Hostname: page-component-848d4c4894-5nwft Total loading time: 0 Render date: 2024-05-14T02:52:45.664Z Has data issue: false hasContentIssue false
  • English
  • Français

Diabetes and cognitive outcomes in a nationally representative sample: the National Health and Aging Trends Study

Published online by Cambridge University Press:  30 July 2014

Alexandra M. V. Wennberg ,
Rebecca F. Gottesman ,
Christopher N. Kaufmann ,
Marilyn S. Albert ,
Lenis P. Chen-Edinboro ,
George W. Rebok ,
Judith D. Kasper  and
Adam P. Spira
Alexandra M. V. Wennberg*
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Rebecca F. Gottesman
Affiliation:
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
Christopher N. Kaufmann
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Marilyn S. Albert
Affiliation:
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Lenis P. Chen-Edinboro
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
George W. Rebok
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA
Judith D. Kasper
Affiliation:
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Adam P. Spira
Affiliation:
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
*
Correspondence should be addressed to: Alexandra M. V. Wennberg, 624 N. Broadway, Room 798, Baltimore, MD 21205, USA. Phone: +1-612-281-2344. Email: awennbe1@jhu.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The prevalence of both type II diabetes mellitus (DM) and cognitive impairment is high and increasing in older adults. We examined the extent to which DM diagnosis was associated with poorer cognitive performance and dementia diagnosis in a population-based cohort of US older adults.

Methods:

We studied 7,606 participants in the National Health and Aging Trends Study, a nationally representative cohort of Medicare beneficiaries aged 65 years and older. DM and dementia diagnosis were based on self-report from participants or proxy respondents, and participants completed a word-list memory test, the Clock Drawing Test, and gave a subjective assessment of their own memory.

Results:

In unadjusted analyses, self-reported DM diagnosis was associated with poorer immediate and delayed word recall, worse performance on the Clock Drawing Test, and poorer self-rated memory. After adjusting for demographic characteristics, body mass index, depression and anxiety symptoms, and medical conditions, DM was associated with poorer immediate and delayed word recall and poorer self-rated memory, but not with the Clock Drawing Test performance or self-reported dementia diagnosis. After excluding participants with a history of stroke, DM diagnosis was associated with poorer immediate and delayed word recall and the Clock Drawing Test performance, and poorer self-rated memory, but not with self-reported dementia diagnosis.

Conclusions:

In this recent representative sample of older Medicare enrollees, self-reported DM was associated with poorer cognitive test performance. Findings provide further support for DM as a potential risk factor for poor cognitive outcomes. Studies are needed that investigate whether DM treatment prevents cognitive decline.

