Abstract
BackgroundThe mechanisms related to cognitive impairment in older persons with Type 2 diabetes (DM) remains unclear. We tested if adiposity parameters and body fat distribution could predict cognitive decline in older persons with DM vs. normal glucose tolerance (NGT).Methodology693 older persons with no dementia were enrolled: 253 with DM in good metabolic control; 440 with NGT (age range:65–85 years). Longitudinal study comparing DM and NGT individuals according to the association of baseline adiposity parameters (body mass index (BMI), waist-hip-ratio (WHR), waist circumference (WC) and total body fat mass) to cognitive change (Mini Mental State Examination (MMSE), a composite score of executive and attention functioning (CCS) over time.FindingsAt baseline, in DM participants, MMSE correlated with WHR (β = −0.240; p = 0.043), WC (β = −0.264; p = 0.041) while CCS correlated with WHR (β = −0.238; p = 0.041), WC (β = −0.326; p = 0.013) after adjusting for confounders. In NGT subjects, no significant correlations were found among any adiposity parameters and MMSE, while CCS was associated with WHR (β = −0.194; p = 0.036) and WC (β = −0.210; p = 0.024). Participants with DM in the 3rd tertile of total fat mass showed the greatest decline in cognitive performance compared to those in 1st tertile (tests for trend: MMSE(p = 0.007), CCS(p = 0.003)). Logistic regression models showed that 3rd vs. 1st tertile of total fat mass, WHR, and WC predicted an almost two-fold decline in cognitive function in DM subjects at 2nd yr (OR 1.68, 95%IC 1.08–3.52).ConclusionsTotal fat mass and central adiposity predict an increased risk for cognitive decline in older person with DM.
Highlights
Type 2 diabetes mellitus(DM) has been consistently associated with a higher risk of cognitive decline, especially in older persons[1]
To address the hypothesis that body fat tissue distribution in older persons with diabetes may predict a greater decline in cognitive performance, we examined the relationship between adiposity parameters at baseline and the risk of decline on cognitive performance over a two year observation period in a large group of older persons with DM and normal glucose tolerance (NGT)
In NGT participants, we found a significant increase in total body fat (25.766.8 vs. 27.267.2 kg; p = 0.023), BMI (26.363.7 vs. 27.263.4 kg/m2; p = 0.012), WC (89.7611.1 vs. 91.269.8 cm; p,0.001), but without any significant change in cognitive performance compared to baseline values
Summary
Type 2 diabetes mellitus(DM) has been consistently associated with a higher risk of cognitive decline, especially in older persons[1]. Such individuals are almost two times more likely to experience cognitive decline and dementia compared to those with normal glucose tolerance (NGT)[2]. Considering that older diabetics are at a significantly higher risk of cognitive disability, a further role of changes in body composition, in particular adipose tissue distribution on cognitive decline may be hypothesized. We tested if adiposity parameters and body fat distribution could predict cognitive decline in older persons with DM vs normal glucose tolerance (NGT)
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