Cognitive performance in midlife type 2 diabetes: results from the ENBIND study

Abstract

Aims To establish the impact of uncomplicated type 2 diabetes on cognitive and neuropsychological performance in midlife. Methods We performed a cross‐sectional study of middle‐aged adults with uncomplicated type 2 diabetes and a cohort of healthy control participants. General cognition was assessed using the Montreal Cognitive Assessment test and neuropsychological assessment was undertaken using a detailed neuropsychological assessment battery. Results A total of 152 participants (102 with type 2 diabetes and 50 controls) were recruited (mean age 52 ± 8 years, 51% women). Participants with midlife type 2 diabetes were more than twice as likely to make an error on the Montreal Cognitive Assessment test [incidence rate ratio 2.44 (95% CI 1.54 to 3.87); P < 0.001]. Further, type 2 diabetes was also associated with significantly lower memory composite score [β: −0.20 (95% CI −0.39 to −0.01); P = 0.04] and paired associates learning score [β: = −1.97 (95% CI −3.51, −0.43); P = 0.01] on the neuropsychological assessment battery following adjustment for age, sex, BMI, educational attainment and hypercholesterolaemia. Conclusions Even in midlife, type 2 diabetes was associated with small but statistically significant cognitive decrements. These statistically significant decrements, whilst not clinically significant in terms of objective cognitive impairment, may have important implications in selecting out individuals most at risk of later cognitive decline for potential preventative interventions in midlife.

Correlation between Body Mass Index (BMI) and Performance on the Montreal Cognitive Assessment (MoCA) in a Cohort of Adult Women in South Africa

“…This finding is similar with the conclusions of Feinkohl et al ( 42 ), who found that older persons who are obese had a greater prevalence of cognitive impairment regardless of comorbidities such as hypertension or diabetes. In contrast to the current finding, the ENBIND research found that type 2 diabetes in midlife (mean age 52 ± 8 years) women was associated with a minor but substantial cognitive decline ( 43 ). Likewise, we did not observe an association between psychological comorbidity (i.e., depression) and neurocognitive status.…”

Neuropsychological decrements in midlife type-2 diabetes are not associated with peripheral NLRP3 inflammasome responsiveness

“…The current study was embedded within the ENBIND (Exploring Novel Biomarkers of Brain Health in Type 2 Diabetes) study ( 28 , 29 ). Ethical Approval was obtained from the Tallaght-St James’s Joint Research Ethics Committee (Reference: 2018/09/02/2018-10 List 34(4)).…”

Glycated haemoglobin (HbA1c), diabetes and neuropsychological performance in community‐dwelling older adults

“…Both the current study and the majority of the previous research linking hyperglycaemia, diabetes and cognitive function have been undertaken in older individuals. Recent studies have demonstrated cross‐sectional relationships between diabetes and tests of neuropsychological function in midlife 29,30 . Furthermore, studies should focus on HbA 1c in midlife and longitudinal change in specific domains of cognitive function in order to identify individuals who may be most at‐risk of later decline.…”

“…Importantly, the association may vary by age and could be time‐ or exposure‐dependent, potentially only acting as a risk factor during a particular window of susceptibility. For instance, diabetes is known to act as a risk factor for dementia in midlife, but not necessarily in later life 29,30 . Future studies are needed to assess individuals using sensitive neuropsychological tests earlier in life who would be followed up longitudinally to gauge the impact of HbA 1c on a cognitive decline over time.…”