TY - JOUR
T1 - Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus
AU - Yaffe, Kristine
AU - Falvey, Cherie M.
AU - Hamilton, Nathan
AU - Harris, Tamara B.
AU - Simonsick, Eleanor M.
AU - Strotmeyer, Elsa S.
AU - Shorr, Ronald I.
AU - Metti, Andrea
AU - Schwartz, Ann V.
PY - 2013/7/22
Y1 - 2013/7/22
N2 - 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.
AB - 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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U2 - 10.1001/jamainternmed.2013.6176
DO - 10.1001/jamainternmed.2013.6176
M3 - Article
C2 - 23753199
AN - SCOPUS:84879643475
SN - 2168-6106
VL - 173
SP - 1300
EP - 1306
JO - JAMA internal medicine
JF - JAMA internal medicine
IS - 14
ER -