(03-09-10) Accelerated Progression from Mild Cognitive Impairment to Dementia in People with Diabetes.

Xu W, Caracciolo B, Wang HX, Winblad B, B?ckman L, Qiu C, Fratiglioni L.

1. Aging Research Center, Department of Neurobiology, Care Sciences and
Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Abstract
AbstractObjective: The effect of diabetes on mild cognitive impairment (MCI)
and its conversion to dementia remains controversial. We sought to examine
whether diabetes and pre-diabetes are associated with MCI, and accelerate the
progression from MCI to dementia. Research design and methods: In the
Kungsholmen Project, 963 cognitively intact participants and 302 subjects with
MCI (120 amnestic MCI [aMCI] and 182 other cognitive impairment no dementia
[oCIND]) aged >/= 75 years were identified at baseline. The two cohorts were
followed for 9 years to detect incident MCI and dementia following
international criteria. Diabetes was ascertained based on medical examination,
hypoglycaemic medication use, and random blood glucose level >/= 11.0 mmol/l.
Pre-diabetes was defined as random blood glucose level of 7.8-11.0 mmol/l in
diabetes-free participants. Data were analyzed using standard and time-
dependent Cox proportional-hazards models. Results: During the follow-up
period, in the cognitively intact cohort, 182 people developed MCI (42 aMCI and
140 oCIND), and 212 developed dementia. In the MCI cohort, 155 subjects
progressed to dementia, the multi-adjusted hazard ratio (95% confidence
interval) of dementia was 2.87 (1.30-6.34) for diabetes, and 4.96 (2.27-10.84)
for pre-diabetes. In Kaplan-Meier survival analysis, diabetes and pre-diabetes
accelerated the progression from MCI to dementia by 3.18 years. Diabetes and
pre-diabetes were neither cross-sectionally nor longitudinally associated with
MCI. Conclusions: Diabetes and pre-diabetes substantially accelerate the
progression from MCI to dementia, and anticipate dementia occurrence by more
than three years in people with MCI. The association of diabetes with the
development of MCI is less evident in old people.

Source: Diabetes. 2010 Aug 16. [Epub ahead of print]

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