State of the science on brain insulin resistance and cognitive decline due to Alzheimer's disease
Open accessAbstract
Type 2 diabetes mellitus (T2DM) is common and increasing in prevalence worldwide, with devastating public health consequences. While peripheral insulin resistance is a key feature of most forms of T2DM and has been investigated for over a century, research on brain insulin resistance (BIR) has more recently been developed, including in the context of T2DM and non-diabetes states. Recent data support the presence of BIR in the aging brain, even in non-diabetes states, and found that BIR may be a feature in Alzheimer's disease (AD) and contributes to cognitive impairment. Further, therapies used to treat T2DM are now being investigated in the context of AD treatment and prevention, including insulin. In this review, we offer a definition of BIR, and present evidence for BIR in AD; we discuss the expression, function, and activation of the insulin receptor (INSR) in the brain; how BIR could develop; tools to study BIR; how BIR correlates with current AD hallmarks; and regional/cellular involvement of BIR. We close with a discussion on resilience to both BIR and AD, how current tools can be improved to better understand BIR, and future avenues for research. Overall, this review and position paper highlights BIR as a plausible therapeutic target for the prevention of cognitive decline and dementia due to AD.
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These multi-omics analyses provide an initial account of aberrant mTOR/INS signaling that may contribute to AD-related pathology in individuals with DS.
“These multi‐omics analyses provide an initial account of aberrant mTOR/INS signaling that may contribute to AD‐related pathology in individuals with DS. 42 , 60”
From Disruption of hippocampal upstream regulators of mTOR and insulin pathways in Down syndrome with Alzheimer's disease neuropathology: Preliminary observations (2026) · cites this paper as [60]
The Post-mortem human brain tissue section reports impaired insulin-receptor signaling early in Down syndrome, before AD pathology develops. It also reports an association between mTOR hyperphosphorylation and amyloid-β, but cites a separate AD study for that finding. The Discovery-driven omics approaches section does not describe multi-omics analyses in people with Down syndrome, so the claimed combined account of mTOR/INS signaling in that population is not fully supported. (LLM, conf=0.85)
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“…analyses provide an initial account of aberrant mTOR/INS signaling that may contribute to AD-related pathology in individuals with DS. 42,60 In contrast to the Z scores of mTOR pathway activators, PTEN had significantly reduced activation Z scores (Figure 2 and 3) that displayed…”
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Diabetes With Elevated A1C is Related to Perceptual Speed Decline in Older Adults
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- Authors
- Rhea, E. M., Leclerc, M., Yassine, H. N., Capuano, A. W., Tong, H., Petyuk, V. A., Macauley, S. L., Fioramonti, X., Carmichael, O., Calon, F., & Arvanitakis, Z.
- Affiliations
- University of Washington (US)
- Université Laval (CA)
- University of Southern California (US)
- Rush University Medical Center (US)
- Pacific Northwest National Laboratory (US)
- University of Kentucky (US)
- Université de Bordeaux (FR)
- Pennington Biomedical Research Center (US)
- Corresponding author
- Rhea, Elizabeth M.
- ORCID
- Venue
- Aging and disease
- Publisher
- Aging and Disease
- Published
- 2023
- Volume
- 15
- Issue
- 4
- Pages
- 0
- ISSN
- 2152-5250 (ISSN-L)
- PMC
- PMC11272209
- OpenAlex
- W4385958194
- Cited by
- 70
- References
- 342
- Citations by year
- 2026: 13 · 2025: 30 · 2024: 23 · 2023: 4
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Aging and Disease (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by)
- Oskar-Bordeaux (Universite de Bordeaux) (submittedVersion, cc-by)
- OSTI OAI (U.S. Department of Energy Office of Scientific and Technical Information) (submittedVersion, cc-by)
- Civil War Book Review (submittedVersion)
- Funders
- University of Washington (P30DK017047)
- Servier
- National Institutes of Health (DK017047)
- Canadian Institutes of Health Research (168927_1)
- National Institute on Aging (RF1AG074549, RF1AG059621, RF1AG078362, R01AG068330, P30AG066530, P30AG072946, R01AG078362, R01AG074549)
- National Institute of General Medical Sciences (P20GM148326)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK017047)
- Topics
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
- Keywords
- brain insulin resistance, Alzheimer's disease, cognitive decline, type 2 diabetes, insulin receptor, insulin signaling, brain aging, dementia prevention, therapeutic target
- MeSH terms
- Alzheimer Disease, Animals, Brain, Diabetes Mellitus, Type 2, Humans, Insulin Resistance, Receptor, Insulin, Cognitive Dysfunction
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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