VANCOUVER—Patients with hypoglycemia have a twofold increased risk for dementia compared to those without hypoglycemia, while older adults with diabetes and dementia have a greater risk of having a hypoglycemic event than those without dementia, according to research presented at the 2012 Alzheimer’s Association International Conference.
“This suggests that elders with diabetes may be particularly vulnerable to a vicious cycle of compromised disease management leading to cognitive impairment and further risk of poor disease management,” reported Cherie Falvey, MPH, staff research associate, Department of Psychiatry, and Kristine Yaffe, MD, Professor of Psychiatry, Neurology, Epidemiology, and Biostatistics, University of California, San Francisco.
Although hypoglycemia may contribute to diabetes-related cognitive impairment, the few investigations of hypoglycemia and cognitive function have had inconsistent findings, noted the researchers.
Ms. Falvey and Dr. Yaffe sought to determine a potential association between hypoglycemia and dementia in 913 older adults with diabetes (mean age, 74; 52% black; 48% female) who were participating in the Health ABC study. All subjects were free of dementia at baseline.
The investigators obtained a history of participants’ hypoglycemic events using hospital records that had indicated a visit that was associated with hypoglycemia. A diagnosis of dementia was determined with the use of hospital records or the use of prescribed dementia medications. Cox-proportional hazard regression models were used to estimate the association between time to dementia diagnosis following a hypoglycemic event and the association between time to a hypoglycemic event after a dementia diagnosis. Models were adjusted for age, race, sex, and education.
After a follow-up period of 12 years, the researchers found that 77 (8.4%) participants experienced a hypoglycemic event and 178 (19.4%) older adults with diabetes developed dementia.
“Compared to those without a hypoglycemic event, participants who experienced a hypoglycemic event had a twofold increased risk of dementia (18.2% vs 33.8%; unadjusted HR = 2.0),” reported the investigators.
“Similarly, older adults with diabetes who were diagnosed with dementia had a greater risk of experiencing a hypoglycemic event than participants without dementia (14.6% vs 6.9%; HR = 1.96). Adjusting for age, race, sex, and education produced similar results,” the researchers concluded.
Yaffe K, Falvey C, Hamilton N, et al. Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia, diabetes, and risk of cognitive decline. Arch Neurol. 2012 Jun 18 [Epub ahead of print].