Use of pioglitazone in diabetic patients with Alzheimer's disease-related cognitive impairment

Authors

DOI:

https://doi.org/10.33448/rsd-v12i5.41438

Keywords:

Dementia; Neurology; Diabetes.

Abstract

Introduction: Studies have suggested that the use of pioglitazone in patients with type 2 diabetes (DM2) was associated with a significantly lower risk of cognitive deterioration. Thus, this article aims to elucidate the effect of pioglitazone on cognition in patients with type 2 diabetes. Materials and methods: This is an integrative review, in which the guiding question was "Is pioglitazone able to reduce the progression of dementia in patients with type 2 diabetes mellitus?" The search for articles was conducted on PubMed using the terms "pioglitazone," "dementia," and "Alzheimer's" combined with Boolean operators. Results and Discussion: It is possible to infer that pioglitazone is associated with a lower risk of dementia progression in patients with recently diagnosed type 2 DM, having positive effects also in individuals with heart disease and stroke.  Final considerations: Therefore, the use of pioglitazone has benefits in reducing dementia depending on the comorbidities that the individual has, and it is not openly recommended for every type of patient. Future studies should analyze the best patient profile for the administration of the drug, so that its maximum effectiveness is achieved.

References

Alhowail A, Alsikhan R, Alsaud M, Aldubayan M, Rabbani SI. Protective Effects of Pioglitazone on Cognitive Impairment and the Underlying Mechanisms: A Review of Literature. Drug Des Devel Ther. 2022 Aug 31;16:2919-2931. doi: 10.2147/DDDT.S367229. PMID: 36068789; PMCID: PMC9441149.

Badhwar, A., Brown, R., Stanimirovic, D. B., Haqqani, A. S., & Hamel, E. (2017). Proteomic differences in brain vessels of Alzheimer's disease mice: Normalization by PPARγ agonist pioglitazone. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 37(3), 1120–1136. https://doi.org/10.1177/0271678X16655172

Burns, D. K., Alexander, R. C., Welsh-Bohmer, K. A., Culp, M., Chiang, C., O’Neil, J., Evans, R. M., Harrigan, P., Plassman, B. L., Burke, J. R., Wu, J., Lutz, M. W., Haneline, S., Schwarz, A. J., Schneider, L. S., Yaffe, K., Saunders, A. M., Ratti, E., Aarsland, D., … Zimmerman, C. (2021). Safety and efficacy of pioglitazone for the delay of cognitive impairment in people at risk of Alzheimer’s disease (TOMMORROW): a prognostic biomarker study and a phase 3, randomised, double-blind, placebo-controlled trial. The Lancet. Neurology, 20(7), 537–547. https://doi.org/10.1016/S1474-4422(21)00043-0

Chang, K. L., Pee, H. N., Yang, S., & Ho, P. C. (2015). Influence of drug transporters and stereoselectivity on the brain penetration of pioglitazone as a potential medicine against Alzheimer's disease. Scientific reports, 5, 9000. https://doi.org/10.1038/srep09000

Chou, P. S., Ho, B. L., & Yang, Y. H. (2017). Effects of pioglitazone on the incidence of dementia in patients with diabetes. Journal of Diabetes and Its Complications, 31(6), 1053–1057. https://doi.org/10.1016/J.JDIACOMP.2017.01.006

Craft, S. (2009). The role of metabolic disorders in Alzheimer disease and vascular dementia: two roads converged. Archives of neurology, 66(3), 300–305. https://doi.org/10.1001/archneurol.2009.27

DeFronzo, R. A., Inzucchi, S., Abdul-Ghani, M., & Nissen, S. E. (2019). Pioglitazone: The forgotten, cost-effective cardioprotective drug for type 2 diabetes. Diabetes & vascular disease research, 16(2), 133–143. https://doi.org/10.1177/1479164118825376

Fiorentino, T. V., Monroy, A., Kamath, S., Sotero, R., Cas, M. D., Daniele, G., Chavez, A. O., Abdul-Ghani, M., Hribal, M. L., Sesti, G., Tripathy, D., DeFronzo, R. A., & Folli, F. (2021). Pioglitazone corrects dysregulation of skeletal muscle mitochondrial proteins involved in ATP synthesis in type 2 diabetes. Metabolism: clinical and experimental, 114, 154416. https://doi.org/10.1016/j.metabol.2020.154416

Gad, E. S., Zaitone, S. A., & Moustafa, Y. M. (2016). Pioglitazone and exenatide enhance cognition and downregulate hippocampal beta amyloid oligomer and microglia expression in insulin-resistant rats. Canadian journal of physiology and pharmacology, 94(8), 819–828. https://doi.org/10.1139/cjpp-2015-0242

Ha J, Choi DW, Kim, Kim KY, Nam CM, Kim E. Pioglitazone Use and Reduced Risk of Dementia in Patients With Diabetes Mellitus With a History of Ischemic Stroke. Neurology. 2023 Feb 15:10.1212/WNL.0000000000207069. doi: 10.1212/WNL.0000000000207069. Epub ahead of print. PMID: 36792375.

