scholarly journals SAT-LB115 Metformin-Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes Mellitus: The Sydney Memory and Ageing Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D Crawford ◽  
Nicole A Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Executive Function ◽  
Older People ◽  
Cognitive Decline ◽  
Community Dwelling ◽  
Incident Dementia ◽  
Ageing Study ◽  
Global Cognition ◽  
Rate Of Decline

Abstract Background Metformin use in diabetes has been associated with both increased and decreased dementia rates in observational studies of people with diabetes. Objective: To examine changes in global cognition and specific cognitive domains over 6 years in older adults with diabetes treated with metformin, compared to other glucose lowering medications, and to people without diabetes. Methods Data were examined from the Sydney Memory and Ageing Study, a prospective observational study of 6 years duration of 1037 non-demented community-dwelling elderly aged 70-90 at baseline, derived from a compulsory electoral roll. Neuropsychological testing was performed every 2 years with domain measures of memory, executive function, language, visuospatial function, attention and processing speed and a composite of global cognition. Data were analysed by linear mixed modelling, including age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking and apolipoprotein E ε4 carriage as covariates. Results: At baseline, 123 participants had diabetes (DM) with 67 receiving metformin (DM+MF) who were similar in demographics to those not receiving metformin (DM-noMF) and those without diabetes (no-DM). Participants with diabetes had higher BMI, lower HDL- and LDL-cholesterol and more prevalent heart disease, hypertension and smoking, compared to no-DM. Over 6-years, DM+MF participants had significantly slower rates of decline in global cognition and executive function, compared to DM-noMF, adjusted for covariates. The rate of decline for each cognitive domain was similar between DM+MF and controls. No impact was found in analyses examining interactions with sex, ApoEε4 carriage or hyperlipidemia. No difference was found in the rate of decline in brain volumes between the groups over 2 years. Incident dementia was significantly higher in DM-noMF, compared to DM+MF (adjusted OR 5.29 [95% CI 1.17-23.88], p,0.05), whereas risk of incident dementia was similar between DM+MF and participants without diabetes. Conclusions: In older people with diabetes receiving metformin, rates of cognitive decline and dementia were similar to that found in people without diabetes and significantly less than that found in people with diabetes not receiving metformin. Large randomized studies in people with and without diabetes are required to determine whether these associations can be attributed to metformin alone or if other factors explain these observations. Future studies will clarify if this cheap and safe medication can be repurposed for prevention of cognitive decline in older people.

scholarly journals Metformin-use is associated with slowed cognitive decline and reduced incident dementia in older adults with type 2 diabetes mellitus: the Sydney Memory and Ageing Study

2020 ◽  
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D. Crawford ◽  
Nicole A. Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Executive Function ◽  
Cognitive Decline ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Ageing Study ◽  
Global Cognition

<b>Objective:</b> Type 2 diabetes mellitus (diabetes) is characterized by accelerated cognitive decline and higher dementia risk. Controversy exists regarding the impact of metformin which is associated with both increased and decreased dementia rates. The objective of this study was to determine the association of metformin-use with incident dementia and cognitive decline over 6 years in diabetes, compared to those not receiving metformin and those without diabetes. <p><b>Research</b> <b>Design and Methods</b>: Prospective observational study of N=1037 non-demented community-dwelling older participants aged 70-90 at baseline (the Sydney Memory and Ageing Study). Exclusion criteria were dementia, major neurological or psychiatric disease or progressive malignancy. Neuropsychological testing measured cognitive function every two years; a battery of tests measured executive function, memory, attention/speed, language and visuospatial function individually and to a construct of global cognition. Incident dementia was ascertained by a multidisciplinary panel. Total brain, hippocampal and parahippocampal volumes were measured by magnetic resonance at baseline and 2 years (n=526). Data were analyzed by linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, hypertension, stroke, smoking and apolipoprotein Ee4 carriage. </p> <p><b>Results</b>: Of n=1037, 123 had diabetes; 67 received metformin (DM+MF) and were demographically similar to those not (DM-noMF) and participants without diabetes (no-DM). DM+MF had significantly slower global cognition and executive function decline compared to DM-noM. Incident dementia was significantly higher in DM-noMF compared to DM+MF (OR 5.29, 95%CI 1.17-23.88, p=0.05).</p> <p><b>Conclusions</b>: Older people with diabetes receiving metformin have slower cognitive decline and lower dementia risk. Large randomized studies in people with and without diabetes will determine whether these associations can be attributed to metformin. </p>

