Glucose level decline precedes dementia in elderly African Americans with diabetes (original) (raw)
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Changes of glucose levels precede dementia in African-Americans with diabetes but not in Caucasians
Alzheimer's & dementia : the journal of the Alzheimer's Association, 2018
Changes in glucose levels may represent a powerful metabolic indicator of dementia in African-Americans with diabetes. It is unclear whether these changes also occur in Caucasians. A secondary data analysis using electronic medical records from 5228 African-Americans and Caucasians aged ≥65 years was carried out. Mixed effects models with repeated serum glucose measurements were used to compare changes in glucose levels between African-Americans and Caucasian patients with and without incident dementia. African-Americans and Caucasians with diabetes had significantly different changes in glucose levels by dementia status (P < .0001). African-Americans experienced a significant decline in glucose levels before the dementia diagnosis (estimated glucose decline 1.3421 mg/dL per year, P < .0001) than those who did not develop dementia. Caucasians with and without dementia showed stable glucose levels over time (P = .3071). Significant changes in glucose levels precede dementia in ...
JAMA internal medicine, 2013
Hypoglycemia commonly occurs in patients with diabetes mellitus (DM) and may negatively influence cognitive performance. Cognitive impairment in turn can compromise DM management and lead to hypoglycemia. To prospectively evaluate the association between hypoglycemia and dementia in a biracial cohort of older adults with DM. Prospective population-based study. We studied 783 older adults with DM (mean age, 74.0 years; 47.0% of black race/ethnicity; and 47.6% female) who were participating in the prospective population-based Health, Aging, and Body Composition Study beginning in 1997 and who had baseline Modified Mini-Mental State Examination scores of 80 or higher. Dementia diagnosis was determined during the follow-up period from hospital records indicating an admission associated with dementia or the use of prescribed dementia medications. Hypoglycemic events were determined during the follow-up period by hospital records. During the 12-year follow-up period, 61 participants (7.8%...
Diabetes and cognitive decline in elderly African Americans: A 15‐year follow‐up study
Alzheimer's & Dementia, 2011
Background-Diabetes mellitus is associated with increased risk of cognitive impairment and vascular factors appear to play a role in this relationship. In a sample of elderly African Americans, with a follow up duration of 15 years, we tested the hypothesis that diabetes accelerates cognitive decline and explored possible mediating mechanisms. Methods-A total of 1702 subjects, of which 441 had diabetes, were given the Community Screening Interview for Dementia (CSI-D) to measure cognitive functioning at 6 time points, over 15 years. Mixed effects models with repeated measures were used to examine the association of diabetes, and vascular risk factors with cognitive scores over time. Results-African Americans with diabetes were shown to have significantly accelerated cognitive decline compared with those without diabetes (p=0.046) when controlling for basic demographics and baseline co morbid conditions (heart disease, hypertension, stroke and depression). Adjusting for incident heart disease, and especially stroke weakened this association (p=0.098) indicating a mediating effect of stroke on the association of diabetes and cognitive decline. However when incident stroke is incorporated into the model, the effect for participants with diabetes is greatly increased (p=0.007) Conclusions-Diabetes, mediated by cerebrovascular pathology, accelerates cognitive decline in an African American sample with a follow up duration of 15 years.
Glucose Peaks and the Risk of Dementia and 20-Year Cognitive Decline
Diabetes Care
Hemoglobin A 1c (HbA 1c), a measure of average blood glucose level, is associated with the risk of dementia and cognitive impairment. However, the role of glycemic variability or glucose excursions in this association is unclear. We examined the association of glucose peaks in midlife, as determined by the measurement of 1,5-anhydroglucitol (1,5-AG) level, with the risk of dementia and 20-year cognitive decline. RESEARCH DESIGN AND METHODS Nearly 13,000 participants from the Atherosclerosis Risk in Communities (ARIC) study were examined. Dementia was ascertained from surveillance, neuropsychological testing, telephone calls with participants or their proxies, or death certificate dementia codes. Cognitive function was assessed using three neuropsychological tests at three visits over 20 years and was summarized as z scores. We used Cox and linear mixed-effects models. 1,5-AG level was dichotomized at 10 mg/mL and examined within clinical categories of HbA 1c. RESULTS Over a median time of 21 years, dementia developed in 1,105 participants. Among persons with diabetes, each 5 mg/mL decrease in 1,5-AG increased the estimated risk of dementia by 16% (hazard ratio 1.16, P = 0.032). For cognitive decline among participants with diabetes and HbA 1c <7% (53 mmol/mol), those with glucose peaks had a 0.19 greater z score decline over 20 years (P = 0.162) compared with those without peaks. Among participants with diabetes and HbA 1c ‡7% (53 mmol/mol), those with glucose peaks had a 0.38 greater z score decline compared with persons without glucose peaks (P < 0.001). We found no significant associations in persons without diabetes. CONCLUSIONS Among participants with diabetes, glucose peaks are a risk factor for cognitive decline and dementia. Targeting glucose peaks, in addition to average glycemia, may be an important avenue for prevention. Diabetes is an established risk factor for cognitive impairment, with evidence showing that it affects performance in several cognitive domains and puts persons at increased risk of dementia (1,2). However, the pathophysiologic mechanisms underlying these associations are unclear. Hemoglobin A 1c (HbA 1c) is a standard clinical measure used for the diagnosis and management of diabetes (3) and reflects the mean blood glucose level over the
Diabetes Mellitus and the Possibility of Developing Dementia
Asian Journal of Pharmaceutical Research and Development, 2021
Background: Dementia and cognitive dysfunction have many causes. There is strong evidence that diabetes mellitus (DM) increases the risk of cognitive impairment and dementia. A prophylactic approach, optimal glycaemic control, and identification of diabetic risk factors are essential to preventing cognitive complications. Objective: The main objectives of this study are to assess the severity of dementia by using the Clinical Dementia Rating scale (CDR), and the effect of longevity of diabetes mellitus on the severity of dementia. Method: It is a Hospital-based prospective observational study, in which the patients were enrolled into the study after taking an informed consent form from them based on the inclusion and exclusion criteria. Results: Out of 80 patients, 62(77.5%) were suffering with dementia and 18(22.5%) were found to be normal. The diabetes patients included in this study had a duration of diabetes ranges from 6 to 30 years. Using the CDR scale, 24 of them (30%) were d...
