scholarly journals Longitudinal Associations Between Glycemic Status and Cognitive Function in Older Participants at High Risk of Cardiovascular Disease: Two-Year Follow-Up in the PREDIMED-Plus Study

2021 ◽  
Author(s):  
Carlos Gómez Martínez ◽  
Nancy Babio ◽  
Jordi Julvez ◽  
Nerea Becerra Tomás ◽  
Miguel A. Martínez González ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Executive Function ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Diabetes Duration ◽  
Glycemic Status ◽  
Logistic Regression Models ◽  
Diabetes Status ◽  
Longitudinal Associations

Abstract BACKGROUND: Type 2 diabetes was related with larger cognitive decline. However, other glycemic dysregulations showed inconsistent results. Our aim was to examine longitudinal associations between diabetes/glycemic status and cognitive function in older adults with metabolic syndrome. METHODS: We conducted a 2-year prospective cohort study (n=6,874) within the framework of the PREDIMED-Plus study. The participants (with overweight/obesity and metabolic syndrome; mean age 64.9 years; 48.5% women) completed a battery of 8 cognitive tests, and a global cognitive function Z-score (GCF) was estimated. Participants were categorized by diabetes status (no-diabetes, prediabetes, and <5 or ≥5-year diabetes duration), and control. At baseline, insulin resistance (HOMA-IR) and glycated hemoglobin (HbA1c) levels were measured and antidiabetic medications were recorded. Linear and logistic regression models, adjusted by potential confounders, were fitted to assess associations between glycemic status and changes in cognitive function. RESULTS: Prediabetes status was unrelated to cognitive decline. However, compared to participants without diabetes, those with ≥5-year diabetes duration had greater reductions in the GCF (β=-0.11 [95%CI -0.16;-0.06]), processing speed and executive function measurements. Inverse associations were observed between baseline HOMA-IR and changes in the GCF (β=-0.0094 [95%CI -0.0164;-0.0023]), but also between HbA1c levels and changes in the GCF (β=-0.0610 [95%CI -0.0889;-0.0331]), the Mini-Mental test, and other executive function tests. Poor diabetes control was inversely associated with phonologic fluency. Sulfonylureas, but especially insulin use, were related to cognitive decline.CONCLUSIONS: Insulin resistance, diabetes status, longer diabetes duration, poor glycemic control, and insulin treatment were associated with worsening cognitive function at short-term in a population at high cardiovascular risk.TRIAL REGISTRATION: ISRCTN, ISRCTN89898870. Registered 28 May 2014 - Retrospectively registered, http://www.isrctn.com/ISRCTN89898870

scholarly journals Glycemic Dysregulations Are Associated With Worsening Cognitive Function in Older Participants at High Risk of Cardiovascular Disease: Two-Year Follow-up in the PREDIMED-Plus Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Carlos Gómez-Martínez ◽  
Nancy Babio ◽  
Jordi Júlvez ◽  
Nerea Becerra-Tomás ◽  
Miguel Á. Martínez-González ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Cardiovascular Disease ◽  
Cognitive Function ◽  
Insulin Treatment ◽  
Diabetes Control ◽  
Diabetes Duration ◽  
Cognitive Tests ◽  
Glycemic Status ◽  
Short Term ◽  
Diabetes Status

