Accelerated progression from mild cognitive impairment to dementia in people with diabetes

Diabetes. 2010 Nov;59(11):2928-35. doi: 10.2337/db10-0539. Epub 2010 Aug 16.


Objective: 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 with amnestic MCI [aMCI] and 182 with other cognitive impairment no dementia [oCIND]) age ≥ 75 years were identified at baseline. The two cohorts were followed for 9 years to detect the incident MCI and dementia following international criteria. Diabetes was ascertained based on a medical examination, hypoglycemic 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% CI) of dementia was 2.87 (1.30-6.34) for diabetes, and 4.96 (2.27-10.84) for pre-diabetes. In a 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 3 years in people with MCI. The association of diabetes with the development of MCI is less evident in old people.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amnesia / complications
  • Amnesia / physiopathology
  • Amnesia / psychology
  • Cognition Disorders / complications
  • Cognition Disorders / epidemiology
  • Cognition Disorders / physiopathology*
  • Cognition Disorders / psychology
  • Cross-Sectional Studies
  • Dementia / epidemiology*
  • Diabetes Complications / physiopathology*
  • Diabetes Complications / psychology
  • Diabetes Mellitus / psychology*
  • Disease Progression*
  • Educational Status
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Prediabetic State / physiopathology
  • Prediabetic State / psychology
  • Risk Assessment
  • Severity of Illness Index
  • Stroke / physiopathology
  • Stroke / psychology