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Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort.

Abstract

BACKGROUND

A few studies have examined change in cognitive performance by diabetes status with disparate results. We examined the 4-year change in cognitive performance among older adults according to glucose tolerance status.

METHODS

Three cognitive tests (Mini-Mental State Examination, Verbal Fluency [VF] test, and Trail-Making Test B) were measured 4 years apart in 999 white men and women aged 42 to 89 years, who were enrolled in the Rancho Bernardo Study. Participants were classified with normal (NGT), impaired (IGT) or diabetic glucose tolerance. Sex-specific linear regression models adjusted for age, education, depression score, apolipoprotein E epsilon4 allele, and current estrogen use. We checked for mediation by further adjusting for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels; blood pressure; glycohemoglobin level; and microalbuminuria, retinopathy, stroke, or coronary heart disease.

RESULTS

At baseline, mean cognitive function scores did not differ between glucose tolerance groups. Women with diabetes mellitus had a 4-fold increased risk of a major cognitive decline on the VF test after 4 years compared with nondiabetic women. After multivariate adjustment, VF test scores at follow-up for women were 15.2 +/- 0.6 for those with diabetes, 16.7 +/- 0.4 for those with IGT, and 17.2 +/- 0.2 for those with NGT (P =.007). Glycohemoglobin attenuated this effect, but lipid levels, blood pressure, and microvascular or macrovascular disease did not. Performance on Mini-Mental State Examination and Trail-Making Test B did not differ by baseline glucose status.

CONCLUSIONS

Elderly white women with diabetes had a more rapid decline in performance on the VF test compared with women with IGT or NGT. Better glucose control might ameliorate this decline.

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  • Authors+Show Affiliations

    ,

    Division of General Internal Medicine, University of California, San Francisco, USA. alkak@itsa.ucsf.edu

    , ,

    Source

    Archives of internal medicine 164:12 2004 Jun 28 pg 1327-33

    MeSH

    Adult
    Age Factors
    Aged
    Aged, 80 and over
    Biomarkers
    Blood Glucose
    Blood Pressure
    California
    Cholesterol, HDL
    Cognition
    Cohort Studies
    Diabetes Mellitus
    Female
    Follow-Up Studies
    Glucose Intolerance
    Humans
    Male
    Middle Aged
    Multivariate Analysis
    Prospective Studies
    Sex Factors
    Statistics as Topic
    Systole
    Vascular Diseases

    Pub Type(s)

    Comparative Study
    Evaluation Studies
    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    15226167

    Citation

    Kanaya, Alka M., et al. "Change in Cognitive Function By Glucose Tolerance Status in Older Adults: a 4-year Prospective Study of the Rancho Bernardo Study Cohort." Archives of Internal Medicine, vol. 164, no. 12, 2004, pp. 1327-33.
    Kanaya AM, Barrett-Connor E, Gildengorin G, et al. Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort. Arch Intern Med. 2004;164(12):1327-33.
    Kanaya, A. M., Barrett-Connor, E., Gildengorin, G., & Yaffe, K. (2004). Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort. Archives of Internal Medicine, 164(12), pp. 1327-33.
    Kanaya AM, et al. Change in Cognitive Function By Glucose Tolerance Status in Older Adults: a 4-year Prospective Study of the Rancho Bernardo Study Cohort. Arch Intern Med. 2004 Jun 28;164(12):1327-33. PubMed PMID: 15226167.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort. AU - Kanaya,Alka M, AU - Barrett-Connor,Elizabeth, AU - Gildengorin,Ginny, AU - Yaffe,Kristine, PY - 2004/7/1/pubmed PY - 2004/8/6/medline PY - 2004/7/1/entrez SP - 1327 EP - 33 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 164 IS - 12 N2 - BACKGROUND: A few studies have examined change in cognitive performance by diabetes status with disparate results. We examined the 4-year change in cognitive performance among older adults according to glucose tolerance status. METHODS: Three cognitive tests (Mini-Mental State Examination, Verbal Fluency [VF] test, and Trail-Making Test B) were measured 4 years apart in 999 white men and women aged 42 to 89 years, who were enrolled in the Rancho Bernardo Study. Participants were classified with normal (NGT), impaired (IGT) or diabetic glucose tolerance. Sex-specific linear regression models adjusted for age, education, depression score, apolipoprotein E epsilon4 allele, and current estrogen use. We checked for mediation by further adjusting for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels; blood pressure; glycohemoglobin level; and microalbuminuria, retinopathy, stroke, or coronary heart disease. RESULTS: At baseline, mean cognitive function scores did not differ between glucose tolerance groups. Women with diabetes mellitus had a 4-fold increased risk of a major cognitive decline on the VF test after 4 years compared with nondiabetic women. After multivariate adjustment, VF test scores at follow-up for women were 15.2 +/- 0.6 for those with diabetes, 16.7 +/- 0.4 for those with IGT, and 17.2 +/- 0.2 for those with NGT (P =.007). Glycohemoglobin attenuated this effect, but lipid levels, blood pressure, and microvascular or macrovascular disease did not. Performance on Mini-Mental State Examination and Trail-Making Test B did not differ by baseline glucose status. CONCLUSIONS: Elderly white women with diabetes had a more rapid decline in performance on the VF test compared with women with IGT or NGT. Better glucose control might ameliorate this decline. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/15226167/Change_in_cognitive_function_by_glucose_tolerance_status_in_older_adults:_a_4_year_prospective_study_of_the_Rancho_Bernardo_study_cohort_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.164.12.1327 DB - PRIME DP - Unbound Medicine ER -