Hypoglycemia may increase the risk of dementia and vice versa, according to a study conducted by researchers from the University of California-San Francisco and published in the journal JAMA Internal Medicine.

The study was conducted on people with diabetes, who are who are paradoxically among those most likely to suffer from hypoglycemia (low blood sugar). Diabetes is characterized by high levels of blood sugar, which can cause cellular damage and produce a wide variety of other health problems over time. For this reason, diabetes treatments focus on lowering blood sugar levels. In some cases, blood sugar can drop too much and hypoglycemia results.

Some researchers have speculated that this hypoglycemia risk may explain elevated rates of dementia among diabetes patients.

"Hypoglycemia commonly occurs in patients with diabetes mellitus (DM) and may negatively influence cognitive performance," the researchers wrote. "Cognitive impairment in turn can compromise DM management and lead to hypoglycemia."

The researchers studied 783 older diabetes patients, with an average age of 74. Over the course of 12 years, 61 of the patients (7.8 percent) reported at least one hypoglycemic event, while 148 of them (8.9 percent) developed some form of dementia, such as Alzheimer's disease.

The risk of developing dementia during the study period was two times higher among those who had experienced a hypoglycemic event than among those who had not, 34.4 percent vs. 17.6 percent. Likewise, receiving a dementia diagnosis more than doubled the risk that a participant would have a hypoglycemic event after that date. These associations remained even after the researchers adjusted for the influence of potential confounding factors including age, education, race/ethnicity, sex and comorbidities.

"These results provide evidence for a reciprocal association between hypoglycemia and dementia among older adults with DM," the researchers wrote.

More reasons to watch your blood sugar

The findings are significant because hypoglycemia is such a common side effect of diabetes treatment, noted Great Neck, N.Y. endocrinologist Stuart Weinerman.

"Sooner or later, everyone is going to have some hypoglycemia," he said.

A commentary accompanying the study noted that hypoglycemic events become more common as diabetes patients get older. Scientists are unsure why this is the case, but they suspect that the body's kidney function and its ability to metabolize drugs - including diabetes medication - both decrease with age.

Hypoglycemic incidents can be dangerous if left untreated. According to Weinerman, anyone taking blood sugar medication should watch out for the signs, which include blurred vision, confusion, fainting, heart palpitations and jitteriness.

The findings suggest that doctors need to be careful not to focus so much on lowering blood sugar that they create other risks for their patients, Yaffe said.

"[Treatment] shouldn't be so aggressive that you get hypoglycemia," she said.

Glen Oaks, N.Y. neurologist Marc Gordon agreed.

"There has been a concern about the association between diabetes and dementia," he said. "Patients need to be careful that they are not either under treated or over treated and that they monitor their blood sugar."

It remains unclear exactly whether dementia and hypoglycemia are really causing each other and, if so, how. But Yaffe suggested that low blood sugar may starve the brain and actually cause damage or death to its neurons. Conversely, dementia may make it difficult for diabetes patients to monitor their medication and blood sugar levels effectively.

"This does raise concern about low blood sugar causing future problems with dementia and dementia causing problems with low blood sugar," Weinerman said.

For those who do not have diabetes, the best way to avoid developing the condition remain eating a healthy diet and getting plenty of exercise.

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