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American Journal of Epidemiology Advance Access originally published online on October 3, 2008
American Journal of Epidemiology 2008 168(10):1132-1139; doi:10.1093/aje/kwn228
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Cognitive Impairment: An Increasingly Important Complication of Type 2 Diabetes

The Age, Gene/Environment Susceptibility–Reykjavik Study

Jane S. Saczynski, María K. Jónsdóttir, Melissa E. Garcia, Palmi V. Jonsson, Rita Peila, Gudny Eiriksdottir, Elin Olafsdottir, Tamara B. Harris, Vilmundur Gudnason and Lenore J. Launer

Correspondence to Dr. Jane S. Saczynski, Division of Geriatric Medicine, University of Massachusetts Medical School, Biotech Four, Suite 315, 377 Plantation Street, Worcester, MA 01605 (e-mail:jane.saczynski{at}umassmed.edu).

Received for publication April 10, 2008. Accepted for publication July 2, 2008.

Persons with type 2 diabetes are at increased risk of cognitive dysfunction. Less is known about which cognitive abilities are affected and how undiagnosed diabetes and impaired fasting glucose relate to cognitive performance. The authors explored this question using data from 1,917 nondemented men and women (average age = 76 years) in the population-based Age, Gene/Environment Susceptibility–Reykjavik Study (2002–2006). Glycemic status groups included diagnosed diabetes (self-reported diabetes or diabetic medication use; n = 163 (8.5%)), undiagnosed diabetes (fasting blood glucose ≥7.0 mmol/L without diagnosed diabetes; n = 55 (2.9%)), and impaired fasting glucose (fasting blood glucose 5.6–6.9 mmol/L; n = 744 (38.8%)). Composites of memory, processing speed (PS), and executive function were constructed from a neuropsychological battery. Linear regression was used to investigate cross-sectional differences in cognitive performance between glycemic groups, adjusted for demographic and health factors. Persons with diagnosed diabetes had slower PS than normoglycemics (β = –0.12; P < 0.05); diabetes duration of ≥15 years was associated with significantly poorer PS and executive function. Undiagnosed diabetics had slower PS (β = –0.22; P < 0.01) and poorer memory performance (β = –0.22; P < 0.05). Persons with type 2 diabetes have poorer cognitive performance than normoglycemics, particularly in PS. Those with undiagnosed diabetes have the lowest cognitive performance.

cognition; diabetes mellitus, type 2

Abbreviations: ADA, American Diabetes Association; AGES-Reykjavik, Age, Gene/Environment Susceptibility–Reykjavik; CI, confidence interval; MRI, magnetic resonance imaging


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