Keywords

dementiaAlzheimer’s diseasecognitiontype II diabetes
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 10 , October 2014 , pp. 1729 - 1735
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alzheimer's Association. (2013). Alzheimer's disease facts and figures. Alzheimer's & Dementia, 9, 1–69.Google Scholar
American Diabetes Association. (2013a). Diabetes Basics: Diabetes Statistics. Alexandria, VA: American Diabetes Association.Google Scholar
American Diabetes Association. (2013b). Economic costs of diabetes in the US in 2012. Diabetes Care, 36, 1033–1046.CrossRefGoogle Scholar
Boustani, M., Peterson, B., Hanson, L., Harris, R. and Lohr, K. N. (2003). Screening for dementia in primary care: a summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine, 138, 927–937.CrossRefGoogle Scholar
Cholerton, B., Baker, L. and Craft, S. (2013). Insulin, cognition, and dementia. European Journal of Pharmacology (Epub ahead of print). doi:10.1016/j.ejphar.2013.08.008.CrossRefGoogle Scholar
Cukierman, T., Gerstein, H. C. and Williamson, J. D. (2005). Cognitive decline and dementia in diabetes – systematic overview of prospective observational studies. Diabetologia, 48, 2460–2469.CrossRefGoogle ScholarPubMed
Curb, J. D. et al. (1999). Longitudinal association of vascular and Alzheimer's dementias, diabetes, and glucose tolerance. Neurology, 52, 971–975.CrossRefGoogle ScholarPubMed
Day, H. R., Parker, J. D. and Office of Analysis and Epidemiology. (2013). Self-report of diabetes and claims-based identification of diabetes among medicare beneficiaries. National Health Statistics Reports, 69, 1–15.Google Scholar
Elias, P. K. et al. (1997). NIDDM and blood pressure as risk factors for poor cognitive performance. The Framingham study. Diabetes Care, 20, 1388–1395.CrossRefGoogle ScholarPubMed
Francis, G. J. et al. (2008). Intranasal insulin prevents cognitive decline, cerebral atrophy and white matter changes in murine type I diabetic encephalopathy. Brain, 131, 3311–3334.Google ScholarPubMed
Irie, F. et al. (2008). Enhanced risk for Alzheimer's disease in persons with type 2 diabetes and APOE e4: the Cardiovascular Health Study Cognition Study. Journal of the American Medical Association, 65, 89–93.Google ScholarPubMed
Kloppenborg, R. P., van den Berg, E., Kappele, L. J. and Biessels, G. J. (2008). Diabetes and other vascular risk factors for dementia: which factor matters most? A systematic review. European Journal of Pharmacology, 585, 97–108.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2003). The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care, 41, 1284–1292.CrossRefGoogle ScholarPubMed
Launer, L. J. et al. (2011). Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy. Lancet Neurology, 10, 969–977.CrossRefGoogle ScholarPubMed
Lu, F.-P., Lin, K.-P. and Kuo, H.-K. (2009). Diabetes and the risk of multi-system aging phenotypes: a systematic review and meta-analysis. PLOS One, 4, e4144.CrossRefGoogle ScholarPubMed
Magaziner, J. et al. (2000). The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: diagnosis by expert panel. Epidemiology of dementia in nursing homes research group. Gerontologist, 40, 663–672.CrossRefGoogle Scholar
Montaquila, J., Freedman, V. A., Edwards, B. and Kasper, J. D. (2012). National Health and Aging Trends Study Round 1 Sample Design and Selection. NHATS technical paper #1. Baltimore, MD: Johns Hopkins University School of Public Health.Google Scholar
Morris, J. C. et al. (1989). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 1159–1165.Google Scholar
Naor, M., Steingruber, H. J., Westhoff, K., Schottenfeld-Naor, Y. and Gries, A. F. (1997). Cognitive function in elderly non-insulin-dependent diabetic patients before and after inpatient treatment for metabolic control. Journal of Diabetes and its Complications, 11, 40–46.CrossRefGoogle ScholarPubMed
Peila, R., Rodriguez, B. L. and Launer, L. J. (2002). Type 2 diabetes, APOE gene, and the risk for dementia and related pathologies: the Honolulu-Asia Aging Study. Diabetes, 51, 1256–1262.CrossRefGoogle ScholarPubMed
Plassman, B. L. et al. (2007). Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology, 29, 125–132.CrossRefGoogle ScholarPubMed
Reijmer, Y. D., van den Berg, E., Ruis, C., Kappelle, L. J. and Biessels, G. J. (2010). Cognitive dysfunction in patients with type 2 diabetes. Diabetes/Metabolism Research and Review, 26, 507–519.CrossRefGoogle ScholarPubMed
Roberts, R. O. et al. (2008). Association of duration and severity of diabetes mellitus with mild cognitive impairment. Archives of Neurology, 65, 1066–1073.CrossRefGoogle ScholarPubMed
Ryan, C. M., Freed, M. I., Rood, J. A., Cobitz, A. R., Waterhouse, B. R. and Strachan, M. W. (2006). Improving metabolic control leads to better working memory in adults with type 2 diabetes. Diabetes Care, 29, 345–351.CrossRefGoogle ScholarPubMed
Schrijvers, E. M., Witteman, J. C., Sijbrands, E. J., Hofman, A., Koudstaal, P. J. and Breteler, M. M. (2010). Insulin metabolism and the risk of Alzheimer disease: the Rotterdam Study. Neurology, 75, 1982–1987.CrossRefGoogle ScholarPubMed
Shulman, K. I., Gold, D. P., Cohen, C. A. and Zucchero, C. A. (1993). Clock drawing and dementia in the community: a longitudinal study. International Journal of Geriatric Psychiatry, 8, 487–496.CrossRefGoogle Scholar
Whiting, D. R., Guariguata, L., Weil, C. and Shaw, J. (2011). IDF diabetes atlas: global estimates of teh prevalence of diabetes for 2011 and 2030. Diabetes Research and Clincal Practice, 94, 311–321.CrossRefGoogle Scholar
Wild, B. et al. (2013). Assessing generalized anxiety disorder in elderly people using the GAD-7 and GAD-2 scales: results of a validation study. American Journal of Geriatric Psychiatry (Epub ahead of print). doi:10.1016/j.jagp.2013.01.076.CrossRefGoogle Scholar
Wolf-Klein, G. P., Silverstone, F. A., Levy, A. P. and Brod, M. S. (1989). Screening for Alzheimer's disease by clock drawing. Journal of the American Geriatrics Society, 37, 730–734.CrossRefGoogle ScholarPubMed
Xu, W., Qiu, C., Gatz, M., Pedersen, N. L., Johansson, B. and Fratiglioni, L. (2009). Mid- and late-life diabestes in relation to the risk of dementia: a population-based twin study. Diabetes, 58, 71–77.CrossRefGoogle Scholar