Predictors of Cognitive Decline in Older Individuals With Diabetes

  1. David G. Bruce, MD1,
  2. Wendy A. Davis, PHD1,
  3. Genevieve P. Casey1,
  4. Sergio E. Starkstein, PHD2,
  5. Roger M. Clarnette, MB3,
  6. Osvaldo P. Almeida, PHD2 and
  7. Timothy M.E. Davis, DPHIL1
  1. 1School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
  2. 2School of Psychiatry and Neurosciences, University of Western Australia, Perth, Western Australia, Australia
  3. 3Department of Community and Geriatric Medicine, Fremantle Hospital, Fremantle, Western Australia, Australia
  1. Corresponding author: Professor David Bruce, dbruce{at}cyllene.uwa.edu.au

Abstract

OBJECTIVE—The purpose of this study was to determine longitudinal predictors of cognitive decline in older individuals with diabetes who did not have dementia.

RESEARCH DESIGN AND METHODS—Cognitive assessments were performed in 205 subjects with diabetes (mean age 75.3 years) and repeated a median 1.6 years later. The sample was drawn from an existing cohort study, and data on diabetes, cardiovascular risk factors, and complications were collected 7.6 ± 1.1 years before and at the time of the initial cognitive assessment. Cognitive status was defined using the Clinical Dementia Rating (CDR) scale, and cognitive decline was defined by change in CDR.

RESULTS—The sample included 164 subjects with normal cognition (CDR 0) and 41 with cognitive impairment without dementia (CDR 0.5). At follow-up, 33 (16.1%) had experienced cognitive decline (4 new cases of dementia and 29 cognitive impairment without dementia). Only educational attainment predicted cognitive decline from the data collected 7.6 years before cognitive assessment. Univariate predictors of cognitive decline at the time of the first cognitive assessment included age, education, urinary albumin-to-creatinine ratio (ACR), and treatment with either ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). With multiple logistic regression controlling for age and education, cognitive decline was predicted by natural logarithm ACR (odds ratio 1.37 [95% CI 1.05–1.78], P = 0.021), whereas treatment with either ACEIs or ARBs was protective (0.28 [0.12–0.65], P = 0.003).

CONCLUSIONS—In this sample of older patients with diabetes, microalbuminuria was a risk factor for cognitive decline, whereas drugs that inhibit the renin-angiotensin system were protective. These observations require confirmation because of their considerable potential clinical implications.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 23 July 2008.

    Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted July 17, 2008.
    • Received March 19, 2008.
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  1. Published online before print July 23, 2008, doi: 10.2337/dc08-0562 Diabetes Care November 2008 vol. 31 no. 11 2103-2107
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