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. 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

Kristine Yaffe  1 , Cherie M Falvey, Nathan Hamilton, Tamara B Harris, Eleanor M Simonsick, Elsa S Strotmeyer, Ronald I Shorr, Andrea Metti, Ann V Schwartz; Health ABC Study
Collaborators, Affiliations

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

Kristine Yaffe et al. JAMA Intern Med. .

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%, P < .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%, P < .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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Yaffe has served on data safety monitoring boards for Takeda Inc, Pfizer Inc, and Medivation Inc and served as a consultant for Novartis Inc.

Figures

Figure
Figure. Survival Probability Curves From Kaplan-Meier Analysis Among Older Adults With Diabetes Mellitus
A, Time to dementia associated with a preceding hypoglycemic event. B, Time to a hypoglycemic event associated with a preceding dementia diagnosis.
See this image and copyright information in PMC

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