The results of a provocative study published online in the Archives of Neurology on September 12, 2011 found that administering insulin through the nose using a special medical device (transnasal delivery) improved both memory as measured by delayed story recall and functional ability as measured by caregivers, in patients with mild cognitive impairment or Alzheimer disease. (The purpose of using transnasal insulin administration is so that more of the insulin reaches the brain rather than the bloodstream.)
Insulin not only plays an important role in regulating blood sugar levels, it also plays an important role in brain function. In the brain, insulin modulates glucose utilization and, in normal metabolism, maintains memory at the optimal levels. When regulation of the insulin in the brain is disrupted, it may contribute to the development and the course of Alzheimer disease. Insulin may also help to protect against the toxic effects of beta-amyloid, which is the brain protein associated with the plaques that form in the brain that are the hallmark of Alzheimer disease. Insulin also prevents the formation of the toxic form of a biomarker known as tau that is found in the cerebrospinal fluids of Alzheimer disease patients. Prior studies have found that the level of insulin and the activity of insulin in the brain and the central nervous systems of Alzheimer disease patients are reduced.
The recent study involved 104 adults who had mild cognitive memory impairments (64 of the study participants) or had mild to moderate Alzheimer disease (40 of the study participants). Of the 104 study participants, 30 received a placebo, 36 received 20IU of insulin, and the remaining 38 received 40IU of insulin, for 4 months. The study found that the participants who had received 20IU of insulin by transnasal delivery had improvement in delayed story recall (memory), that the participants who received 40IU of insulin did not show improved delayed story recall, and that the participants who received either 20IU or 40IU of transnasal insulin showed preserved functional ability as measured by their caregivers. (One possible explanation for the finding that 40IU of insulin did not improve delayed story recall may be that the 40IU dose may have exceeded the optimal dose for memory but not for other aspects of cognition or daily function.)
The results of the recent study are exciting for researchers of Alzheimer disease and dementia but caution must be exercised because of the small number of participants and the relatively short period of the study. The authors of the study urge longer studies of transnasal insulin therapy for patients with mild memory cognitive impairments and patients with Alzheimer disease.
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