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Some diabetes drugs tied to lower risk of dementia and Parkinson’s

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A class of drugs for diabetes may be associated with a lower risk of dementia and Parkinson’s disease, according to a study published in the September 18, 2024, online issue of Neurology.

The study looked at sodium-glucose cotransporter-2 (SGLT2) inhibitors, which are also known as gliflozins.

They lower blood sugar by causing the kidneys to remove sugar from the body through urine.

Minyoung Lee, MD, PhD, of Yonsei University College of Medicine in Seoul, South Korea, is the study’s author.

The researcher said: “We know that these neurodegenerative diseases like dementia and Parkinson’s disease are common and the number of cases is growing as the population ages, and people with diabetes are at increased risk of cognitive impairment, so it’s encouraging to see that this class of drugs may provide some protection against dementia and Parkinson’s disease,.”

The retrospective study looked at people with type 2 diabetes who started diabetes medication from 2014 to 2019 in South Korea. People taking SGLT2 inhibitors were matched with people taking other oral diabetes drugs, so the two groups had people with similar ages, other health conditions and complications from diabetes.

Then researchers followed the participants to see whether they developed dementia or Parkinson’s disease.

Those taking the SGLT2 inhibitors were followed for an average of two years and those taking the other drugs were followed for an average of four years.

Among the 358,862 participants with an average age of 58, a total of 6,837 people developed dementia or Parkinson’s disease during the study.

For Alzheimer’s disease, the incidence rate for people taking SGLT2 inhibitors was 39.7 cases per 10,000 person-years, compared to 63.7 cases for those taking other diabetes drugs.

Person-years represent both the number of people in the study and the amount of time each person spends in the study.

For vascular dementia, which is dementia caused by vascular disease, the incidence rate for people taking the SGLT2 drugs was 10.6 cases per 10,000, compared to 18.7 for those taking the other drugs.

For Parkinson’s disease, the incidence rate for those taking the SGLT2 drugs was 9.3 cases per 10,000, compared to 13.7 for those taking the other drugs.

After researchers adjusted for other factors that could affect the risk of dementia or Parkinson’s disease, such as complications from diabetes and medications, they found that SGLT2 inhibitor use was associated with a 20 per cent reduced risk of Alzheimer’s disease and a 20 per cent reduced risk of Parkinson’s disease.

Those taking the drugs had a 30 per cent reduced risk of developing vascular dementia.

Lee said: “The results are generally consistent even after adjusting for factors like blood pressure, glucose, cholesterol and kidney function.

“More research is needed to validate the long-term validity of these findings.”

Lee said that since participants were followed for less than five years at the most, it’s possible that some participants would later develop dementia or Parkinson’s disease.

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Shingles vaccine may slow biological ageing in older adults

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Shingles vaccination may slow biological ageing in older adults, research suggests.

The study examined more than 3,800 people aged 70 and older and found that those who received the vaccine showed slower biological ageing on average than unvaccinated individuals.

The study used data from a nationally representative US survey to assess how shingles vaccination related to several measures of biological ageing.

Even when controlling for other sociodemographic and health variables, vaccinated individuals had lower inflammation measurements, slower epigenetic ageing (changes in how genes are switched on or off) and slower transcriptomic ageing (changes in how genes are transcribed into RNA used to create proteins).

The research was carried out at the USC Leonard Davis School of Gerontology, using data from the US Health and Retirement Study.

Shingles, also called herpes zoster, is a painful, blistering skin rash caused by reactivation of the chickenpox virus. Anyone who has had chickenpox is at risk of shingles. While shingles can occur at younger ages, risk is higher for those 50 and older and for immunocompromised people. Vaccination offers protection from shingles and lowers the chance of postherpetic neuralgia, or long-term pain after infection.

While vaccines are designed to protect against acute infection, recent research has highlighted a possible link between adult vaccines, including those for shingles and influenza, and lower risks of dementia and other neurodegenerative disorders, said research associate professor of gerontology Jung Ki Kim, the study’s first author.

“This study adds to emerging evidence that vaccines could play a role in promoting healthy ageing by modulating biological systems beyond infection prevention.”

Biological ageing refers to how the body changes over time, including how well organs and systems are working, unlike chronological ageing, which is simply time passing. Two people who are both 65 years old may look very different inside: one may have the biological profile of someone younger, while another may show signs of ageing earlier.

Kim and coauthor Eileen Crimmins, USC university professor and AARP professor of gerontology, measured seven aspects of biological ageing: inflammation, innate immunity (the body’s general defences against infection), adaptive immunity (responses to specific pathogens after exposure or vaccination), cardiovascular haemodynamics (blood flow), neurodegeneration, epigenetic ageing and transcriptomic ageing. The team also used the measures collectively to record a composite biological ageing score.

Chronic, low-level inflammation is a contributor to many age-related conditions, including heart disease, frailty and cognitive decline. This phenomenon is known as inflammaging, Kim said.

