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. 2016 Sep 8:7:123.
doi: 10.3389/fendo.2016.00123. eCollection 2016.

Predictors of Cognitive Decline in Older Adult Type 2 Diabetes from the Veterans Affairs Diabetes Trial

Mark B Zimering  1 , Jeffrey Knight  2 , Ling Ge  3 , Gideon Bahn  3 ; VADT Investigators
Collaborators, Affiliations

Predictors of Cognitive Decline in Older Adult Type 2 Diabetes from the Veterans Affairs Diabetes Trial

Mark B Zimering et al. Front Endocrinol (Lausanne). .

Abstract

Aims: Cognitive decline disproportionately affects older adult type 2 diabetes. We tested whether randomized intensive (INT) glucose-lowering reduces the rate(s) of cognitive decline in adults with advanced type 2 diabetes (mean: age, 60 years; diabetes duration, 11 years) from the Veterans Affairs Diabetes Trial.

Methods: A battery of neuropsychological tests [digit span, digit symbol substitution (DSym), and Trails-making Test-Part B (TMT-B)] was administered at baseline in ~1700 participants and repeated at year 5. Thirty-seven risk factors were evaluated as predictors of cognitive decline in multivariable regression analyses.

Results: The mean age-adjusted DSym or TMT-B declined significantly in all study participants (P < 0.001). Randomized INT glucose-lowering did not significantly alter the rate of cognitive decline. The final model of risk factors associated with 5-year decline in age-adjusted TMT-B included as significant predictors: longer baseline diabetes duration (beta = -0.028; P = 0.0057), lower baseline diastolic blood pressure (BP; beta = 0.028; P = 0.002), and baseline calcium channel blocker medication use (beta = -0.639; P < 0.001). Higher baseline pulse pressure was significantly associated with decline in age-adjusted TMT-B suggesting a role for both higher systolic and lower diastolic BPs. Baseline thiazide diuretic use (beta = -0.549; P = 0.015) was an additional significant predictor of 5-year decline in age-adjusted digit symbol score. Post-baseline systolic BP-lowering was significantly associated (P < 0.001) with decline in TMT-B performance. There was a significant inverse association between post-baseline plasma triglyceride-lowering (P = 0.045) and decline in digit symbol substitution task performance.

Conclusion: A 5-year period of randomized INT glucose-lowering did not significantly reduce the rate of cognitive decline in older-aged adults with type 2 diabetes. Systolic and diastolic BPs as well as plasma triglycerides appeared as modifiable risk factors of the rate of cognitive decline in older adult type 2 diabetes.

Keywords: blood pressure; cognitive decline; diabetes duration; risk factors; type 2 diabetes mellitus.

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Figures

Figure 1
Figure 1
Box–whisker plot of the distribution of 5-year change in (A) digit span, (B) Trails making Test-Part B, or (C) Digit Symbol age-adjusted test score in standard vs. intensive glucose-lowering treatment groups. (A–C) P-value(s) from T-test comparing mean scaled score in standard vs. intensive glucose-lowering treatment group. Boxes represent first and third quartiles, horizontal line denotes median value, whiskers represent minimum and maximum values. (A) N = 1174; (B) N = 1155; (C) N = 1114.
Figure 1
Figure 1
Box–whisker plot of the distribution of 5-year change in (A) digit span, (B) Trails making Test-Part B, or (C) Digit Symbol age-adjusted test score in standard vs. intensive glucose-lowering treatment groups. (A–C) P-value(s) from T-test comparing mean scaled score in standard vs. intensive glucose-lowering treatment group. Boxes represent first and third quartiles, horizontal line denotes median value, whiskers represent minimum and maximum values. (A) N = 1174; (B) N = 1155; (C) N = 1114.
See this image and copyright information in PMC

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