IntroductionType 2 diabetes has been linked to greater cognitive decline, but other glycemic parameters such as prediabetes, diabetes control and treatment, and HOMA-IR and HbA1c diabetes-related biomarkers have shown inconsistent results. Furthermore, there is limited research assessing these relationships in short-term studies. Thus, we aimed to examine 2-year associations between baseline diabetes/glycemic status and changes in cognitive function in older participants at high risk of cardiovascular disease.MethodsWe conducted a 2-year prospective cohort study (n=6,874) within the framework of the PREDIMED-Plus study. The participants (with overweight/obesity and metabolic syndrome; mean age 64.9 years; 48.5% women) completed a battery of 8 cognitive tests, and a global cognitive function Z-score (GCF) was estimated. At baseline, participants were categorized by diabetes status (no-diabetes, prediabetes, and &lt;5 or ≥5-year diabetes duration), and also by diabetes control. Furthermore, insulin resistance (HOMA-IR) and glycated hemoglobin (HbA1c) levels were measured, and antidiabetic medications were recorded. Linear and logistic regression models, adjusted by potential confounders, were fitted to assess associations between glycemic status and changes in cognitive function.ResultsPrediabetes status was unrelated to cognitive decline. However, compared to participants without diabetes, those with ≥5-year diabetes duration had greater reductions in GCF (β=-0.11 (95%CI -0.16;-0.06)], as well as in processing speed and executive function measurements. Inverse associations were observed between baseline HOMA-IR and changes in GCF [β=-0.0094 (95%CI -0.0164;-0.0023)], but also between HbA1c levels and changes in GCF [β=-0.0085 (95%CI -0.0115, -0.0055)], the Mini-Mental State Examination, and other executive function tests. Poor diabetes control was inversely associated with phonologic fluency. The use of insulin treatment was inversely related to cognitive function as measured by the GCF [β=-0.31 (95%CI -0.44, -0.18)], and other cognitive tests.ConclusionsInsulin resistance, diabetes status, longer diabetes duration, poor glycemic control, and insulin treatment were associated with worsening cognitive function changes in the short term in a population at high cardiovascular risk.Clinical Trial Registrationhttp://www.isrctn.com/ISRCTN89898870, identifier ISRCTN: 89898870.

scholarly journals Eight-Year Longitudinal Associations of the Onset of Prediabetes and Diabetes with Cognitive Function Decline Among Chinese Adults Aged 45 Years or Older

2021 ◽  
Author(s):  
Xiaojie Wang ◽  
Xiuwen Li ◽  
Wanxin Wang ◽  
Guangduoji Shi ◽  
Ruipeng Wu ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Lifestyle Modification ◽  
Significant Risk ◽  
Chinese Adults ◽  
Diabetic Status ◽  
Diabetes Status ◽  
Longitudinal Associations ◽  
Diabetes Patients

Abstract Background With the population aging, diabetes and cognitive function decline are increasingly common among older adults worldwide. However, the evidence about the effects and mechanism of prediabetes and diabetes on cognitive function is still limited. The purposes of this longitudinal study were to estimate the longitudinal associations of the onset of prediabetes and diabetes status with cognitive function among Chinese adults aged 45 years or older during an 8-year period; to estimate the clinical risk factors associated with cognitive function among patients with prediabetes and diabetes. Methods Participants were enrolled between 2011 and 2012, and followed up between 2018 and 2019 in the China Health and Retirement Longitudinal Study. In this study, we focused on newly diagnosed diabetic status, and those diagnosed with diabetes before or not providing fasting blood samples were excluded. Diabetic status was assessed according to the 2010 American Diabetes Association (ADA) guidelines. The general cognitive function, demographic characteristics, and clinical and biochemical factors were also measured. Results At baseline, 849 (21.3%) participants were first diagnosed with prediabetes, and 444 (11.1%) were diabetes patients. After adjusting for age, gender, marital status, education level, ever smoking, ever drinking, self-comment about health, hypertension, dyslipidemia, depressive symptoms, cognitive function, and clinical and biochemical measurements at baseline, diabetes status was a significant risk factor for subsequent cognitive decline (unstandardized β estimate=-0.47, 95% CI=-0.91~-0.04). Further stratification analyses found that only triglyceride concentrations were negatively associated with cognitive function among prediabetes patients (unstandardized β estimate=-0.004, 95% CI=-0.007~-0.001), and only creatine reactive protein was significantly associated with cognitive decline among diabetes patients (unstandardized β estimate=-0.065, 95% CI=-0.122~-0.009). Conclusions There is a positive longitudinal association between the onset of diabetes and cognitive decline among middle-aged and elderly Chinese. The management of triglycerides through lifestyle modification for prediabetes and specific adjunctive anti-inflammatory therapy for diabetes could benefit cognitive performance.

scholarly journals Moderating Effect of Insulin Resistance on the Relationship between Gray Matter Volumes and Cognitive Function

2018 ◽  
Vol 7 (11) ◽  
pp. 413 ◽  
Author(s):  
Jiyeon Lee ◽  
Jihyeon Kim ◽  
Seong Shin ◽  
Soowon Park ◽  
Dong Yoon ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Insulin Resistance ◽  
Alzheimer's Disease ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Gray Matter ◽  
Structural Changes ◽  
Gray Matter Volume ◽  
Volume Loss ◽  
Matter Volume

