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Peripheral Insulin Resistance and Alzheimer's Disease

Possible Mediators Including Extracellular Vesicles

Bibliographic Data

ID22423014
AuthorsNaotaka Izuo (0000-0002-2642-5045, Research Center for Advanced Science and Technology The University of Tokyo Tokyo Japan, corresponding author), Hiroshi Kondoh (Geriatric Unit, Graduate School of Medicine Kyoto University Kyoto Japan), Takahiko Shimizu (0000-0002-3351-3342, Department of Food and Reproductive Function Advanced Research Juntendo University Graduate School of Medicine Tokyo Japan, corresponding author)
Year2026
Volume26
Issue4
Pagese70483-e70483
Publication date2026-04-01
Open AccessYes
TypeARTICLE
VenueGeriatrics and gerontology international/Geriatrics & gerontology international (JOURNAL)
Journal identifiersISSN: 1444-1586 • E-ISSN: 1447-0594
PublisherWiley (PUBLISHER • GB)
DOI10.1111/ggi.70483
PMID41969120
OpenAlexW7154185097
LanguageEN
Citations received1
References cited50

Epidemiological studies consistently indicate that type 2 diabetes mellitus increases the risk of Alzheimer's disease (AD). Accumulating evidence suggests that insulin resistance, rather than hyperglycemia per se, is the principal metabolic factor associated with AD development. Population‐based longitudinal studies show that insulin resistance is strongly linked to earlier amyloid β (Aβ) accumulation, whereas its association with tau pathology remains inconsistent. Importantly, insulin resistance‐related cognitive decline and earlier disease onset cannot be fully explained by the extent of Aβ deposition alone, implying the involvement of additional pathogenic pathways. Animal studies further support a role for insulin resistance independent of sustained hyperglycemia. Genetic models of systemic insulin resistance demonstrate impairments in cognition, cerebral blood flow regulation, and emotional behavior, distinct from phenotypes observed in models with brain‐specific disruption of insulin signaling. Together with clinical observations showing preserved central insulin responsiveness in individuals with type 2 diabetes, these findings highlight peripheral insulin resistance as a key contributor to brain vulnerability in AD. How peripheral insulin resistance influences the brain remains incompletely understood. Emerging evidence suggests that extracellular vesicles may act as a possible mediator of peripheral–central communication by conveying bioactive molecules across tissues. In this review, we summarize epidemiological and experimental evidence linking peripheral insulin resistance to AD and discuss the potential, yet still speculative, role of extracellular vesicles in this process.

Diabetes mellitus · Disease · Extracellular · Extracellular vesicles · Insulin · Insulin resistance · Mediator · Type 2 diabetes · Alzheimer's disease research and treatments · Barrier Structure and Function Studies · Extracellular vesicles in disease

  • Commentary on “Peripheral Insulin Resistance and Alzheimer's Disease

    Open Access•Ping Zhang•Geriatrics and gerontology…•2026

Citations per year1
Citation span2026 - 2026 (1)
Highly citedNo

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