Hildreth, K. L., Van Pelt, R. E., Moreau, K. L., Grigsby, J., Hoth, K. F., Pelak, V., Anderson, C. A., Parnes, B., Kittelson, J., Wolfe, P., Nakamura, T., Linnebur, S. A., Trujillo, J. M., Aquilante, C. L., & Schwartz, R. S. (2015). Effects of pioglitazone or exercise in older adults with mild cognitive impairment and insulin resistance: a pilot study. Dementia and Geriatric Cognitive Disorders Extra, 5(1), 51–63. https://doi.org/10.1159/000371509

Krinock, M. J., & Singhal, N. S. (2021). Diabetes, stroke, and neuroresilience: looking beyond hyperglycemia. Annals of the New York Academy of Sciences, 1495(1), 78–98. https://doi.org/10.1111/nyas.14583

McGuire, J. L., Correll, E. A., Lowery, A. C., Rhame, K., Anwar, F. N., McCullumsmith, R. E., & Ngwenya, L. B. (2019). Pioglitazone improves working memory performance when administered in chronic TBI. Neurobiology of disease, 132, 104611. https://doi.org/10.1016/j.nbd.2019.104611

Sánchez-Valle R. (2021). Pioglitazone for prevention of cognitive impairment: results and lessons. The Lancet. Neurology, 20(7), 500–502. https://doi.org/10.1016/S1474-4422(21)00140-X

Saunders, A. M., Burns, D. K., & Gottschalk, W. K. (2021). Reassessment of Pioglitazone for Alzheimer's Disease. Frontiers in neuroscience, 15, 666958. https://doi.org/10.3389/fnins.2021.666958

Seok H, Lee M, Shin E, et al. Low-dose pioglitazone can ameliorate learning and memory impairment in a mouse model of dementia by increasing LRP1 expression in the hippocampus. Sci Rep. 2019;9(1). doi: 10.1038/s41598-019-40736-x.

Singh G, Can AS, Correa R. Pioglitazone. 2023 Mar 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31335007.

SOUZA, Marcela Tavares de; SILVA, Michelly Dias da; CARVALHO, Rachel de. Revisão integrativa: o que é e como fazer. Einstein (São Paulo), v. 8, p. 102-106, 2010.

Tseng CH. Pioglitazone Reduces Dementia Risk in Patients with Type 2 Diabetes Mellitus: A Retrospective Cohort Analysis. J Clin Med. 2018 Sep 27;7(10):306. doi: 10.3390/jcm7100306. PMID: 30262775; PMCID: PMC6209987.

Xue, M., Xu, W., Ou, Y. N., Cao, X. P., Tan, M. S., Tan, L., & Yu, J. T. (2019). Diabetes mellitus and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 144 prospective studies. Ageing research reviews, 55, 100944. https://doi.org/10.1016/j.arr.2019.100944

Zamanian, M. Y., Taheri, N., Opulencia, M. J. C., Bokov, D. O., Abdullaev, S. Y., Gholamrezapour, M., Heidari, M., & Bazmandegan, G. (2022). Neuroprotective and Anti-inflammatory Effects of Pioglitazone on Traumatic Brain Injury. Mediators of inflammation, 2022, 9860855. https://doi.org/10.1155/2022/9860855

Downloads

Published

30/04/2023

How to Cite

FONSECA, M. S. .; ROCHA, G. T. .; SOARES, I. E. .; THEODORO, A. P. .; CORRÊA, M. L. .; CORRÊA, E. A. L. .; SANCHEZ, G. J. J. .; BARBOSA NETO, A. T. .; VASCONCELOS, L. R. .; CHERAIN, L. G. G. . Use of pioglitazone in diabetic patients with Alzheimer’s disease-related cognitive impairment. Research, Society and Development, [S. l.], v. 12, n. 5, p. e5212541438, 2023. DOI: 10.33448/rsd-v12i5.41438. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/41438. Acesso em: 28 apr. 2024.

Issue

Vol. 12 No. 5

Section

Review Article

License

Copyright (c) 2023 Marina Santana Fonseca; Gabryella Teixeira Rocha; Isabella Elias Soares; Alana Pimenta Theodoro; Mariana Lasmar Corrêa; Eduardo Augusto Lasmar Corrêa; Gabriel Jorge Jacopeti Sanchez; Antônio Taveira Barbosa Neto; Lara Ramos Vasconcelos; Luiz Gabriel Gonçalves Cherain

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.