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

JAMA Intern Med. 2013 Jul 22;173(14):1300-6. doi: 10.1001/jamainternmed.2013.6176.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Continental Ancestry Group / statistics & numerical data
  • Age Factors
  • Aged
  • Apolipoprotein E4 / genetics
  • Dementia / epidemiology*
  • Diabetes Mellitus / epidemiology*
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Humans
  • Hypoglycemia / epidemiology*
  • Male
  • Multivariate Analysis
  • Neuropsychological Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors

Substances

  • Apolipoprotein E4