The role of diabetes, glycemia, and glucose peaks in cognitive impairment and dementia among community-dwelling adults

cognition;diabetes;prospective cohort;neuropsychological testing;Epidemiology

Rawlings, Andreea MonicaBandeen-Roche, Karen ;

Johns Hopkins University

关键词: cognition;    diabetes;    prospective cohort;    neuropsychological testing;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60659/RAWLINGS-DISSERTATION-2016.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

This dissertation explores the association between diabetes, measures of glycemia (average glycemia and glycemic peaks), and cognitive decline and dementia. We also examine the association between diabetes, glycemia, and cognitive impairment in older adults. Additionally, we address two methodological issues: handling missing cognitive data in longitudinal analyses of change in cognitive function, and characterizing the factor structure of the neurocognitive battery used in some of these analyses. We have used data from the Atherosclerosis Risk in Communities (ARIC).We document that diabetes, higher average glycemic levels (measured by hemoglobin A1c), and more glycemic peaks (measured by 1,5-anhydroglucitol) are associated with accelerated cognitive decline over 20 years. Among persons with diabetes, those with HbA1c ≥7% (poorly controlled diabetes) had greater decline over 20 years than persons with diabetes and HbA1c <7%. Among persons with diabetes, glycemic peaks were associated with incident dementia, independent of HbA1c and other risk factors.To address attrition, we used multiple imputation by chained equations (MICE) to impute cognitive performance scores. MICE produced unbiased imputations of cognitive function, and simulations showed a substantial reduction in the bias of the 20-year association between diabetes and cognitive decline comparing MICE to analyses without imputed values. Finally, estimated associations between diabetes and 20-year cognitive decline were stronger with MICE than in the analyses without imputed values.We found that the cognitive battery of 11 tests given at the 2011-2013 ARIC exam represented 3 underlying constructs of memory, language, and sustained attention and processing speed. These constructs were not different by age, race, sex, education, diabetes, and hypertension, providing compelling evidence for the robustness of the cognitive domains measured by the test battery across demographic and vascular factors.Lastly, we characterized the level of cognitive impairment by diabetes status and glycemia among older adults. Persons with diabetes, longer duration of diabetes, and with glucose peaks had higher estimated prevalence of cognitive impairment.In conclusion, we have documented the association of diabetes, mean glycemia (HbA1c), and glucose peaks (1,5-AG) with cognitive decline and dementia. This research adds to the literature that diabetes, HbA1c, and glucose peaks are risk factors for cognitive decline and dementia. This has important implications for the prevention of diabetes as a means to prevent or delay cognitive decline. Additionally, the careful management of glycemia among middle-aged adults with diabetes may be an important avenue for prevention of cognitive decline and dementia.