scholarly journals Cognitive decline after elective and nonelective hospitalizations in older adults

Neurology ◽  
2019 ◽  
Vol 92 (7) ◽  
pp. e690-e699 ◽  
Author(s):  
Bryan D. James ◽  
Robert S. Wilson ◽  
Ana W. Capuano ◽  
Patricia A. Boyle ◽  
Raj C. Shah ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Sex Education ◽  
Hospital Admissions ◽  
Community Dwelling ◽  
Significant Difference ◽  
Before And After ◽  
Education Medical ◽  
Global Cognition ◽  
Rate Of Decline

ObjectiveTo determine whether emergent and urgent (nonelective) hospitalizations are associated with faster acceleration of cognitive decline compared to elective hospitalizations, accounting for prehospital decline.MethodsData came from the Rush Memory and Aging Project, a prospective cohort study of community-dwelling older persons without baseline dementia. Annual measures of cognition via a battery of 19 tests were linked to 1999 to 2010 Medicare claims records.ResultsOf 777 participants, 460 (59.2%) were hospitalized over a mean of 5.0 (SD = 2.6) years; 222 (28.6%) had at least one elective and 418 (53.8%) at least one nonelective hospitalization. Mixed-effects regression models estimated change in global cognition before and after each type of hospitalization compared to no hospitalization, adjusted for age, sex, education, medical conditions, length of stay, surgery, intensive care unit, and comorbidities. Persons who were not hospitalized had a mean loss of 0.051 unit global cognition per year. In comparison, there was no significant difference in rate of decline before (0.044 unit per year) or after (0.048 unit per year) elective hospitalizations. In contrast, decline before nonelective hospitalization was faster (0.076 unit per year; estimate = −0.024, SE = 0.011, p = 0.032), and accelerated by 0.036 unit (SE = 0.005, p < 0.001) to mean loss of 0.112 unit per year after nonelective hospitalizations, more than doubling the rate in those not hospitalized.ConclusionsNonelective hospitalizations are related to more dramatic acceleration in cognitive decline compared to elective hospitalizations, even after accounting for prehospital decline. These findings may inform which hospital admissions pose the greatest risk to the cognitive health of older adults.

scholarly journals Metformin-use is associated with slowed cognitive decline and reduced incident dementia in older adults with type 2 diabetes mellitus: the Sydney Memory and Ageing Study

2020 ◽  
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D. Crawford ◽  
Nicole A. Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Executive Function ◽  
Cognitive Decline ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Ageing Study ◽  
Global Cognition

<b>Objective:</b> Type 2 diabetes mellitus (diabetes) is characterized by accelerated cognitive decline and higher dementia risk. Controversy exists regarding the impact of metformin which is associated with both increased and decreased dementia rates. The objective of this study was to determine the association of metformin-use with incident dementia and cognitive decline over 6 years in diabetes, compared to those not receiving metformin and those without diabetes. <p><b>Research</b> <b>Design and Methods</b>: Prospective observational study of N=1037 non-demented community-dwelling older participants aged 70-90 at baseline (the Sydney Memory and Ageing Study). Exclusion criteria were dementia, major neurological or psychiatric disease or progressive malignancy. Neuropsychological testing measured cognitive function every two years; a battery of tests measured executive function, memory, attention/speed, language and visuospatial function individually and to a construct of global cognition. Incident dementia was ascertained by a multidisciplinary panel. Total brain, hippocampal and parahippocampal volumes were measured by magnetic resonance at baseline and 2 years (n=526). Data were analyzed by linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, hypertension, stroke, smoking and apolipoprotein Ee4 carriage. </p> <p><b>Results</b>: Of n=1037, 123 had diabetes; 67 received metformin (DM+MF) and were demographically similar to those not (DM-noMF) and participants without diabetes (no-DM). DM+MF had significantly slower global cognition and executive function decline compared to DM-noM. Incident dementia was significantly higher in DM-noMF compared to DM+MF (OR 5.29, 95%CI 1.17-23.88, p=0.05).</p> <p><b>Conclusions</b>: Older people with diabetes receiving metformin have slower cognitive decline and lower dementia risk. Large randomized studies in people with and without diabetes will determine whether these associations can be attributed to metformin. </p>

