The Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes Study (ACCORD-MIND): Rationale, Design, and Methods

Williamson, Jeff D.; Miller, Michael E.; Bryan, R. Nick; Lazar, Ronald M.; Coker, Laura H.; Johnson, Janice; Cukierman, Tali; Horowitz, Karen R.; Murray, Anne M.; Launer, Lenore J.

doi:10.1016/j.amjcard.2007.03.029

Cited by 110 publications

(97 citation statements)

References 29 publications

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“…To account for a 15% loss to follow-up, .350 participants were recruited for each cell. Power calculations for arriving at these estimates were previously published (17,18).…”

Section: Methodsmentioning

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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“…To account for a 15% loss to follow-up, .350 participants were recruited for each cell. Power calculations for arriving at these estimates were previously published (17,18).…”

Section: Methodsmentioning

confidence: 99%

“…ACCORD MIND was an ancillary study to ACCORD (17). It consisted of 2977 ACCORD participants, recruited from August 2003 through December 2005 and followed through June 2009.…”

Section: Methodsmentioning

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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“…In terms of therapeutics, it raises the question of whether improved glycemic control would improve the outcome for VaD. The results of the ongoing multi-centric trial, Action to Control Cardiovascular Risk in Diabetes Memory (ACCORD-MIND) [18], will be particularly important in this regard. It will assess the impact of strict glycemic, blood pressure and lipid control on the outcomes for validated cognitive measures.…”

Section: Diagnostic and Therapeutic Implicationsmentioning

confidence: 99%

“…For example, DM has been shown to lead to neuronal injury through a variety of metabolic pathways that may affect endothelial function, protein synthesis, DNA, and mitochondrial function, and may enhance free radical damage and inflammation [18]. Another study, which was autopsy based, demonstrated that elderly patients with dementia and DM had more microvascular infarcts and increased cortical IL-6 concentration [19].…”

Section: Dm and Cognitive Decline In Vadmentioning

confidence: 99%

Does Diabetes Mellitus Alter the Onset and Clinical Course of Vascular Dementia?

Murthy

Jawaid

Qureshi

et al. 2010

Behavioural Neurology

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Abstract. Background: Vascular dementia (VaD) is the second most common dementing illness. Multiple risk factors are associated with VaD, but the individual contribution of each to disease onset and progression is unclear. We examined the relationship between diabetes mellitus type 2 (DM) and the clinical variables of VaD. Methods: Data from 593 patients evaluated between June, 2003 and June, 2008 for cognitive impairment were prospectively entered into a database. We retrospectively reviewed the charts of 63 patients who fit the NINDS-AIREN criteria for VaD. The patients were divided into those with DM (VaD-DM, n = 29) and those without DM (VaD, n = 34). The groups were compared with regard to multiple variables. Results: Patients with DM had a significantly earlier onset of VaD (71.9 ± 6.54 vs. 77.2 ± 6.03, p < 0.001), a faster rate of decline per year on the mini mental state examination (MMSE; 3.60 ± 1.82 vs. 2.54 ± 1.60 points, p = 0.02), and a greater prevalence of neuropsychiatric symptoms at the time of diagnosis (62% vs. 21%, p = 0.02). Conclusions: A history of pre-morbid DM was associated with an earlier onset and faster cognitive deterioration in VaD. Moreover, DM was associated with neuropsychiatric symptoms in patients with VaD. A larger study is needed to verify these associations. It will be important to investigate whether better glycemic control will mitigate the potential effects of DM on VaD.

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“…To test this hypothesis, an integrated vertical approach is needed that is based on multiple measures of brain structure/function. The Honolulu Asia Aging Study (HAAS), 9 the Age Gene/Environment Susceptibility-Reykjavik Study (AGES-Reykjavik Study), 28 and the Memory in Diabetes (MIND) 29 substudy embedded in the ACCORD trial 30 provide the opportunity to take this approach.…”

Section: Integrated Community-based Studies Of Diabetes and The Brainmentioning

confidence: 99%

Diabetes: Vascular or Neurodegenerative

Launer

2009

Stroke

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T ype 2 diabetes and cognitive impairment are 2 of the most common chronic conditions found in persons 60 years and older. After that age, approximately 18% to 20% of older persons have diabetes, 1 approximately 19% suffer from mild cognitive impairment in multiple domains, 2 and approximately 6% of community-dwelling individuals have some dementia. 3 The prevalence of mild cognitive impairment and dementia increases with age as does the prevalence of diabetes; there is also an alarming trend toward a younger age of diabetes onset. 4 Several lines of investigation suggest a link among diabetes, cognitive impairment, and dementia, described briefly subsequently. Thus, the age-related trends in diabetes and cognitive disorders indicate a further increase in the number of persons with mild cognitive impairment and dementia, beyond the increase that is expected as the population ages.

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The Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes Study (ACCORD-MIND): Rationale, Design, and Methods

Cited by 110 publications

References 29 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

Does Diabetes Mellitus Alter the Onset and Clinical Course of Vascular Dementia?

Diabetes: Vascular or Neurodegenerative

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