Eight-Year Longitudinal Associations of the Onset of Prediabetes and Diabetes with Cognitive Function Decline Among Chinese Adults Aged 45 Years or Older

Abstract

\n Background\n\nWith the population aging, diabetes and cognitive function decline are increasingly common among older adults worldwide. However, the evidence about the effects and mechanism of prediabetes and diabetes on cognitive function is still limited. The purposes of this longitudinal study were to estimate the longitudinal associations of the onset of prediabetes and diabetes status with cognitive function among Chinese adults aged 45 years or older during an 8-year period; to estimate the clinical risk factors associated with cognitive function among patients with prediabetes and diabetes.\nMethods\n\nParticipants were enrolled between 2011 and 2012, and followed up between 2018 and 2019 in the China Health and Retirement Longitudinal Study. In this study, we focused on newly diagnosed diabetic status, and those diagnosed with diabetes before or not providing fasting blood samples were excluded. Diabetic status was assessed according to the 2010 American Diabetes Association (ADA) guidelines. The general cognitive function, demographic characteristics, and clinical and biochemical factors were also measured.\nResults\n\nAt baseline, 849 (21.3%) participants were first diagnosed with prediabetes, and 444 (11.1%) were diabetes patients. After adjusting for age, gender, marital status, education level, ever smoking, ever drinking, self-comment about health, hypertension, dyslipidemia, depressive symptoms, cognitive function, and clinical and biochemical measurements at baseline, diabetes status was a significant risk factor for subsequent cognitive decline (unstandardized β estimate=-0.47, 95% CI=-0.91~-0.04). Further stratification analyses found that only triglyceride concentrations were negatively associated with cognitive function among prediabetes patients (unstandardized β estimate=-0.004, 95% CI=-0.007~-0.001), and only creatine reactive protein was significantly associated with cognitive decline among diabetes patients (unstandardized β estimate=-0.065, 95% CI=-0.122~-0.009).\nConclusions\n\nThere is a positive longitudinal association between the onset of diabetes and cognitive decline among middle-aged and elderly Chinese. The management of triglycerides through lifestyle modification for prediabetes and specific adjunctive anti-inflammatory therapy for diabetes could benefit cognitive performance.