Abstract 01: Diabetes is a Risk Factor for 20-year Cognitive Decline
Introduction: Most studies examining the association between diabetes and cognitive decline have been among older individuals and/or have had limited follow-up. We undertook this study to examine the association of diabetes in mid-life with long-term change in cognitive function in a community-based population of blacks and whites.
Hypothesis: We hypothesized that diabetes and chronic hyperglycemia - as measured by HbA1c at baseline - would be associated with 20-year cognitive decline.
Methods: We used generalized estimating equations to examine the association of diabetes at baseline (1990-1992, aged 48-67 years) with 20-year change in cognitive performance among 13015 (24% black; 55% female; 1205 with diabetes) ARIC participants. Delayed Word Recall, Digit Symbol Substitution, and Word Fluency were used to assess cognitive performance, and were summarized using a global Z score. Self-reported diagnosis or diabetes medication use at baseline was used to assess diabetes and HbA1c was categorized using clinical cutpoints. Models were adjusted for demographic and clinical variables.
Results: Diagnosed diabetes was associated with significantly more cognitive decline compared to persons without diabetes (Z = -0.17, 95% CI: -0.26, -0.07) (Figure). This represents 19% faster decline compared to persons without diabetes. We also observed a significant trend in decline among clinical categories of HbA1c, even below the threshold for diagnosis of diabetes. Results were similar in race-stratified analyses. In addition, among white participants poorly controlled diabetes (HbA1c>7) had significantly more decline compared to persons whose diabetes was controlled (Z = -0.24 (95% CI: -0.46, -0.02)).
Conclusions: Diabetes in middle-age was associated with substantially more rapid cognitive decline across 20 years of follow-up. Our results also suggest that pre-diabetes and poor control of diabetes lead to greater cognitive decline.
Author Disclosures: A.M. Rawlings: None. A. Sharrett: None. J. Coresh: None. M. Albert: None. D.J. Couper: None. M. Griswold: None. R.F. Gottesman: None. L. Wagenknecht: None. B. Windham: None. E. Selvin: None.
- © 2014 by American Heart Association, Inc.