“By helping to reduce this background inflammation, possibly by preventing reactivation of the virus that causes shingles, the vaccine may play a role in supporting healthier ageing. While the exact biological mechanisms remain to be understood, the potential for vaccination to reduce inflammation makes it a promising addition to broader strategies aimed at promoting resilience and slowing age-related decline.”

The effect may persist. When analysing how time since vaccination related to results, Kim and Crimmins found that participants who received their vaccine four or more years before providing their blood sample still showed slower epigenetic, transcriptomic and overall biological ageing on average than unvaccinated participants.

“These findings indicate that shingles vaccination influences key domains linked to the ageing process. While further research is needed to replicate and extend these findings, especially using longitudinal and experimental designs, our study adds to a growing body of work suggesting that vaccines may play a role in healthy ageing strategies beyond solely preventing acute illness.

The work was supported by the National Institute on Aging at the National Institutes of Health. The Health and Retirement Study is supported by the National Institute on Aging.

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Thousands of men in England to be offered life-extending prostate cancer drug

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Thousands of men in England will get the prostate cancer drug abiraterone on the NHS within weeks.

For the first time, patients in England whose cancer has not spread will be able to receive abiraterone as the health service widens access to the treatment.

Around 2,000 men diagnosed in the last three months whose cancer has not spread will get access to the treatment if it is of clinical benefit.

An additional 7,000 men are expected to be diagnosed each year and will be eligible for the drug.

The national clinical director for cancer at NHS England, professor Peter Johnson, said: “For thousands of men with prostate cancer, this treatment option could be life-changing by helping keep their cancer at bay for several years.

“The life-extending treatment available on the NHS within weeks will mean thousands of men can kick-start their year with the news that they will have a better chance of living longer and healthier lives.

“The NHS will continue to work hard to offer people the most effective and evidence-based treatments, with several new prostate cancer drugs rolled over the last five years.”

Abiraterone is a hormone-blocking tablet that helps stop prostate cancer spreading by cutting off the testosterone it needs to grow.

Research has shown that for these earlier-stage patients, survival after six years is improved, with trials showing 86 per cent of men alive after six years on abiraterone compared with 77 per cent on standard treatment (hormone therapy with or without radiotherapy).

NHS England has been able to expand access to the drug for thousands more eligible patients by securing better-value supply, following clinical advice to roll this out last year.

The NHS has set a target to save over £1bn on clinically effective biosimilar drugs during this parliament. Biosimilars are approved, lower-cost versions of biological medicines.

More than eight in 10 drugs the NHS now prescribes are lower-cost biosimilar or generic medicines, creating funding for other treatments.

The NHS in England already commissions abiraterone, now available as a lower-cost generic medicine, for advanced prostate cancer, having introduced a policy to commission the treatment in December 2024, nearly one year ahead of positive NICE guidance recommending it in November 2025.

NHS England has worked with campaigners including Prostate Cancer UK to secure this rollout.

In the past five years alone, the NHS in England has also commissioned targeted prostate cancer therapies, including the branded drugs enzalutamide, darolutamide, relugolix and apalutamide.

The health and social care secretary, Wes Streeting, said: “When you’re living with prostate cancer, every day with your loved ones matters.

“I’m delighted the NHS have taken the steps needed to make the drug available, giving thousands of men access to abiraterone, a treatment that significantly improves survival rates and can give patients precious extra years of life.

“We’re backing the best clinical evidence, making smart funding decisions, and ensuring patients get the care they need when they need it most.

“We’re serious about improving prostate cancer outcomes, treating it faster and giving loved ones more time together.”

In parallel with confirming abiraterone’s commissioning, NHS England will also offer blood plasma treatment for people with the rare condition Clarkson’s Syndrome, and genetic testing for parents with pre-existing conditions going through IVF, following clinical advice and enabled by long-term funding.

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Blood sugar spike after meals may increase Alzheimer’s risk

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Sharp rises in blood sugar after meals may raise Alzheimer’s risk, according to genetic analysis of more than 350,000 adults.

The findings point to after-meal glucose, rather than overall blood sugar, as a possible factor in long-term brain health.

Researchers examined genetic and health data from over 350,000 UK Biobank participants aged 40 to 69, focusing on fasting glucose, insulin, and blood sugar measured two hours after eating.

The team used Mendelian randomisation, a genetic method that helps test whether biological traits may play a direct role in disease risk.

People with higher after-meal glucose had a 69 per cent higher risk of Alzheimer’s disease.

This pattern, known as postprandial hyperglycaemia (elevated blood sugar after eating), stood out as a key factor.

The increased risk was not explained by overall brain shrinkage (atrophy) or white matter damage, suggesting after-meal glucose may affect the brain through other pathways not yet fully understood.

Dr Andrew Mason, lead author, said: “This finding could help shape future prevention strategies, highlighting the importance of managing blood sugar not just overall, but specifically after meals.”

Dr Vicky Garfield, senior author, added: “We first need to replicate these results in other populations and ancestries to confirm the link and better understand the underlying biology.

“If validated, the study could pave the way for new approaches to reduce dementia risk in people with diabetes.”

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