Insulin is differentially related to cognitive decline and atrophy in Alzheimer's disease and aging

We assessed the relationship of insulin resistance with cognitive decline and brain atrophy over two years in early Alzheimer's disease (AD, n = 48) and nondemented controls (n = 61). Intravenous glucose tolerance tests were conducted at baseline to determine insulin area-under-the-curve (AUC). A standard battery of cognitive tasks and MRI were conducted at baseline and 2-year follow-up. In nondemented controls, higher baseline insulin AUC was associated with 2-year decline in global cognitive performance (beta = − 0.36, p = 0.005). In early AD, however, higher insulin AUC was associated with less decline in global cognitive performance (beta = 0.26, p = 0.06), slower global brain atrophy (beta = 0.40, p = 0.01) and less regional atrophy in the bilateral hippocampi and cingulate cortices. While insulin resistance is associated with cognitive decline in nondemented aging, higher peripheral insulin may have AD-specific benefits or insulin signaling may be affected by systemic physiologic changes associated with AD. This article is part of a Special Issue entitled: Imaging Brain Aging and Neurodegenerative disease.

► Peripheral insulin, cognitive change, and brain atrophy in aging and Alzheimer's. ► Higher insulin in aging is associated with greater 2-year decline in cognition. ► Higher insulin in AD is associated with less cognitive decline and brain atrophy.