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Aims According to the recent increase in life expectancy in patients with diabetes, the incidence of dementia with diabetes is increasing drastically in Japan. However, the number of studies on the prevalence of abnormal cognition and the associated risk factors in a large number of outpatients with diabetes in a primary care setting is very limited. Methods The Mini-Mental State Examination (MMSE) test was performed in 1,449 outpatients aged C50 years with diabetes, hypertension or dyslipidemia (126 without and 1,323 with diabetes). Prevalence of abnormal cognition defined as an MMSE score \24 and the associated risk factors were explored. Results Prevalence of abnormal cognition was 5.8 % in total, and was 8.3 % in outpatients aged C65 years with diabetes. Logistic regression analysis after adjustment for age, sex, BMI and smoking indicated that abnormal cognition was associated with lower serum albumin and higher uric acid levels in all subjects. In subjects with diabetes, in addition to the associations with serum albumin and uric acid levels, lower renal function, retinopathy, use of insulin and a-glucosidase inhibitor, and non-use of pioglitazone and metformin were significantly associated with abnormal cognition independent of the effect of duration of diabetes, hypertension, dyslipidemia, and history of coronary heart disease and stroke. Conclusions Because of the higher prevalence of abnormal cognition in aged outpatients with diabetes found in primary care practice and significant associations with serum albumin, uric acid, renal function, retinopathy and antidiabetic drugs, there is a need for early diagnosis and strategies against dementia.

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