Diabetes and Prediabetes Inhibit Reversion from Mild Cognitive Impairment to Normal Cognition

Keitaro Makino; Sangyoon Lee; Seongryu Bae; Ippei Chiba; Kenji Harada; Osamu Katayama; Yohei Shinkai; Hyuma Makizako; Hiroyuki Shimada

doi:10.1016/j.jamda.2021.02.033

Diabetes and Prediabetes Inhibit Reversion from Mild Cognitive Impairment to Normal Cognition

J Am Med Dir Assoc. 2021 Sep;22(9):1912-1918.e2. doi: 10.1016/j.jamda.2021.02.033. Epub 2021 Mar 31.

Authors

Keitaro Makino¹, Sangyoon Lee², Seongryu Bae², Ippei Chiba², Kenji Harada², Osamu Katayama², Yohei Shinkai², Hyuma Makizako³, Hiroyuki Shimada⁴

Affiliations

¹ Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan; Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan. Electronic address: kmakino@ncgg.go.jp.
² Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan.
³ Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan; Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
⁴ Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan.

PMID: 33798483
DOI: 10.1016/j.jamda.2021.02.033

Abstract

Objectives: Diabetes and prediabetes contribute to an increased risk of cognitive decline and dementia. Currently, it remains unclear whether elevated blood HbA1c levels, including prediabetes levels, affect reversion from mild cognitive impairment (MCI) to normal cognition. This study, therefore, aimed to examine the prospective associations of diabetes and prediabetes with reversion from MCI to normal cognition among community-dwelling older adults.

Design: Longitudinal cohort study with a 4-year follow-up.

Setting and participants: Community-dwelling older adults with MCI, aged ≥65 years at baseline (n = 787).

Methods: Participants' medical history of diabetes and blood HbA1c levels at baseline were assessed, and they were classified as control, prediabetes, and diabetes. Objective cognitive screening was performed using a multicomponent neurocognitive test at baseline and follow-up. Reversion from MCI to normal cognition over 4 years was determined. In the longitudinal analysis, we performed multiple imputations to adjust for a selection bias and loss of information.

Results: The reversion rates of MCI in the control, prediabetes, and diabetes groups were 63.4%, 55.6%, and 42.9%, respectively, in the completed follow-up dataset, and 54.6%, 47.2%, and 34.1%, respectively, in the imputed dataset. Multivariate logistic regression showed that diabetes decreases the probability of MCI reversion both before and after multiple imputations [odds ratio (OR) 0.37; 95% confidence interval (CI) 0.18-0.74 for before imputation, OR 0.37; 95% CI 0.19-0.72 for after imputation]. Furthermore, prediabetes also showed significantly decreased probabilities of MCI reversion both before and after multiple imputations (OR 0.57; 95% CI 0.34-0.94 for before imputation, OR 0.60; 95% CI 0.37-0.97 for after imputation).

Conclusions and implications: Diabetes and prediabetes could inhibit MCI reversion. Adequate glycemic control may be effective in enhancing the reversion from MCI to normal cognition in a community setting.

Keywords: Community-dwelling; HbA1c; MCI; diabetes; prediabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cognition
Cognitive Dysfunction* / diagnosis
Cognitive Dysfunction* / epidemiology
Cohort Studies
Humans
Longitudinal Studies
Neuropsychological Tests
Prediabetic State* / diagnosis