Background: It is controversial whether exposure to insulin resistance accelerates cognitive deterioration. The present study aimed to investigate the association between insulin resistance and gray matter volume loss to predict the cognitive decline. Methods: We recruited 160 participants (78 with Alzheimer’s disease and 82 without Alzheimer’s disease). Insulin resistance, regional gray matter volume, and cognitive function were assessed. A hierarchical moderated multiple regression (MMR) model was used to determine any associations among insulin resistance, structural changes in the brain, and cognitive decline. Results: The volumes of 7 regions in the gray matter were negatively related to insulin resistance in Alzheimer’s disease (p =0.032). Hierarchical MMR analysis indicated that insulin resistance did not directly affect the cognitive decline but moderated the cognitive decline through the decrease in gray matter volume in the key brain regions, i.e., inferior orbitofrontal gyrus (left), middle cingulate gyrus (right), hippocampus (right), and precuneus (right) (p < 0.05 in each case). Conclusion: Insulin resistance appears to exacerbate the cognitive decline associated with several gray matter volume loss.

scholarly journals Plasma Carboxy-Terminal Provasopressin (Copeptin): A Novel Marker of Insulin Resistance and Metabolic Syndrome

2009 ◽  
Vol 94 (7) ◽  
pp. 2558-2564 ◽  
Author(s):  
Umer Saleem ◽  
Mahyar Khaleghi ◽  
Nils G. Morgenthaler ◽  
Andreas Bergmann ◽  
Joachim Struck ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Odds Ratio ◽  
Density Lipoprotein ◽  
Model Assessment ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Bottom Quartile ◽  
Novel Biomarkers ◽  
Carboxy Terminal

Context: Stress-mediated hypothalamic-pituitary-adrenal axis activation, regulated by arginine vasopressin (AVP), may have a role in the pathophysiology of metabolic syndrome (MetSyn). Objective: The objective of the study was to investigate whether plasma C-terminal provasopressin fragment (copeptin), a surrogate for circulating AVP, was associated with measures of insulin resistance and presence of MetSyn. Design, Setting, and Participants: This was a multicenter, community-based study, investigating novel biomarkers for vascular disease. Participants included 1293 African-Americans (AA) (64 ± 9 yr) and 1197 non-Hispanic whites (NHW) (59 ± 10 yr) belonging to hypertensive sibships. Main Outcome Measures: Plasma copeptin levels were measured by an immunoluminometric assay. MetSyn was defined per Adult Treatment Panel III criteria. Generalized estimating equations were used to assess whether plasma copeptin was associated with measures of insulin resistance and MetSyn. Results: The prevalence of MetSyn was 50% in AA and 49% in NHW. In each group, after adjustment for age and sex, plasma copeptin levels significantly correlated with body mass index, fasting plasma glucose and insulin, homeostasis model assessment of insulin resistance, triglycerides, and (inversely) high-density lipoprotein cholesterol (P &lt; 0.05 for each variable). In multivariable logistic regression models that adjusted for age, sex, smoking, statin use, serum creatinine, education, physical activity, and diuretic use, plasma copeptin levels in the highest quartile were associated with an increased odds ratio of having MetSyn compared with bottom quartile: odds ratio (95% confidence interval) in AA, 2.07 (1.45–2.95); in NHW, 1.74 (1.21–2.5). Conclusions: Our findings indicate a novel cross-sectional association between plasma copeptin and measures of insulin resistance and MetSyn.

scholarly journals Recurrent diabetic ketoacidosis and cognitive function among older adults with type 1 diabetes: findings from the Study of Longevity in Diabetes

2020 ◽  
Vol 8 (1) ◽  
pp. e001173 ◽  
Author(s):  
Mary E Lacy ◽  
Paola Gilsanz ◽  
Chloe W Eng ◽  
Michal S Beeri ◽  
Andrew J Karter ◽  
...  
Keyword(s):  
Older Adults ◽  
Type 1 Diabetes ◽  
Executive Function ◽  
Cognitive Function ◽  
Diabetic Ketoacidosis ◽  
Brain Health ◽  
Psychomotor Speed ◽  
Logistic Regression Models ◽  
Global Cognitive Function

