Diabetes, Glucose Control, and 9-Year Cognitive Decline Among Older Adults Without Dementia

Yaffe, Kristine; Falvey, Cherie; Hamilton, Nathan; Schwartz, Ann V.; Simonsick, Eleanor M.; Satterfield, Suzanne; Cauley, Jane A.; Rosano, Caterina; Launer, Lenore J.; Strotmeyer, Elsa S.; Harris, Tamara B.

doi:10.1001/archneurol.2012.1117

Cited by 270 publications

(220 citation statements)

References 32 publications

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“…They also develop cognitive decline more rapidly and at an earlier age (2). Identifying markers for very early cognitive decline in people with DM before the onset of evident impairment is therefore of interest and importance.…”

Section: Introductionmentioning

confidence: 99%

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Albuminuria and Cognitive Decline in People with Diabetes and Normal Renal Function

Barzilay¹,

Lovato²,

Murray³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Diabetes mellitus is associated with increased risk of cognitive impairment. This study examines whether microvascular disease, as measured by albuminuria and decline in estimated GFR (eGFR), is associated with cognitive decline during 3.3 years of follow-up in individuals with diabetes with a normal baseline eGFR (approximately 90 ml/min per 1.73 m 2 ). Mixed-effects models were used to assess the association of albuminuria and eGFR on the percentage decline in each test.Results Participants with albuminuria at baseline and follow-up (persistent albuminuria) (25.8% [95% confidence interval (CI), 27.3 to 24.2]) and participants with albuminuria at follow-up but none at baseline (progressive albuminuria) (24.1% [95% CI, 25.6 to 22.7]) had greater percentage declines on information processing speed than participants without albuminuria at baseline and at follow-up (no albuminuria) (22.6% [95% CI, 23.4 to 21.9]) (P=0.001 and P=0.10, respectively). There were borderline percentage changes in the test of verbal memory (4.8% [95% CI, 2.4 to 7.1] and 4.7% [95% CI, 2.5 to 7.0] versus 7.1% [95% CI, 6.0 to 8.3]; P=0.11 and P=0.08, respectively). On logistic regression analysis, persistent albuminuria (odds ratio, 1.37 [95% CI, 1.09 to 1.72]) and progressive albuminuria (odds ratio, 1.25 [95% CI, 1.02 to 1.56]) were associated with a $5% decline in information processing speed scores but not with verbal memory or executive function performance. A 1 ml/min per 1.73 m 2 per year eGFR decline had a borderline association with decline in tests of cognitive function.Conclusions Persistent albuminuria and progressive albuminuria are associated with a decline in cognitive function in relatively young individuals with diabetes with unimpaired eGFR. These findings do not rule out the possibility of other processes causing cognitive decline.

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Section: Introductionmentioning

confidence: 99%

“…In this study, we examine the association between albuminuria status with performance on three tests of cognitive function in a cohort of adults with DM whose baseline eGFR level was approximately 90 ml/min per 1.73 m 2 . We further test whether decline in eGFR during follow-up was an independent risk factor for cognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

Albuminuria and Cognitive Decline in People with Diabetes and Normal Renal Function

Barzilay¹,

Lovato²,

Murray³

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Another study showed no differences in cognitive measures in diabetic and nondiabetic controls, however, diabetic statin users had worse performance on tests of executive function, suggesting potentially worse vascular disease that could impact executive function [34]. Previous reports on neuropsychological testing in DM versus non-DM have varied from comparisons of a single test [35,36] to a comprehensive battery [37][38][39]. Generally, population-based studies tend to use briefer tests, while hospital-based research utilizes a more detailed battery.…”

Section: Discussionmentioning

confidence: 99%

P2‐260: Diabetes is associated with worse executive function in both eastern and western populations: Shanghai aging study and mayo clinic study of aging

Zhao

2015

Alzheimer's & Dementia

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“…1 The DCCT/EDIC study found that glycaemic control was associated with declining cognitive function and the ACCORD-MIND trial noted that, for each 1% rise in Hba1c, there was a 0.14 point drop in MMSE score. 2,3 In addition, studies have noted the effects of hypoglycaemia on increasing risk of cognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

Management of diabetes and dementia

Puttanna

Padinjakara

2017

Br J Diabetes

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Continued advances in medicine have contributed to an ageing population in most countries, with a resultant increased prevalence of dementia as well as type 2 diabetes. Consequently, the combined co-morbidity of diabetes and dementia is on the increase. While there is a wealth of therapeutic options for diabetes in general, we need to adapt these medications and strategies to suit those with dementia. The intricacies of managing diabetes in patients with cognitive dysfunction are multiple and require a sound understanding of the patient, living environment and available therapeutic options. With the exception of metformin, dipeptidyl peptidase-4 inhibitors and to some extent insulin secretagogues, non-insulin therapy has a limited role. Insulin therapy, if initiated with a specified goal in mind and concentration on avoidance of hypoglycaemic episodes with relatively lax glycaemic targets, is the most straightforward way of managing glycaemia. Therapy should be individualised with involvement of the patient's care team and clear instructions to define roles, goals of therapy and need for regular review. In this article we discuss the effect of dementia on diabetes management and vice versa, glycaemic goals based on available evidence and recommendations including drug and regimen selection to safely achieve this. Br J Diabetes 2017;17:93-99

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Diabetes, Glucose Control, and 9-Year Cognitive Decline Among Older Adults Without Dementia

Abstract: To determine if prevalent and incident diabetes mellitus (DM) increase risk of cognitive decline and if, among elderly adults with DM, poor glucose control is related to worse cognitive performance.

Cited by 270 publications

References 32 publications

Albuminuria and Cognitive Decline in People with Diabetes and Normal Renal Function

Albuminuria and Cognitive Decline in People with Diabetes and Normal Renal Function

P2‐260: Diabetes is associated with worse executive function in both eastern and western populations: Shanghai aging study and mayo clinic study of aging

Management of diabetes and dementia

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