Predictors of cognitive impairment and dementia in older people with diabetes
Diabetologia, 2008
Aims/hypothesis Diabetes is associated with an increased risk of dementia but the reasons for this association are unclear because there are many potential mechanisms. We explored the relative contribution of diabetes-related variables as predictors of dementia in older individuals with diabetes. Methods Survivors, aged ≥70 or more, were recruited from an existing observational cohort study 7.6±1.0 years after baseline, when they underwent a comprehensive assessment of diabetes, complications and cardiovascular risk factors. Dementia, probable Alzheimer's disease and cognitive impairment without dementia were diagnosed clinically. Logistic regression modelling determined independent predictors of cognitive diagnoses. Results Of 302 participants, aged 75.7±4.6 years, 28 (9.3%) had dementia (16 with probable Alzheimer's disease) and 60 (19.9%) had cognitive impairment without dementia. The major independent longitudinal predictors of dementia were older age (per decade; odds ratio 4.0, 95% CI 1.59-10.10), diabetes duration (for each 5 years; odds ratio 1.69, 95% CI 1.24-2.32), peripheral arterial disease (odds ratio 5.35, 95% CI 2.08-13.72) and exercise (which was protective; odds ratio 0.26, 95% CI 0.09-0.73). For Alzheimer's disease, diabetes duration was an independent predictor in addition to age and diastolic blood pressure. The results of the cross-sectional analyses were similar with respect to diabetes duration and peripheral arterial disease. Conclusions/interpretation Peripheral arterial disease is a strong independent risk factor for dementia in diabetes. After adjustment for a wide range of potential risk factors, diabetes duration remains independently associated with dementia and probable Alzheimer's disease, indicating that factors not measured in this study may be important in the pathogenesis of dementia in diabetes.
Cognitive decline following incident and preexisting diabetes mellitus in a population sample
Neurology, 2016
To examine if incident and preexisting diabetes mellitus (DM) were associated with cognitive decline among African Americans (AAs) and European Americans (EAs). Based on a prospective study of 7,740 older adults (mean age 72.3 years, 64% AA, 63% female), DM was ascertained by hypoglycemic medication use and Medicare claims during physician or hospital visits, and cognition by performance on a brief battery for executive functioning, episodic memory, and Mini-Mental State Examination (MMSE). Decline in composite and individual tests among those with incident DM, with preexisting DM, and without DM was studied using a linear mixed effects model with and without change point. At baseline, 737 (15%) AAs and 269 (10%) EAs had preexisting DM. Another 721 (17%) AAs and 289 (12%) EAs had incident DM in old age. Following incident DM, cognitive decline increased by 36% among AAs and by 40% among EAs compared to those without DM. No significant difference was observed between AAs and EAs (p =...
Diabetes Care and Dementia Among Older Adults: A Nationwide 3-Year Longitudinal Study
Journal of the American Medical Directors Association, 2018
Objectives: To compare diabetes monitoring and the incidence of acute diabetic complications between patients with and without incident Alzheimer's Disease and Related Syndromes (ADRS). Design: Longitudinal observational study from 2010 to 2014. Setting: Data from the French national health system database. Participants: The France-Démence cohort: individuals aged 65 years or older suffering from incident ADRS, based on long-term disease registry, hospitalization for dementia, or antidementia drug delivery. They were matched (1:1) to a pair free of ADRS on age, sex, residence area, and insurance scheme. This study included France-Démence population with known diabetes for at least 2 years. Measurements: Data related to diabetes control and complications: biological monitoring such as glycated hemoglobin A 1c (HbA 1c , !1/y, !2/y), lipid profile, microalbuminuria; eye examination; hospitalization for diabetes-related complications such as coma with ketoacidosis; and hospitalization for hypoglycemia were studied between the year prior to ADRS identification (Y-1) and the 2 following years (Y 0 ; Y 1). Incidences between the 2 groups (ADRS/non-ADRS) were compared using age-standardized incidence ratios (SIR). Results: The studied population included 87,816 individuals. HbA1c determination was less frequent in ADRS group, no matter the study period and the minimal annual threshold used. Respectively, 82.6% and 88.5% of ADRS and non-ADRS group had at least 1 HbA 1c testing during Y-1 [SIR ¼ 0.94, 95% confidence interval (CI) 0.93e0.95], 73.4% and 89.0% during Y 0 (SIR ¼ 0.83, 95% CI 0.82e0.84), and 75.4% and 89.3% during Y 1 (SIR ¼ 0.85, 95% CI 0.83-0.86). Subjects with ADRS were also consistently more hospitalized than non-ADRS peers. The gap was maximal in the year following the diagnosis, as observed for hospitalizations for any cause related to diabetes (