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

Kristine Yaffe, Cherie M. Falvey, Nathan Hamilton, Tamara B. Harris, Eleanor M. Simonsick, Elsa S. Strotmeyer, Ronald I. Shorr, Andrea Metti, Ann V. Schwartz

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1300-1306
Number of pages7
JournalJAMA internal medicine
Volume173
Issue number14
DOIs
StatePublished - Jul 22 2013
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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    Yaffe, K., Falvey, C. M., Hamilton, N., Harris, T. B., Simonsick, E. M., Strotmeyer, E. S., Shorr, R. I., Metti, A., & Schwartz, A. V. (2013). Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA internal medicine, 173(14), 1300-1306. https://doi.org/10.1001/jamainternmed.2013.6176