Abstract MP76: Severe Hypoglycemia and Prevalence of Cognitive Impairment in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Hypoglycemia and cognitive impairment are major problems in older adults with diabetes. It is unknown whether persons with prior hypoglycemia have distinct patterns of cognitive impairment compared to persons without hypoglycemia. Hypothesis: Compared to older adults with diabetes and no history of hypoglycemia, persons with prior hypoglycemia will have worse cognitive performance across all domains, but particularly in the executive function domain. Methods: We conducted a cross-sectional analysis of older adults with diagnosed diabetes using data from the ARIC study (2011-2013). Participants completed eight cognitive tests that measured three domains: memory, language, and executive function. Cognitive impairment in each domain was defined as having at least one test score lower than 1.5 standard deviations below age-, race-, and education-specific norms. We identified prior severe hypoglycemic events through 2012 with ICD-9 codes from hospitalizations and emergency department visits. We used Poisson regression with robust standard errors to generate prevalence ratios (PR) adjusted for demographic and clinical characteristics. Results: Among 1,867 adults with diagnosed diabetes: mean age 76 years, 56% female, 32% black, and 3% with prior hypoglycemia. In persons with prior hypoglycemia, 50% had cognitive impairment in at least one domain, compared to 43% in persons without prior hypoglycemia (p=0.24). After adjustment, persons with prior hypoglycemia were more likely to have worse performance in executive function (PR=1.73; 95% CI: 1.14-2.64) and language (PR=1.78; 95% CI: 1.08-2.93) but not memory (PR=1.19; 95% CI: 0.81-1.76) (Figure). Conclusions: Persons with prior severe hypoglycemia are a unique subset of older adults with diabetes with greater cognitive deficits in the domains of executive function and language. Their cognitive impairment presents challenges for the management of their diabetes and the prevention of additional hypoglycemic episodes and cognitive decline.

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Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

10.2337/figshare.12315224 ◽

2020 ◽

Author(s):

Alexandra K. Lee ◽

Stephen P. Juraschek ◽

B. Gwen Windham ◽

Clare J. Lee ◽

A. Richey Sharrett ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Cohort Analysis ◽

Severe Hypoglycemia ◽

Emergency Department Visits ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Risk Of Falls ◽

Aric Study

Background: Hypoglycemia has been postulated to contribute to falls risk in older adults with type 2 diabetes. However, few studies have prospectively examined the association between severe hypoglycemia and falls, both important causes of morbidity and mortality. <div>Methods: We conducted a prospective cohort analysis of participants from the Atherosclerosis Risk in Communities (ARIC) Study with diagnosed diabetes at Visit 4 (1996-1998). Episodes of severe hypoglycemia requiring medical treatment were identified using ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls; total falls were identified from medical claims using E-codes (1996-2013). Secondary analyses examined hospitalized falls and falls with fracture. We calculated incidence rates and used Cox regression models to evaluate the independent associations of severe hypoglycemia with falls occurring after Visit 4 through 2013. Results: Among 1,162 participants with diabetes, 149 ever had a severe hypoglycemic event, either before baseline or during the median of 13.1 years of follow-up. The crude incidence rate of falls among persons without severe hypoglycemia was 2.17 per 100 person-years (PY) (95%CI: 1.93-2.44), compared to 8.81 per 100PY (6.73-11.53) with severe hypoglycemia. After adjustment, severe hypoglycemia was associated with over twofold higher risk of falls (hazard ratio (HR) 2.23, 95%CI 1.61-3.07). Associations were consistent in subgroups defined by age, sex, race, BMI, duration of diabetes, or functional difficulty. Conclusions: Severe hypoglycemia was associated with a substantially higher risk of falls in this community-based population of adults with diabetes. Fall risk should be considered when individualizing glycemic treatment in older adults. Assessing hypoglycemia history and future hypoglycemia risk could also improve multifactorial fall prevention interventions for older adults with diabetes. </div>

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Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

10.2337/figshare.12315224.v1 ◽

2020 ◽

Author(s):

Alexandra K. Lee ◽

Stephen P. Juraschek ◽

B. Gwen Windham ◽

Clare J. Lee ◽

A. Richey Sharrett ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Cohort Analysis ◽

Severe Hypoglycemia ◽

Emergency Department Visits ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Risk Of Falls ◽

Aric Study

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Abstract P275: Growth Differentiation Factor (gdf)-15 and Metabolic Outcomes: The ARIC Study

Circulation ◽

10.1161/circ.141.suppl_1.p275 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Justin B Echouffo Tcheugui ◽

Natalie R Daya ◽

Kunihiro Matsushita ◽

Chiadi E Ndumele ◽

Ron C Hoogeveen ◽

...