IntroductionDiabetic ketoacidosis (DKA) is a serious complication of diabetes. DKA is associated with poorer cognition in children with type 1 diabetes (T1D), but whether this is the case in older adults with T1D is unknown. Given the increasing life expectancy in T1D, understanding the role of DKA on brain health in older adults is crucial.Research design and methodsWe examined the association of DKA with cognitive function in 714 older adults with T1D from the Study of Longevity in Diabetes. Participants self-reported lifetime exposure to DKA resulting in hospitalization; DKA was categorized into 0 hospitalization, 1 hospitalization or ≥2 hospitalizations (recurrent DKA). Global and domain-specific cognition (language, executive function/psychomotor speed, episodic memory and simple attention) were assessed. The association of DKA with cognitive function was evaluated via linear and logistic regression models.ResultsTwenty-eight percent of participants (mean age=67 years; mean age at diagnosis=28 years; average duration of diabetes=39 years) reported a lifetime history of DKA resulting in hospitalization (18.5% single DKA; 9.7% recurrent DKA). In fully adjusted models, those with recurrent DKA had lower global cognitive function (β=−0.13; 95% CI −0.22 to 0.02) and lower scores on the executive function/psychomotor speed domain (β=−0.34; 95% CI −0.51 to 0.17). Individuals with recurrent DKA were also more likely to have the lowest level of cognitive function on the executive function/psychomotor speed domain (defined as 1.5 SD below the population mean; OR=3.26, 95% CI 1.43 to 7.42).ConclusionsAmong 714 older adults with T1D, recurrent DKA was associated with lower global cognitive function, lower scores on the executive function/psychomotor speed domain and 3.3 times greater risk of having the lowest level of cognitive function in our sample on the executive function/psychomotor speed domain. These findings suggest that recurrent DKA may negatively impact the brain health of older patients with T1D and highlight the importance of DKA prevention.

Abstract WMP115: The Metabolic Syndrome Components and Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jennifer L Dearborn ◽  
David Knopman ◽  
Richey Sharrett ◽  
Andrea L Schneider ◽  
Clifford Jack ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Sex Education ◽  
Later Life ◽  
Cognitive Change ◽  
Word Recall ◽  
Digit Symbol Substitution Test ◽  
The Metabolic Syndrome ◽  
Aric Study

Background: Midlife obesity is associated with dementia in later life, but how the metabolic syndrome (MetS) relates to cognitive change is less understood. We hypothesized that MetS would be more predictive of 6-year cognitive decline than its individual components in a large biethnic cohort (the ARIC study) and that combinations of risk factors would further increase likelihood of change. Methods: The MetS was defined in 1987-89 on 10,687 participants with two cognitive assessments at two time points. In subjects aged 44 to 66, obesity measures included body mass index (BMI) and waist-to-hip ratio (WTHR). The main outcome measure was change in 1990-92 to 96-99 of three cognitive tests: Delayed Word Recall (DWR), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT). Linear and logistic regressions were all adjusted for age, combined race-center, sex, education, smoking, drinking, coronary artery disease and prior stroke. Change was measured as the difference divided by the number of years between visits. Results: At baseline, the prevalence of MetS was 22% (mean age 54 years, 27% black, 55% female, and 28% BMI>30 kg/m2). Subjects with MetS performed in the lowest test quintile (adjusted ORs: DWR 1.3 95% CI 1.1-1.4) in 1996-99, and much of this effect size was explained by an elevated WTHR (DWR OR 1.3 CI 1.1-1.5) and diabetes (DWR OR 1.4 CI 1.2-1.7). MetS was not associated with annual cognitive change, and diabetes was the only significant component associated with change (adjusted beta: DWR 0.03 p=.01, DSST 0.2 p<.001, WFT 0.09 p=.01). Conclusion: MetS at ages 44 to 66 was associated with worse cognitive function at follow-up, but not with annual cognitive decline over several years. Elevated WTHR and diabetes explained most of the association of MetS with cognitive function measures, and diabetes with cognitive decline. Until we have a definition of the MetS more based on pathophysiology, the components of the MetS should be the focus of analysis in future studies.

scholarly journals Individual and Combined Associations of Glucose Metabolic Components With Cognitive Function Modified by Obesity

2021 ◽  
Vol 12 ◽  
Author(s):  
Ruixin He ◽  
Ruizhi Zheng ◽  
Jie Li ◽  
Qiuyu Cao ◽  
Tianzhichao Hou ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Cognitive Function ◽  
Regression Models ◽  
Positive Association ◽  
Digit Symbol Substitution Test ◽  
Metabolic Risk ◽  
Model Assessment ◽  
Linear Regression Models ◽  
Logistic Regression Models ◽  
The Individual

