The University of Michigan is looking to launch a population-based study on Alzheimer’s disease and related dementias in India.

Eva Feldman, a U-M expert in neurodegenerative disease, and Vijay Viswanathan of the M.V. Hospital for Diabetes in India, are leading the research. The long-range goal of this collaboration is to inform new treatments for Alzheimer’s, related dementias and neuropathy.

“While AD has been extensively studied in the United States and European populations, much less is known about AD in India,” said Feldman, a neurology professor at the U-M Medical School and director of the ALS Center of Excellence and the NeuroNetwork for Emerging Therapies.

“Socioeconomic, linguistic, geographical, lifestyle and genetic differences between India and other populations strongly suggest that previous results from the U.S. and Europe may not translate to India.”

The study aims to determine the metabolic risk factors for neurologic complications and identify lipid classes/species associated with cognitive impairment and neuropathy. The researchers will conduct clinical training for hospital and community-based health care providers to improve the region’s diagnosis and management. They aim to have 1,000 participants from four zones in Chennai and two zones in the nearby Tiruvallur district.

Additionally, enhanced epidemiologic training will be given to the data collection team for future intervention studies, mentoring for master’s of social work interns, and ongoing professional development for dedicated grants administrators.

Why Alzheimer’s in India?

The prevalence of Alzheimer’s disease in India is at 3 million people compared to 4 million in the U.S. A tripling of the current AD prevalence by 2050 is expected to be driven mainly by the Indian population, according to Feldman.

Alzheimer’s and neuropathy

Studies have shown that type 2 diabetes can be a risk factor for AD, vascular dementia and other types of dementia. The same cardiovascular problems that increase the risk of type 2 diabetes also can increase the risk of dementia, including obesity, heart disease or family history of heart disease, impaired blood vessels, circulation problems, high cholesterol and high blood pressure.

“We will identify patients at risk of developing cognitive deficits that exist with neuropathy,” said Viswanathan, who will be in charge of the study in India and oversee aspects of the research collaboration. “It will determine whether central obesity (truncal fat mass), but not general obesity, may be associated with cognitive impairment and neuropathy.

“We hope to identify other metabolic risk factors and, eventually, improve the quality of life among people with diabetes by preventing or delaying these complications.”

Collaboration background

The current collaboration with the University of Michigan and the M.V. Hospital for Diabetes in Chennai was established in 2016. The Chennai Complication Cohort was established to better understand the factors underlying neuropathy in India with the idea that central obesity, not general obesity, is associated with neuropathy.

“I am immensely thankful for this collaboration,” said Viswanathan, who has co-authored publications with Feldman in the past. “My work has focused on diabetes complications, a major problem in India. My ongoing work with Dr. Feldman focuses on phenotyping these people with diabetes and prediabetes.”

Details of the Chennai study

Chennai consists of 15 zones comprising 200 wards. Two zones were selected randomly, consisting of the urban poor (Tondiarpet and Royapuram) and two zones of the urban middle class (Adyar and Teynampet) from which to sample. From the peri-urban Tiruvallur district, there are two randomly selected zones (Gummidipoondi and Ponneri).

Participants will be equal numbers of men and women and equal numbers in areas representing the urban poor, urban middle class and peri-urban populations. The urban and peri-urban are intentionally selected zones because metabolic risk factors differ between these communities.

Urban communities have a higher prevalence of metabolic risk factors, such as hypertension, whereas peri-urban communities are less likely to be diagnosed and treated appropriately, according to the researchers. Peri-urban communities have lower literacy rates, socioeconomic status, nutritional status and health care access, whereas urban communities have a more sedentary lifestyle.

“In all of these individuals, we will assess their blood sugar levels, lipid levels along with lipidomics, blood pressure, weight, height, measures of central obesity, waist-hip measures and body mass composition,” Feldman said. “We will also assess cognition with a well-established tool, cog state, and neuropathy with our neuropathy screening instruments.”