Keyword(s):

Older Adults ◽

Metabolic Syndrome ◽

Cross Sectional ◽

Atherosclerosis Risk In Communities ◽

Differentiation Factor ◽

Metabolic States ◽

Unit Increase ◽

Sectional Analysis ◽

Roche Diagnostics ◽

Aric Study

Introduction: Mechanistic studies suggest an involvement of growth differentiation factor 15 (GDF-15) in metabolic dysregulation. However, the potential utility of GDF-15 as a marker of diabetes or metabolic syndrome (MetS) risk remains unclear, especially in older adults. Hypothesis: GDF-15 is positively associated with biomarkers of hyperglycemia, diabetes, and MetS. Methods: We conducted a cross-sectional analysis of older adults who attended visit 6 (2016-2017) of the Atherosclerosis Risk in Communities (ARIC) Study. GDF-15 was measured using electrochemiluminescence immunoassay (Elecsys, Roche Diagnostics). Linear regression was used to assess continuous outcomes after appropriate transformations, and multivariable-adjusted odds of diabetes or MetS by quartiles of GDF-15 were derived using logistic regression. Results: Among 3,792 participants (mean age 80 years, 59% women, 23% blacks and 77% whites), higher GDF-15 concentrations (per 1-unit increase in ln[GDF-15]) were associated with higher levels of fasting plasma glucose (mg/dL) (adjusted β coefficient : 10.98, 95% CI:8.86 - 13.09) and HbA 1C (%)(0.41, 95% CI: 0.35 - 0.48). Higher GDF-15 was associated with greater odds of diabetes (adjusted odds ratio [OR]: 5.81 for highest vs. lowest GDF-15 quartile, 95% CI 4.43-7.61) and of MetS syndrome (adjusted OR: 2.57, 95% CI 2.01-3.20) among individuals without diabetes (Figure). Conclusions: In this sample of older adults, elevated GDF-15 was strongly associated with diabetes and metabolic syndrome. These data strongly suggest that GDF-15 could be a robust biomarker of adverse metabolic states.

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Loneliness and its predictors among older adults prior to and during the COVID-19 pandemic: cross-sectional and longitudinal survey findings from participants of the Atherosclerosis Risk in Communities (ARIC) Study cohort in the USA

BMJ Open ◽

10.1136/bmjopen-2021-053542 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053542

Author(s):

Anna Kucharska-Newton ◽

Kunihiro Matsushita ◽

Yejin Mok ◽

Melissa Minotti ◽

Elizabeth C Oelsner ◽

...

Keyword(s):

High School ◽

Older Adults ◽

Los Angeles ◽

Study Cohort ◽

Cross Sectional ◽

Emotional Resilience ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

The Usa ◽

Aric Study

ObjectivesWe aimed to ascertain the prevalence of perceived loneliness among older adults following the onset of the COVID-19 pandemic and to examine factors contributing to the perception of loneliness.DesignCross-sectional and longitudinal data from the Atherosclerosis Risk in Communities (ARIC) Study cohort.SettingThe ARIC Study cohort, a prospective cohort that recruited (1987–1989) participants from four distinct communities in the USA.Participants2984 ARIC cohort members.Primary and secondary outcomesPerceived loneliness assessed using the University of California at Los Angeles (UCLA) UCLA three-item Loneliness Scale telephone interviews conducted May–October 2020 and prior to March 2020.ResultsOf the total 5037 participants alive in 2020, 2984 (56.2%) responded to the UCLA three-item questionnaire (mean age 82.6 (SD 4.6) years, 586 (19.6%) black participants, 1081 (36.2%) men), of which 66 (2.2%) reported having had a COVID-19 infection during the observation period. The proportion of participants reporting feeling lonely was 56.3% (n=1680). Among participants with repeat measures of loneliness (n=516), 35.2% (n=182) reported feeling more lonely following pandemic onset. Self-rated health and emotional resilience were strongly associated with self-perceived loneliness. The burden of COVID-19 infections, concern about the pandemic and decreased self-reported physical activity were greater among black as compared with white participants and among those with an educational attainment of less than high school as compared with high school or more.ConclusionFindings from this study document the increase in perceived loneliness among older adults during the COVID-19 pandemic in the USA.

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Abstract MP56: Progression of Hyperglycemia in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.141.suppl_1.mp56 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Cited By ~ 1

Author(s):

Mary R Rooney ◽

Andreea Rawlings ◽

James S Pankow ◽

Justin Echouffo Tcheugui ◽

Josef Coresh ◽

...

