Cognitive Impairment in Older Adults with Type 1 Diabetes: Longitudinal data from the Wireless Innovation for Seniors with Diabetes Mellitus (WISDM) Study

Abstract

AbstractBackgroundAdults with type 1 diabetes (T1D) are at increased risk for cognitive impairment, accelerated brain aging, and Alzheimer’s disease and related dementias (ADRD). However, longitudinal data on cognitive aging, cognitive impairment and ADRD in adults with T1D are still scarce. The aim of this study was to characterize cognitive impairment in a longitudinal sample of older adults with T1D.MethodWe analyzed data collected as part of the Wireless Innovation for Seniors with Diabetes Mellitus (WISDM) Study (Pratley et al., JAMA, 2020; 323(23):2397‐2406), in which 22 endocrinology practices in the United States participated. Participants with T1D ≥ 60 years of age who completed the NIH Toolbox Cognition Battery at two time points (baseline and one year follow up) were included in this study (n = 171). Cognitive impairment was classified using recommendations from Holdnack et al, 2017 (Holdnack et al., Arch Clin Neuropsychol, 2017; 32(5):574‐584).ResultAt baseline, 50% of the participants (N = 86/171) met criteria for cognitive impairment. Of those, 56% (N = 48/86) were still classified as having cognitive impairment a year later (28% of the total sample, N = 48/171). Conversely, 44% (N = 38/86) of the participants classified with impairment at baseline reverted to no impairment by a year. Of those classified as having normal cognition during the baseline assessment, 20% converted to impaired at the follow up (N = 17/85), while 80% (N = 68/85) remained normal.ConclusionThese data indicate that caution is warranted when assessing cognition in older adults with T1D, as a large percentage of those identified as having cognitive impairment at baseline reverted to normal after a year. Serial cognitive assessment is suggested. Longitudinal research with more diverse samples of older adults with T1D is needed to better understand the clinical utility of the NIH toolbox cognition battery and other neuropsychological assessments in older individuals with T1D.