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JAMA Intern Med. 2013 Jul 22;173(14):1300-6. doi: 10.1001/jamainternmed.2013.6176.

Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus.

Author information

1
Department of Psychiatry, University of California, San Francisco, San Francisco, California 94121, USA. kristine.yaffe@ucsf.edu

Abstract

IMPORTANCE:

Hypoglycemia commonly occurs in patients with diabetes mellitus (DM) and may negatively influence cognitive performance. Cognitive impairment in turn can compromise DM management and lead to hypoglycemia.

OBJECTIVE:

To prospectively evaluate the association between hypoglycemia and dementia in a biracial cohort of older adults with DM.

DESIGN AND SETTING:

Prospective population-based study.

PARTICIPANTS:

We studied 783 older adults with DM (mean age, 74.0 years; 47.0% of black race/ethnicity; and 47.6% female) who were participating in the prospective population-based Health, Aging, and Body Composition Study beginning in 1997 and who had baseline Modified Mini-Mental State Examination scores of 80 or higher.

MAIN OUTCOME MEASURES:

Dementia diagnosis was determined during the follow-up period from hospital records indicating an admission associated with dementia or the use of prescribed dementia medications. Hypoglycemic events were determined during the follow-up period by hospital records.

RESULTS:

During the 12-year follow-up period, 61 participants (7.8%) had a reported hypoglycemic event, and 148 (18.9%) developed dementia. Those who experienced a hypoglycemic event had a 2-fold increased risk for developing dementia compared with those who did not have a hypoglycemic event (34.4% vs 17.6%, Pā€‰<ā€‰.001; multivariate-adjusted hazard ratio, 2.1; 95% CI, 1.0-4.4). Similarly, older adults with DM who developed dementia had a greater risk for having a subsequent hypoglycemic event compared with participants who did not develop dementia (14.2% vs 6.3%, Pā€‰<ā€‰.001; multivariate-adjusted hazard ratio, 3.1; 95% CI, 1.5-6.6). Further adjustment for stroke, hypertension, myocardial infarction, and cognitive change scores produced similar results.

CONCLUSION AND RELEVANCE:

Among older adults with DM, there seems to be a bidirectional association between hypoglycemia and dementia.

PMID:
23753199
PMCID:
PMC4041621
DOI:
10.1001/jamainternmed.2013.6176
[Indexed for MEDLINE]
Free PMC Article

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