Keyword(s):

Older Adults ◽

Multinomial Logistic Regression ◽

Older Age ◽

Self Report ◽

Atherosclerosis Risk In Communities ◽

High Prevalence ◽

Risk Of Progression ◽

Using Data ◽

Aric Study

Introduction: Despite the high prevalence of prediabetes and diabetes in old age, the progression of hyperglycemia in older adults is not well-characterized. Objective: To characterize prevalence and predictors of hyperglycemia progression during 5 years of follow-up among 2894 older adults without diabetes (mean age 76, 60% female, 18% black). Methods: Using data from the ARIC Study, we report according to hyperglycemia (normal or prediabetes) status at baseline (visit 5, 2011-13) the incidence of visit 6 (2016-17) outcomes (normoglycemia, prediabetes, diabetes, or mortality). Multinomial logistic regression was used to identify predictors of these outcomes stratified by baseline hyperglycemia status. In a sensitivity analysis, we applied inverse probability of attrition weights (IPAW) to account for informative missingness. Results: Most participants (64%) with normal HbA1c at baseline had normal HbA1c at the follow-up visit, 19% progressed to prediabetes, 16% died, and 1% developed diabetes (HbA1c ≥6.5% or diabetes medication use or self-report diagnosis). Among participants with prediabetes at baseline, most remained prediabetic 5 years later (61%), 18% died, 14% reverted to normoglycemia, and 7% developed diabetes. Black participants, men, and those with hypercholesterolemia had a higher risk of hyperglycemia progression ( Table ). Physical activity was inversely associated with risk of progression. Body mass index (BMI) in older age was not associated with hyperglycemia progression and BMI was inversely associated with mortality. Results were similar when we used IPAW. Conclusions: In this community-based population of older adults, progression from prediabetes to diabetes was relatively uncommon over the 5 year period. Risk factors for hyperglycemia progression and mortality, such as BMI, may differ when measured in older adulthood. We also identified subgroups with higher risk of hyperglycemia progression in older age and who may benefit from targeted diabetes prevention efforts.

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Abstract P055: Diabetes, Early Heart Failures Stages (A & B), And Progression To Overt Heart Failure In Older Adults: The Atherosclerosis Risk In Communities Study

Circulation ◽

10.1161/circ.143.suppl_1.p055 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Justin B Echouffo Tcheugui ◽

Chiadi E Ndumele ◽

Sui Zhang ◽

Roberta Florido ◽

Kunihiro Matsushita ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Glycemic Control ◽

Cox Regression ◽

Absolute Risk ◽

Atherosclerosis Risk In Communities ◽

Uncontrolled Diabetes ◽

Clinical Benefits ◽

Diagnosed Diabetes ◽

Aric Study

Introduction: Diabetes confers a high risk of heart failure (HF). However, the influence of diabetes in preclinical HF (stages A or B) on the progression to overt HF is not well understood. Hypothesis: Diabetes accelerates progression to clinically overt HF, but significantly more so in stage A than B. Methods: We included older adults (aged 66-90 years) without clinical HF (n= 4782) who attended ARIC study visit 5 (2011-2013). We categorized participants into stage A (n=3067) or B (n=1715) HF. Within each stage A or B, we used Cox regression to quantify the associations of diagnosed diabetes and glycemic control (HbA 1C <7% vs. ≥ 7%) with progression to HF. We also evaluated the relative and absolute risk associations of cross-categories of HF stages (A vs. B) and diabetes and glycemic control with incident HF. Results: There were 401 HF events during a median 6.3 years follow-up (mean age 75, 59% female, 21% Black, 28% with diabetes). The 7.6-year cumulative HF risk among individuals with diabetes and HbA 1C ≥ 7% vs. those without diabetes was 11.9% vs. 4.5% in stage A, and 18.1% vs. 13.6% in stage B. In stages A and B, individuals with uncontrolled diabetes had significantly higher risks of HF compared to those without diabetes (all P <0.05; Table ). Uncontrolled diabetes was more strongly associated with HF in stage A than stage B ( P =0.02). In cross-categories of HF stage, diabetes, and glycemic control, individuals with stage B HF and uncontrolled diabetes had greater than 4-fold risk of HF than those with stage A HF without diabetes. Conclusions: Among older adults with preclinical HF stages (A and B), uncontrolled diabetes is associated with substantial short-term (~8 year) risk of HF and should be a focus of aggressive preventive therapies. Newer anti-diabetes therapies such as SGLT2 inhibitors are currently recommended in adults with diabetes and clinical HF, but not stages A and B. Our results suggest that among older adults, such therapies may yield clinical benefits in early HF stages.

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1398-P: Mortality Implications of Comorbid Health Status in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Diabetes ◽

10.2337/db20-1398-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1398-P

Author(s):

MARY R. ROONEY ◽

OLIVE TANG ◽

B. GWEN WINDHAM ◽

JUSTIN B. ECHOUFFO TCHEUGUI ◽

PAMELA LUTSEY ◽

...

