Predictors of cognitive decline in older adult type 2 diabetes from the Veterans Affairs Diabetes Trial

Frontiers in Endocrinology

Jeffrey Knight¹  VADT Investigators²  Ling Ge²  Gideon Bahn²  Mark Zimering³ 

[1] Boston University School of Medicine;Hines Veterans Affairs Hospital;Rutgers-Robert Wood Johnson Medical School;VA Boston Healthcare System;Veterans Affairs New Jersey Healthcare System;

关键词: Blood Pressure;    Risk factors;    cognitive decline;    type 2 diabetes mellitus;    Diabetes duration;   

DOI  :  10.3389/fendo.2016.00123

来源: DOAJ

【 摘 要 】

Aims: Cognitive decline disproportionately affects older adult type 2 diabetes. We tested whether randomized intensive glucose-lowering reduces the rate(s) of cognitive decline in adults with advanced type 2 diabetes (mean: age, 60 years; diabetes duration, 11 years) from the Veterans Affairs Diabetes Trial. Methods: A battery of neuropsychological tests (digit span, digit symbol substitution (DSym), and Trails-making Part B (TMT-B)) was administered at baseline in ~1700 participants and repeated at year 5. Thirty-six risk factors were evaluated as predictors of cognitive decline in multivariable regression analyses.Results: The mean age-adjusted, DSym or TMT-B declined significantly in all study participants (P < 0.001).Randomized intensive glucose-lowering did not significantly alter the rate of cognitive decline.The final model of risk factors associated with 5-year decline in age-adjusted TMT-B included as significant predictors: longer baseline diabetes duration (beta = -0.028; P = 0.0057), lower baseline diastolic blood pressure (beta = 0.028; P < 0.001), and baseline calcium channel blocker medication use (beta = -0.639; P < 0.001). Higher baseline pulse pressure was significantly associated with decline in age-adjusted TMT-B suggesting a role for both higher systolic and lower diastolic blood pressure.Baseline thiazide diuretic use (beta= -0.549; P =0.015) was an additional significant predictor of 5-year decline in age-adjusted digit symbol score.Post-baseline systolic blood pressure-lowering was significantly associated (P < 0.001) with decline in TMT-B performance. There was a significant inverse association between post-baseline plasma triglyceride- lowering (P = 0.045) and decline in digit symbol substitution task performance.Conclusions:A five-year period of randomized intensive glucose-lowering did not significantly reduce the rate of cognitive decline in older-aged adults with type 2 diabetes.Systolic and diastolic blood pressure as well as plasma triglycerides were modifiable risk factors of the rate of cognitive decline in older adult type 2 diabetes.

【 授权许可】

Unknown