed lifestyle interventions could affect insulin resistance and noted research shows that 45% of dementias can be prevented or delayed by modifying 14 risk factors. One such risk factor is obesity, and insulin resistance 'goes hand and hand' with obesity, he said. 'We expect that people who modify their lifestyle in order to lose weight and reduce insulin resistance will decline more slowly,' Engelborghs said.
Medical News Today
28-06-2025
- Health
- Medical News Today
Insulin resistance test may help predict early Alzheimer's cognitive decline rate
There is currently no tool for predicting how quickly early stage Alzheimer's disease will progress. A new study has identified a simple blood test used to measure insulin resistance that may also help doctors determine which people with early stage Alzheimer's disease are most likely to experience rapid cognitive decline. The test found that higher insulin resistance indicated quicker deterioration in cognitive estimate that about 69 million people around the world are living with prodromal Alzheimer's disease, or early stage Alzheimer's disease. People in the earliest stage of Alzheimer's disease begin to experience some mild cognitive impairment that may affect their memory and ability to complete tasks and communicate. Past studies show that detecting Alzheimer's disease in its earliest stage allows currently available medications and lifestyle changes to be more effective in helping to slow down disease progression. 'Alzheimer's (disease) begins silently, often decades before symptoms appear, and so detecting risk early is essential to slow or alter the disease course,' Bianca Gumina, MD, a neurology resident for the Neurology Unit in the Department of Clinical and Experimental Sciences at the University of Brescia and for the Neurology Unit in the Department of Continuity of Care and Frailty at ASST Spedali Civili Hospital, both in Italy, told Medical News Today. 'Current tools can diagnose the disease, but they don't always predict how fast it will progress. Identifying individuals at higher risk of rapid decline [c]ould allow for timely, targeted interventions during a critical window when the disease could be still responsive to treatment or changes in (lifestyle),' she is part of the research team for a study recently presented at the European Academy of Neurology (EAN) Congress 2025 that has identified a simple blood test used to measure insulin resistance that may also help doctors determine which people with early stage Alzheimer's disease are most likely to experience rapid cognitive decline. The findings of the study are yet to be published in a peer-reviewed TyG Index Test for Alzheimer'sFor this study, researchers analyzed medical records from 315 adults with an average age of about 70 that did not have diabetes. Two hundred of the study participants had received biological confirmation they had Alzheimer's disease. All study participants received insulin resistance assessment using a test called the triglyceride-glucose (TyG) index, with a clinical follow-up three years later. 'The TyG index is a validated marker of insulin resistance, a condition often seen in prediabetes or metabolic syndrome,' Gumina explained. 'It combines triglycerides and fasting blood glucose, two common and non-invasive blood values. (It is) easy to calculate and already available in routine labs.' Higher TyG index results predict quicker cognitive declineAt the study's conclusion, the research team found that when grouping study participants by their TyG index results, those in the highest TyG index group experienced a quicker deterioration in cognitive decline than those with lower TyG index results. 4-fold higher risk'This finding is significant because it highlights a vulnerable window (mild cognitive impairment, the early phase of the disease) when the disease may be especially sensitive to metabolic stress. Patients in this early phase with high TyG levels had a fourfold increased risk of rapid cognitive decline compared to those with lower TyG levels. This suggests that insulin resistance may actively influence how fast Alzheimer's progresses, and identifying this risk early could open new avenues for intervention.'— Bianca Gumina, MD'The TyG index is a low-cost, widely available tool that could be easily integrated into routine clinical practice to flag patients at higher risk of rapid decline,' she continued. 'By identifying these individuals early, clinicians could prioritize them for closer monitoring, lifestyle interventions, or even enrollment in clinical trials, maybe individualizing sub phenotypes of the disease. It also supports the development of metabolic-based treatment strategies, potentially paving the way for therapies targeting insulin resistance to modify disease progression.'As for the next steps in this research, Gumina said the research group is currently exploring whether the TyG index also correlates with neuroimaging biomarkers of brain degeneration. 'The next goal is to integrate metabolic profiling with genetic and imaging data to refine risk models and guide early, personalized interventions,' she added. New potential variable for Alzheimer's progression predictionsMNT spoke with Rehan Aziz, MD, geriatric psychiatrist at Jersey Shore University Medical Center in New Jersey, about this study. Aziz commented that he thought this was a very interesting study involving a new variable to consider when working with patients in the early stages of Alzheimer's dementia, especially as it may predict who is likely to decline faster.'Accurate progression prediction is crucial for multiple reasons,' he explained. 