Sex-related differences in the prevalence of cognitive impairment among overweight and obese adults with type 2 diabetes

Abstract

Introduction: Type 2 diabetes mellitus and obesity may increase risks for cognitive decline as individuals age. It is unknown whether this results in different prevalences of cognitive impairment for women and men.

Methods: The Action for Health in Diabetes, a randomized controlled clinical trial of a 10-year intensive lifestyle intervention, adjudicated cases of cross-sectional cognitive impairment (mild cognitive impairment or dementia) 10-13 years after enrollment in 3802 individuals (61% women).

Results: The cross-sectional prevalences of cognitive impairment were 8.3% (women) and 14.8% (men): adjusted odds ratio 0.55, 95% confidence interval [0.43, 0.71], P < .001. Demographic, clinical, and lifestyle risk factors varied between women and men but did not account for this difference, which was limited to individuals without apolipoprotein E (APOE)-ε4 alleles (interaction P = .034).

Conclusions: Among overweight and obese adults with type 2 diabetes mellitus, traditional risk factors did not account for the lower prevalence of cognitive impairment observed in women compared with men.

Trial registration: ClinicalTrials.gov NCT00017953.

Keywords: Cognitive impairment; Obesity; Risk factors; Sex differences; Type 2 diabetes mellitus.

Fig. 1.

Prevalence of cognitive impairment (mild cognitive impairment or dementia) by age and sex (interaction P = .669).

Fig. 2.

Probability estimates from a multivariable logistic regression model for cognitive impairment (mild cognitive impairment or dementia) that includes age, history of cardiovascular disease, education, and depression symptoms as predictors.