Diabetes, Prediabetes Hasten Mental Decline in Older Adults

The following article is part of conference coverage from the 2018 Alzheimer’s Association International Conference in Chicago, Illinois. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAIC 2018.

CHICAGO — Both diabetes and prediabetes are associated with accelerated mental decline in older adults without dementia, and serve as predictors of microvascular lesions. This research was presented at the 2018 Alzheimer’s Association International Conference, held July 22-26, 2018 in Chicago, Illinois.

Individuals in this study were drawn from the Swedish National Study on Aging and Care-Kungsholmen. The study had a 9-year follow-up period, with each wave including a Mini-Mental State Examination assessment. Self-reporting, medical records, use of medication, or a glycated hemoglobin level of at least 6.5% was used to identify diabetes. The threshold for prediabetes was a glycated hemoglobin level of at least 5.7%. Multivariable linear regression was used to analyze cross-sectional associations, and mixed-effect models were used for longitudinal relationships.

The study included 2746 adults without dementia at baseline, 947 (34.5%) of whom had prediabetes and 242 (8.8%) of whom had diabetes. Those with prediabetes and diabetes showed more rapid cognitive decline over 9 years as measured by the Mini-Mental State Examination. Magnetic resonance imaging was administered to 455 participants at baseline and at follow-up meetings, with markers including total brain tissue, gray matter, hippocampal, white matter, and white-matter hyperintensities volumes. Magnetic resonance imaging scans revealed smaller total brain tissue volume (β = -18.1; 95% CI, -32.6 to -3.7) and a significant decrease in white matter volume in participants with prediabetes. An association was also found between diabetes and larger white-matter hyperintensities volume (β = 3.38; 95% CI, -0.04 to 6.80). A longitudinal association was found between diabetes and more rapid accumulation of white-matter hyperintensities volume (βslope = 0.57; 95% CI, 0.07-1.05). Notably, prediabetes and diabetes were not found to be associated with hippocampal volume.

“Our findings suggest that microvascular processes might underlie the initial cognitive decline in prediabetes and diabetes,” the study investigators concluded.

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Reference

Marseglia A, Fratiglioni L, Kalpouzos G, Wang R, Bäckman L, Xu W. Prediabetes and diabetes accelerate cognitive decline and predict microvascular lesions. Presented at: 2018 Alzheimer’s Association International Conference. July 22-26, 2018; Chicago, IL. Abstract 22108.