Intranasal Insulin as a Treatment for Alzheimer’s Disease: A Review of Basic Research and Clinical Evidence

Introduction: Considering that Alzheimer’s disease (AD) and diabetes mellitus share pathophysiological features and AD remains with no cure, antidiabetic drugs like intranasal insulin, glitazones, metformin, and liraglutide are being tested as a potential treatment. Objective: The aim of this systematic review was to assess the efficacy of antidiabetic drugs in patients with AD, mild cognitive impairment (MCI), or subjective cognitive complaints (SCCs). Cognition was studied as the primary outcome and modulation of AD biomarkers, and imaging was also assessed as a secondary outcome. Methods: We conducted a search in the electronic databases PubMed/MEDLINE, EMBASE, and Scopus seeking clinical trials evaluating the effect on cognition of antidiabetic drugs in patients with AD, MCI, or SCCs. Results: A total of 23 articles were found eligible. Intranasal regular insulin improved verbal memory in most studies, especially in apoE4− patients, but results in other cognitive domains were unclear. Detemir improved cognition after 2 months of treatment, but it did not after 4 months. Pioglitazone improved cognition in diabetic patients with AD or MCI in 3 clinical trials, but it is controversial as 2 other studies did not show effect. Metformin and liraglutide showed promising results, but further research is needed as just 2 clinical trials involved each of these drugs. Almost all drugs tested were shown to modulate AD biomarkers and imaging. Conclusions: Intranasal insulin, pioglitazone, metformin, and liraglutide are promising drugs that could be useful in the treatment of AD. However, many questions remain to be answered in future studies, so no particular antidiabetic drug can currently be recommended to treat AD.

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Association between Down's Syndrome and Alzheimer's Disease: Review of the Literature

Journal of Learning Disabilities for Nursing Health and Social Care ◽

10.1177/174462959900300405 ◽

1999 ◽

Vol 3 (4) ◽

pp. 194-203 ◽

Cited By ~ 6

Author(s):

N. J. Hutchinson

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Clinical Evidence ◽

Neuropsychological Testing ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Signs And Symptoms ◽

Diagnostic Process ◽

Review Of The Literature ◽

Therapeutic Needs

In recent years, advances in medical, surgical and nursing care have resulted in a dramatic increase in the life expectancy of children born with Down's syndrome (DS), giving rise to an older population of people with DS not previously seen. It has become clear from the study of the ageing DS population that an association exists between DS and Alzheimer's disease (AD). This paper reviews neuropathological and clinical evidence of an association between DS and AD. The clinical features of AD in people with DS and apparent differences between the signs and symptoms of AD seen in individuals with DS and older people with AD in the general population are discussed. Issues pertaining to the diagnosis of AD in people with DS, such as diagnostic criteria, the process of diagnosis, and specific problems of diagnosing AD in people with DS are also discussed. The therapeutic needs of individuals with DS who are diagnosed as having AD are considered and the necessity to strive to make the diagnostic procedure as valid as possible is expressed. The paper concludes that neuropsychological testing has an important role to play in the diagnostic process.

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