Steroid-induced elevation of glucose in Alzheimer’s disease: relationship to gender, apolipoprotein E genotype and cognition

Aisen, P.S; Berg, J.D; Craft, S; Peskind, E.R; Sano, M; Teri, L; Mulnard, R.A; Thomas, R.G; Thal, L.J

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Volume 28, Issue 1 , Pages 113-120, January 2003

Steroid-induced elevation of glucose in Alzheimer’s disease: relationship to gender, apolipoprotein E genotype and cognition

P.S Aisen
- Department of Neurology, Georgetown University Medical Center, 1Bles Building, 3800 Reservoir Road NW, 20007 Washington, DC, USA
- Corresponding author. Tel.: +1-202-687-7337; fax: +1-202-784-4334
J.D Berg
- Alzheimer s Disease Cooperative Study, University of California San Diego, San Diego, CA, USA
S Craft
- Geriatric Research, Education and Clinical Center, Veteran Affairs Puget Sound Health Care System, University of Washington School of Medicine, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
E.R Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Mental Illness Research, Education and Clinical Center, Veteran Affairs Puget Sound Health Care System, University of Washington School of Medicine, Seattle, WA, USA
M Sano
- Gertrude H. Sergievsky Center, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
L Teri
- Department of Psychosocial and Community Health, University of Washington School of Medicine, Seattle, WA, USA
R.A Mulnard
- Institute for Brain Aging and Dementia, University of California Irvine, Irvine, CA, USA
R.G Thomas
- Departments of Family and Preventive Medicine, University of California San Diego, San Diego, CA, USA
L.J Thal
- Department of Neurosciences, University of California at San Diego, San Diego, CA, USA

Received 6 December 2001; received in revised form 1 February 2002; accepted 6 February 2002.

Abstract

Glucose and insulin may play an important role in the pathophysiology and symptomatology of Alzheimer s disease (AD), and prior studies suggest interactions among glucose, insulin, gender and apolipoprotein E genotype. We analyzed the relationship between steroid-induced glucose elevation and gender, presence of the apolipoprotein E ε4 (APOE-4) allele and cognition using data from a multicenter trial of prednisone therapy in AD. The low-dose prednisone regimen (initial dose: 20 mg/day, maintenance dose: 10 mg/day) caused a moderate increase in random blood glucose (mean post-baseline glucose 115 mg/dl). There was a significant interaction between rise in glucose, gender and presence of the APOE-4 allele. There was no important relationship between glucose and cognitive function at baseline or with prednisone treatment. Meta-analysis including data from three other AD trials showed a small influence of random blood glucose on cognitive scores. These results support a relationship between gender, apolipoprotein E genotype and glucose metabolism, but do not indicate that mild changes in glucose have an important impact on cognitive function.

Keywords: Alzheimer s disease, Prednisone, Hyperglycemia, Apolipoprotein E, Gender, Cognition