'It empowers families to make informed decisions about care planning, financial arrangements, and how to prioritize quality time together. Clinically, it helps us identify patients who need more intensive monitoring and earlier intervention.''With new disease-modifying treatments like aducanumab and lecanemab becoming available — treatments that carry real risks including brain swelling and bleeding — we urgently need better ways to identify which patients are most likely to benefit from aggressive treatment versus those who might have slower progression,' Aziz continued.'This metabolic marker could help us personalize the risk-benefit calculation for each patient, ensuring we're offering these powerful but potentially risky therapies to those who need them most while protecting slower-progressing patients from unnecessary exposure.'— Rehan Aziz, MDAziz said he'd like to see this study's results validated in larger populations. 'We also need longer follow-up studies to see if this predictive power holds over five to 10 years,' he continued. 'I'm particularly interested in whether interventions targeting insulin resistance — like lifestyle modifications or medications like metformin — could actually slow progression in high-TyG patients. Finally, I'd like to see this integrated with other biomarkers to create a more comprehensive risk stratification tool.' More information on how Alzheimer's progressesMNT also spoke with Peter Gliebus, MD, director of cognitive and behavioral neurology at Marcus Neuroscience Institute, part of Baptist Health South Florida, about this commented that he found the study both fascinating and highly applicable to daily clinical practice. 'As clinicians, we frequently encounter questions from patients and their families, such as, 'How quickly will it worsen?'— and we often don't have a definitive answer,' he explained. 'The prospect that a simple, cost-effective marker like the TyG index could predict progression in Alzheimer's disease is extremely encouraging. It has the potential to bridge an important gap between diagnosis and practical prognosis, which has been a missing element in this field,' he said.'Early-stage Alzheimer's, especially during the mild cognitive impairment stage, exhibits significant variability-some individuals remain stable for years, while others decline rapidly. Identifying those at higher risk of swift decline enables us to customize clinical care and research strategies. It also helps families set clearer expectations and facilitates early, potentially more effective interventions, whether through lifestyle changes, medications or future planning.' — Peter Gliebus, MD'As new treatments are developed, timing and patient stratification will be essential — tools like the TyG index may play a crucial role in that process,' he added.
UPI
23-06-2025
- Health
- UPI
Blood test may predict rapid brain decline in Alzheimer's patients
A common blood test can flag early Alzheimer's disease patients who are four times more likely to experience rapid brain decline, a new study says. Photo by Adobe Stock/HealthDay News A common blood test can flag early Alzheimer's disease patients who are four times more likely to experience rapid brain decline, a new study says. The test -- the triglyceride-glucose (TyG) index -- assesses a person's level of insulin resistance and can estimate their risk of developing Type 2 diabetes. But the test also can help determine which people newly diagnosed with Alzheimer's might experience a faster decline in brain function, researchers reported at the European Academy of Neurology's annual meeting. "Once mild cognitive impairment is diagnosed, families always ask how fast it will progress," lead investigator Dr. Bianca Gumina, a neurology resident at the University of Brescia's Brain Health Center in Italy, said in a news release. "Our data show that a simple metabolic marker available in every hospital laboratory can help identify more vulnerable subjects who may be suitable candidates for targeted therapy or specific intervention strategies," she added. Insulin resistance has been linked to the onset of Alzheimer's, but its role in how quickly the disease progresses has received less attention, researchers said in background notes. For the study, researchers reviewed medical records for 315 non-diabetic patients in cognitive decline, including 200 with confirmed Alzheimer's disease. All underwent the TyG index blood test and were followed for three years. The third of Alzheimer's patients with the highest levels of insulin resistance had a quadrupled risk of faster cognitive decline, when compared to those with the least insulin resistance, results show. "We were surprised to see the effect only in the Alzheimer's spectrum and not in other neurodegenerative diseases," Gumina noted. "It suggests a disease-specific vulnerability to metabolic stress during the prodromal window, when interventions may still change the trajectory." Insulin resistance is believed to advance Alzheimer's by impeding blood sugar uptake to neurons, promoting accumulation of toxic beta amyloid proteins, disrupting the blood-brain barrier and fueling inflammation, researchers said. This study found that high TyG-assessed insulin resistance was indeed associated with disruption to the blood-brain barrier, researchers said. However, insulin resistance did not appear to interact with a person's genetic risk for Alzheimer's, indicating that these are separate risk factors that might operate independently. Researchers now are investigating whether TyG levels track with imaging scans of Alzheimer's, as combining the two could aid earlier detection. "If targeting metabolism can delay progression, we will have a readily modifiable target that works alongside emerging disease-modifying drugs," Gumina said. She presented her findings Monday at the EAN meeting in Helsinki. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal. More information The University of Washington has more on insulin resistance and Alzheimer's disease. Copyright © 2025 HealthDay. All rights reserved.