Abstract P402: Aortic Stiffness and 5-year Cognitive Decline Among Community-dwelling Older Adults: The Atherosclerosis Risk in Communities Neurocognitive Study (aric-ncs)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jingkai Wei ◽  
Priya Palta ◽  
Aozhou Wu ◽  
Michelle Meyer ◽  
A. Richey Sharret ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Aortic Stiffness ◽  
Community Dwelling ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Rate Of Decline ◽  
Community Dwelling Older Adults ◽  
Annual Decline

Background: Vascular aging is associated with cognitive decline. Aortic stiffness is a hallmark of vascular aging. We tested the hypothesis that greater aortic stiffness is associated with a faster rate of cognitive decline over 5 years among older adults. Methods: A prospective cohort study at the 5th (2011-2013) and 6th (2016-2017) examinations of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) was conducted to quantify the association between baseline aortic stiffness and cognitive decline over 5 years. A total of 4639 participants (mean age: 75 years, 41% men, 22% Black) with baseline measures of aortic stiffness and cognitive function were included in the analysis. Aortic stiffness was measured as carotid-femoral pulse wave velocity (cfPWV) using the Omron VP-1000 Plus device and analyzed continuously per 1 standard deviation meter/second (3.20 m/s). Elevated aortic stiffness was defined as the upper 25th percentile of cfPWV (13.39 m/s). Cognitive function was based on ten neuropsychological tests across multiple domains of cognition, including memory, executive function/processing speed, and language. A global cognitive performance factor score was estimated based on all cognitive tests at both visits. Multivariable linear regression was used to examine the associations of each standard deviation (SD) increment in cfPWV and elevated cfPWV with annual cognitive decline over 5 years. Interactions with baseline cognitive status were assessed. To account for attrition (35% over 5 years), multiple imputation by chained equations was used to impute missing global cognitive performance factor scores at visit 6. Results: Each 1 SD increase in cfPWV was associated with 0.008 SD (Beta (β)=-0.008, 95% confidence interval (CI): -0.010, -0.003) annual rate of decline in cognitive function after adjustment for age, sex, education, race-center and ApoE4. With additional adjustment for ever smoking, total weekly physical activity time, mean arterial pressure, diabetes, and body mass index, each SD higher cfPWV was associated with 0.005 SD (β=-0.005, 95% CI: -0.010, -0.001) annual rate of decline in cognitive function. Elevated cfPWV was associated with 0.015 SD (β=-0.015, 95% CI: -0.024, -0.005) annual decline in cognitive function, and with 0.010 SD (β=-0.010, 95% CI: -0.020, 0.0001) annual decline after additional adjustment. Conclusion: Higher aortic stiffness is associated with the rate of decline in global cognitive function among community-dwelling older adults. The hemodynamic sequelae of aortic stiffening may contribute to cognitive decline among older adults.

scholarly journals Metformin Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes: The Sydney Memory and Ageing Study