AimWe aimed to detect the individual and combined effect of glucose metabolic components on cognitive function in particular domains among older adults.MethodsData of 2,925 adults aged over 60 years from the 2011 to 2014 National Health and Nutrition Examination Survey were analyzed. Individuals’ cognitive function was evaluated using the Digit Symbol Substitution Test (DSST), the Animal Fluency Test (AF), the Consortium to Establish a Registry for Alzheimer’s Disease Immediate Recall (CERAD-IR), and CERAD Delayed Recall (CERAD-DR). Participants’ glucose metabolic health status was determined based on fasting plasma glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), and 2-h postload glucose. Linear regression models were used to delineate the associations of cognitive function with individual glucose metabolic component and with metformin use. Logistic regression models were performed to evaluate the associations of cognition with the number of glucose metabolic risk components.ResultsCERAD-IR was significantly associated with HOMA-IR and insulin. HbA1c was related to all the cognitive tests except AF. Among participants without obesity, HOMA-IR and insulin were both negatively associated with CERAD-IR and CERAD-DR. Odds of scoring low in DSST increased with the number of glucose metabolic risk components (odds ratio 1.94, 95% confidence interval [CI] 1.26 to 2.98). Metformin use was associated with better performance in DSST among diabetes patients (β = 4.184, 95% CI 1.655 to 6.713).ConclusionsOur findings support the associations of insulin resistance and glycemic level with cognitive function in key domains, especially among adults without obesity. There is a positive association between metformin use and cognition.

scholarly journals Fatty Liver as a Potential Surrogate for Waist Circumference in the Diagnosis of Metabolic Syndrome: A Population-Based Study among Chinese Adults

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Boren Jiang ◽  
Ting Gu ◽  
Kun Zhou ◽  
Yanjun Zheng ◽  
Yuyu Guo ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Metabolic Disorder ◽  
Surrogate Marker ◽  
Population Based ◽  
Model Assessment ◽  
Chinese Adults ◽  
Severe Insulin Resistance ◽  
Logistic Regression Models

Increased waist circumference (WC) is an essential component of metabolic syndrome (MetS). Asians have been found to have more intra-abdominal adipose tissue than Caucasians, in spite of having smaller WC. The purpose of this study was to explore whether NAFLD could be used as a surrogate for MetS diagnosis in the normal WC population. A total of 9694 Chinese residents were selected from SPECT-China, a population-based survey of Chinese adults aged ≥ 18 years in East China. Insulin resistance was calculated by the homeostatic model assessment for insulin resistance (HOMA-IR). MetS z-score was used to evaluate the degree of total metabolic disorder. Logistic regression models were used to obtain the associations between different categories and metabolic syndrome (MetS) components. The prevalence of NAFLD was 27.6%, in which 35.2% were without abnormal WC. Subjects with only NAFLD had similarly severe insulin resistance and OR for clustering of MetS components compared with those with only abnormal WC. A considerable number of NAFLD cases, although had severe metabolic disorder, would not be detected by the current MetS definition. NAFLD could be used as a potential surrogate marker for the diagnosis of MetS in normal WC population.

Cognitive Syndrome(s) in Preclinical and Clinical Vascular Dementia

2003 ◽  
Vol 15 (S1) ◽  
pp. 127-131 ◽  
Author(s):  
Ove Almkvist
Keyword(s):  
Executive Function ◽  
Cognitive Function ◽  
Executive Functions ◽  
Cognitive Decline ◽  
Vascular Dementia ◽  
Cognitive Dysfunction ◽  
Stroke Survivors ◽  
Clinical Stages

It is still a challenge to identify typical features of cognitive function in vascular dementia (VaD) in clinical as well as in preclinical stages. Selective empirical findings are described to illuminate degrees of cognitive decline. In predementia stages, speeded performance (motor and mental) and executive functions may be affected as demonstrated by CADASIL subjects and stroke survivors. In dementia stages, motor and mental speed as well as executive functions is commonly affected in addition to typical cognitive dysfunction in dementia (memory, verbal, and visuospatial). To summarize characteristics during preclinical and clinical stages, VaD appears to be associated with impairment in motor and mental speed as well as in executive function.

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