Extra.ie
23-06-2025
- Health
- Extra.ie
Blood test can tell if you're at risk of severe Alzheimer's
A simple blood test can tell which patients will rapidly develop severe Alzheimer's, a new study has revealed. Identifying those with mild cognitive impairment who are most likely to suffer an accelerated decline could allow them to enter clinical trials and get extra support, researchers say. Neurologists tested 315 non-diabetic patients with cognitive deficits, including 200 with Alzheimer's disease, for resistance to insulin – a hormone that regulates blood-sugar levels. A simple blood test can tell which patients will rapidly develop severe Alzheimer's, a new study has revealed. Pic: Getty Images This was assessed using the triglyceride-glucose (TYG) index. Among those with mild cognitive impairment due to Alzheimer's, individuals with the highest TYG scores declined four times faster over the three-year follow-up period than those with lower TYG levels. Researchers suggest that insulin resistance, which has been linked to the onset of Alzheimer's, may accelerate progression by impairing the uptake of glucose in the brain, promoting inflammation and disrupting the blood-brain barrier. It may also contribute to the build-up of amyloid, a toxic protein, in the brains of Alzheimer's patients. Identifying those with mild cognitive impairment who are most likely to suffer an accelerated decline could allow them to enter clinical trials and get extra support, researchers say. Pic: Shutterstock The scientists at the University of Brescia, Italy, also found that high TYG was associated with blood-brain barrier disruption and cardiovascular risk factors. However, they found no link between high TYG and other neurodegenerative diseases. Lead researcher Dr Bianca Gumina said: 'Once mild cognitive impairment is diagnosed, families always ask how fast it will progress. 'Our data shows that a simple metabolic marker available in every hospital laboratory can help identify more vulnerable subjects who may be suitable candidates for targeted therapy or specific intervention strategies.' Neurologists tested 315 non-diabetic patients with cognitive deficits, including 200 with Alzheimer's disease, for resistance to insulin – a hormone that regulates blood-sugar levels. Pic: Shutterstock While insulin resistance has been linked to the onset of Alzheimer's disease, its role in how quickly the condition progresses has received less attention. This study aimed to fill that gap by focusing on its impact during the prodromal mild cognitive impairment (MCI) stage, when patients follow highly variable trajectories. Dr Gumina commented: 'We were surprised to see the effect only in the Alzheimer's spectrum and not in other neurodegenerative diseases. 'It suggests a disease-specific vulnerability to metabolic stress during the prodromal window, when interventions may still change the trajectory.' The researchers found that high TYG was also associated with blood-brain barrier disruption and cardiovascular risk factors. The researchers found that high TYG was associated with blood-brain barrier disruption and cardiovascular risk factors. Pic: Getty Images However, it showed no interaction with the APOE genotype, a genetic vulnerability that increases the carrier's risk of developing Alzheimer's. This indicates metabolic and genetic risks may act through distinct pathways, they said. Identifying high-TYG patients could refine enrolment for clinical trials and prompt earlier lifestyle or drug-based measures to improve insulin sensitivity. The researchers are currently investigating whether TYG levels also align with neuroimaging biomarkers to aid earlier detection. 'If targeting metabolism can delay progression, we will have a readily modifiable target that works alongside emerging disease-modifying drugs', concluded Dr Gumina. The study will be presented today at the European Academy of Neurology Congress in Helsinki, Finland. There are over 64,000 people in this country living with dementia, according to the Alzheimer Society of Ireland, and this number is projected to more than double to over 150,000 by 2045.