Diabetes Care ◽  
2020 ◽  
Vol 43 (11) ◽  
pp. 2691-2701
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D. Crawford ◽  
Nicole A. Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Cognitive Decline ◽  
Incident Dementia ◽  
Ageing Study

scholarly journals Comment on Samara et al. Metformin Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes: The Sydney Memory and Ageing Study. Diabetes Care 2020;43:2691–2701

Diabetes Care ◽  
2021 ◽  
Vol 44 (4) ◽  
pp. e73-e73
Author(s):  
Jorge Rafael Violante-Cumpa ◽  
Luis Alberto Pérez-Arredondo ◽  
José Gerardo González-González ◽  
Leonardo Guadalupe Mancillas-Adame
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Cognitive Decline ◽  
Diabetes Care ◽  
Incident Dementia ◽  
Ageing Study

scholarly journals Cognitive performance of older adults with a low level of education with and without depression

2021 ◽  
Vol 15 (1) ◽  
pp. 121-127
Author(s):  
Ana Julia de Lima Bomfim ◽  
Natália Mota de Souza Chagas ◽  
Lívio Rodrigues Leal ◽  
Rebeca Mendes de Paula Pessoa ◽  
Bianca Letícia Cavalmoretti Ferreira ◽  
...  
Keyword(s):  
Older Adults ◽  
Major Depression ◽  
Older People ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Community Dwelling ◽  
Assessment Tools ◽  
Health Examination ◽  
Low Level ◽  
Community Dwelling Older Adults

ABSTRACT. Major depression can develop in individuals aged 60 years or older and is commonly associated with cognitive decline in this population, especially the domains of working memory, attention, executive functions, and processing speed. Schooling is a protective factor with regard to cognitive decline. Objective: To compare the cognitive performance of community-dwelling older adults with a low level of schooling with and without major depression. Methods: A descriptive, analytical, cross-sectional study was conducted with 22 community-dwelling older adults with depression and 187 without depression. The following assessment tools were employed: Mini Mental Health Examination, Brief Cognitive Screening Battery, Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), Digit Span Test (forward and backward), and an object similarity test. Results: No statistically significant differences were found between the groups with and without depression on any of the tests. Conclusions: This study demonstrated that there are no differences in the cognitive performance of older people with and without depression on neurocognitive tests commonly used in clinical practice. Future studies with different designs and methods as well as specific tests for older people with a low level of schooling could assist in the understanding of these relations and the mechanisms involved.

Abstract 47: Subclinical Atherosclerosis and 20-Year Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Shelly-Ann M Love ◽  
Priya Palta ◽  
Corey A Kalbaugh ◽  
A.Richey Sharrett ◽  
Alden L Gross ◽  
...  
Keyword(s):  
Executive Function ◽  
Cognitive Decline ◽  
Subclinical Atherosclerosis ◽  
Word Recall ◽  
Digit Symbol Substitution Test ◽  
Z Score ◽  
Domain Specific ◽  
Z Scores ◽  
Global Cognition ◽  
Rate Of Decline