Keyword(s):

Older Adults ◽

Health Status ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Aric Study

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Do Communication Patterns Affect the Association between Cognitive Impairment and Hearing Loss among Older Adults in Vietnam?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041603 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1603

Author(s):

Tran Dai Tri Han ◽

Keiko Nakamura ◽

Kaoruko Seino ◽

Vo Nu Hong Duc ◽

Thang Van Vo

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Cognitive Impairment ◽

Cognitive Function ◽

Vision Loss ◽

Community Dwelling ◽

Cross Sectional ◽

Ordinal Logistic Regression Analysis ◽

Communication Devices ◽

Community Dwelling Older Adults

This study examined the prevalence of cognitive impairment among older adults in central Vietnam and the roles of communication (with or without communication devices) in the association between cognitive impairment and hearing loss. This cross-sectional study was performed on 725 randomly selected community-dwelling older adults aged ≥60 years from Thua Thien Hue province, Vietnam. Participants attended a face-to-face survey. Sociodemographic characteristics, social interaction with or without communication devices, health status and cognitive function using the Mini-Mental State Examination were reported. Ordinal logistic regression analysis was performed to quantify the association between hearing loss and cognitive function by frequency of communication with and without devices. Mild and severe cognitive impairment had prevalence rates of 23.6% and 19.3%, respectively. Cognitive impairment was more prevalent among older adults with hearing-loss, vision loss and difficulties with instrumental activities of daily living (IADL). The association between hearing loss and cognitive impairment was not significant when older adults had frequent communication with others using devices. This study presented the relatively high prevalence of cognitive impairment in community-dwelling older adults in Vietnam. Frequent communication using devices attenuated the association between hearing loss and cognitive impairment.

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The effects of combined cognitive training on prospective memory in older adults with mild cognitive impairment

Scientific Reports ◽

10.1038/s41598-021-95126-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yifan Chen ◽

Wei Zhou ◽

Zijing Hong ◽

Rongrong Hu ◽

Zhibin Guo ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Executive Function ◽

Cognitive Training ◽

Prospective Memory ◽

Training Group ◽

Strategy Training ◽

Control Group ◽

Executive Function Training ◽

Encoding Strategy

AbstractThis study aimed to assess the effects of combined cognitive training on prospective memory ability of older adults with mild cognitive impairment (MCI). A total of 113 participants were divided into a control group and three intervention groups. Over three months, the control group received only community education without any training, whereas for the first six weeks, an executive function training group received executive function training, a memory strategy training group received semantic encoding strategy training, and the combined cognitive training group received executive function training twice a week for the first six weeks, and semantic encoding strategy training twice a week for the next six weeks. The combined cognitive training group showed improvement on the objective neuropsychological testing (Montreal Cognitive Assessment scale). The memory strategy training group showed improvement on the self-evaluation scales (PRMQ-PM). Combined cognitive training improved the prospective memory and cognitive function of older adults with MCI.

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Prevalence of Cognitive Impairment and Dementia in Older Adults Living at High Altitude: A Systematic Review and Meta-Analysis

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000514471 ◽

2021 ◽

pp. 1-11

Author(s):

Diego Urrunaga-Pastor ◽

Diego Chambergo-Michilot ◽

Fernando M. Runzer-Colmenares ◽

Josmel Pacheco-Mendoza ◽

Vicente A. Benites-Zapata

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

High Altitude ◽

Web Of Science ◽

Meta Analysis ◽

Cross Sectional ◽

Language Restriction ◽

Newcastle Ottawa Scale ◽

Meta Analyses ◽

Ottawa Scale

Introduction: Dementia is a chronic disease with a variable prevalence throughout the world; however, this could be higher at high-altitude populations. We aimed to summarize the prevalence of cognitive impairment and dementia in older adults living at high altitude. Methods: We searched in PubMed, Medline, Scopus, Web of Science, and Embase and included the studies published from inception to July 20, 2020, with no language restriction, which reported the frequency of cognitive impairment or dementia in older adults living at high-altitude populations. Random-effects meta-analyses were performed to calculate the overall prevalence and 95% confidence intervals (95% CI) of cognitive impairment and dementia. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Results: Six studies were included (3,724 participants), and 5 of the 6 included studies were carried out in Latin America. The altitude ranged from 1,783 to 3,847 m, the proportion of women included varied from 38.7 to 65.6%, and the proportion of participants with elementary or illiterate educational level ranged from 71.7 to 97.6%. The overall prevalence of cognitive impairment was 22.0% (95% CI: 8–40, I2: 99%), and the overall prevalence of dementia was 11.0% (95% CI: 6–17, I2: 92%). In a subgroup analysis according to the instrument used to evaluate cognitive impairment, the prevalence of cognitive impairment was 21.0% (95% CI: 5–42, I2: 99%) in the MMSE group while the prevalence was 29.0% (95% CI: 0–78) in the non-MMSE group. Conclusions: The prevalence of cognitive impairment and dementia in older adults living at high altitude is almost twice the number reported in some world regions.

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