Time of India
23-06-2025
- Health
- Time of India
THIS common condition may speed up Alzheimer's disease: Experts recommend a simple blood test to determine it
A recent study presented at the European Academy of Neurology Congress 2025 reveals that a blood test could predict rapid cognitive decline in early Alzheimer's patients. Researchers at the University of Brescia found insulin resistance, measured by the TyG index, significantly accelerates the disease's progression. Alzheimer's disease, which is the most common type of dementia, is on the rise. About 57 million people had dementia worldwide in 2021, and the numbers are escalating. This progressive neurodegenerative disorder affects the quality of life, even impacting daily activities, and hence, early diagnosis is crucial. Researchers have now found that a simple blood test may soon help doctors predict which patients with early Alzheimer's disease are most at risk of rapid cognitive decline. They also found that a common condition related to metabolic disorders could dramatically accelerate the disease. The research was led by neurologists at the University of Brescia in Italy and was presented at the European Academy of Neurology (EAN) Congress 2025. Common condition linked to accelerated Alzheimer's disease The common condition in question is insulin resistance . The researchers looked at the records of 315 non-diabetic patients with cognitive deficits, including 200 with biologically confirmed Alzheimer's disease. All participants underwent a TyG index assessment and were followed clinically over three years. The researchers found that the patients in the highest third of the TyG index within the Mild Cognitive Impairment-AD subgroup declined significantly faster than those with lower readings, losing more than 2.5 points per year on the widely used Mini-Mental State Examination. The ratio for rapid progression was 4.08 (95% CI 1.06–15.73), which is a fourfold increase in risk. 'Once mild cognitive impairment is diagnosed, families always ask how fast it will progress. Our data show that a simple metabolic marker available in every hospital laboratory can help identify more vulnerable subjects who may be suitable candidates for targeted therapy or specific intervention strategies,' lead investigator Dr Bianca Gumina said in a statement. Impact of insulin resistance on Alzheimer's disease Though previous research has shown the association between insulin resistance and Alzheimer's disease , its role in how quickly the condition progresses has not been much explored. This recent study looked into insulin resistance's impact during the prodromal mild cognitive impairment (MCI) stage, when patients follow highly variable trajectories. What is insulin resistance Insulin resistance is a condition where the body's cells do not respond properly to insulin. Insulin is a hormone produced by the pancreas that helps glucose (sugar) enter cells for energy. To compensate, the pancreas produces more insulin, but over time, this can lead to elevated blood sugar levels (hyperglycemia), increasing the risk of type 2 diabetes and other serious health conditions. The study The researchers used the TyG index, a simple and affordable way to measure insulin resistance, to see if metabolic problems could help predict how quickly cognitive decline happens after diagnosis. 'We were surprised to see the effect only in the Alzheimer's spectrum and not in other neurodegenerative diseases. It suggests a disease-specific vulnerability to metabolic stress during the prodromal window, when interventions may still change the trajectory', Dr Gumina added. Salman Khan Drops Health Bombshell on National TV The researchers at the University of Brescia, led by Professor Padovani and Professor Pilotto, found that high TyG was also associated with blood–brain barrier disruption and cardiovascular risk factors. However, it showed no interaction with the APOE ε4 genotype, and hinted that metabolic and genetic risks may act through distinct pathways. 'If targeting metabolism can delay progression, we will have a readily modifiable target that works alongside emerging disease-modifying drugs', Dr Gumina concluded. One step to a healthier you—join Times Health+ Yoga and feel the change