Introduction: Cardiovascular risk factors are reportedly predictive of cognitive decline and dementia but the association between the extent and severity of subclinical atherosclerosis with cognitive decline remains understudied. Hypothesis: The systemic burden of atherosclerosis measured non-invasively is associated with the rate of decline in domain-specific (memory, executive function and language) and global cognition from mid-life to late life. Methods: Members of the ARIC cohort (N=12313; 58% women, 24% African American (AA), 76% white) aged 46-70 years at their 1990-1992 examination were followed through 2011-2013. Participants with prevalent stroke, myocardial infarction or coronary heart disease were excluded. Atherosclerosis at baseline (n=5217) was assessed by carotid artery b-mode ultrasound (presence and number of plaques, bilaterally) and by ankle-brachial index <0.9 measured with an oscillometric device. Tests of memory (Delayed Word Recall Test), executive function (Digit Symbol Substitution Test), and language (Word Fluency Test) were administered in 1990-92, 1996-98 and 2011-13. Test-specific z scores were calculated at each exam based on the means and standard deviations at baseline. A global cognition z score was estimated by averaging the 3 test-specific z scores and standardizing to baseline. Race-stratified linear random effects regression was used to estimate the association between subclinical atherosclerosis and 20-year declines in domain-specific cognition and global cognition. We adjusted for age, sex and level of education. Inverse probability weighting (IPW) was used to limit bias due to attrition. Results: In AA, the presence of carotid plaque and/or ABI <0.90 (n=490) was associated with a lower memory z score (Beta=-0.10, 95% confidence interval, CI: -0.18, -0.02), a lower language z score (Beta=-0.07, 95% CI: -0.14,-0.002) and a lower global cognition z score at baseline (Beta=-0.09, 95% CI: -0.16, -0.02), but not with rates of change in any cognitive score. Among whites at baseline, individuals with subclinical atherosclerosis (n=4099) exhibited lower executive function (Beta=-0.05, 95% CI: -0.08, -0.02) and global cognition (Beta=-0.04, 95% CI: -0.07, -0.01). White participants with subclinical atherosclerosis had a greater 20-year rate of decline in global cognition (Beta=-0.06, 95% CI: -0.10, -0.00) compared to those without subclinical atherosclerosis. Conclusions: Baseline memory, language, and global cognition in AA and executive function and global cognition in whites were lower among those with non-invasively ascertained atherosclerosis compared to those without, independent of covariates in the model. Among whites, subclinical clinical measures of atherosclerosis in mid-life may be indicative of modest, but measurable declines in cognition after additional adjustment for potential bias due to attrition.

DETERIORATION IN MOTOR FUNCTION OVER TIME IN OLDER ADULTS WITH TYPE 2 DIABETES IS ASSOCIATED WITH ACCELERATED COGNITIVE DECLINE

2020 ◽  
Vol 26 (10) ◽  
pp. 1143-1152
Author(s):  
Ithamar Ganmore ◽  
Isak Elkayam ◽  
Ramit Ravona-Springer ◽  
Hung-Mo Lin ◽  
Xiaoyu Liu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Cognitive Decline ◽  
Motor Function ◽  
Gait Speed ◽  
Semantic Categorization ◽  
Z Scores ◽  
Global Cognition ◽  
Rate Of Decline

Objective: Type 2 diabetes (T2D) is associated with motor impairments and a higher dementia risk. The relationships of motor decline with cognitive decline in T2D older adults has rarely been studied. Using data from the Israel Diabetes and Cognitive Decline study (N = 892), we examined associations of decline in motor function with cognitive decline over a 54-month period. Methods: Motor function measures were strength (handgrip) and gait speed (time to walk 3 m). Participants completed a neuropsychologic battery of 13 tests transformed into z-scores, summarized into 4 cognitive domains: episodic memory, attention/working memory, executive functions, and language/semantic categorization. The average of the 4 domains’ z-scores defined global cognition. Motor and cognitive functions were assessed in 18-months intervals. A random coefficients model delineated longitudinal relationships of cognitive decline with baseline and change from baseline in motor function, adjusting for sociodemographic, cardiovascular, and T2D-related covariates. Results: Slower baseline gait speed levels were significantly associated with more rapid decline in global cognition ( P = .004), language/semantic categorization ( P = .006) and episodic memory ( P = .029). Greater decline over time in gait speed was associated with an accelerated rate of decline in global cognition ( P = .050), attention/working memory ( P = .047) and language/semantic categorization ( P<.001). Baseline strength levels were not associated with cognitive decline but the rate of declining strength was associated with an accelerated decline in executive functions ( P = .025) and language/semantic categorization ( P = .006). Conclusion: In T2D older adults, the rate of decline in motor function, beyond baseline levels, was associated with accelerated cognitive decline, suggesting that cognitive and motor decline share common neuropathologic mechanisms in T2D. Abbreviations: HbA1c = hemoglobin A1c; IDCD = Israel Diabetes and Cognitive Decline; T2D = type 2 diabetes

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