Diabetes, Hemoglobin A1c, and Cognitive Performance in Older Adults: is There Any Impact of Frailty? Evidence from the ELSI-Brazil Study

Overview

Journal Braz J Med Biol Res

Specialties Biology
General Medicine

Date 2024 Feb 21

PMID 38381882

Authors

J G Souza

D S Farias-Itao

M J R Aliberti

T S Alexandre

C Szlejf

C P Ferri

M F Lima-Costa

C K Suemoto

Affiliations

Soon will be listed here.

Abstract

The aim of this study was to evaluate the association between diabetes and cognitive performance in a nationally representative study in Brazil. We also aimed to investigate the interaction between frailty and diabetes on cognitive performance. A cross-sectional analysis of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline data that included adults aged 50 years and older was conducted. Linear regression models were used to study the association between diabetes and cognitive performance. A total of 8,149 participants were included, and a subgroup analysis was performed in 1,768 with hemoglobin A1c data. Diabetes and hemoglobin A1c levels were not associated with cognitive performance. Interaction of hemoglobin A1c levels with frailty status was found on global cognitive z-score (P-value for interaction=0.038). These results suggested an association between higher hemoglobin A1c levels and lower cognitive performance only in non-frail participants. Additionally, undiagnosed diabetes with higher hemoglobin A1c levels was associated with both poor global cognitive (β=-0.36; 95%CI: -0.62; -0.10, P=0.008) and semantic verbal fluency performance (β=-0.47; 95%CI: -0.73; -0.21, P=0.001). In conclusion, higher hemoglobin A1c levels were associated with lower cognitive performance among non-frail participants. Higher hemoglobin A1c levels without a previous diagnosis of diabetes were also related to poor cognitive performance. Future longitudinal analyses of the ELSI-Brazil study will provide further information on the role of frailty in the association of diabetes and glycemic control with cognitive decline.

References

Rockwood K, Mitnitski A . Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2010; 27(1):17-26. DOI: 10.1016/j.cger.2010.08.008. View

de Oliveira Duarte Y, Pires Nunes D, Andrade F, Corona L, Brito T, Dos Santos J . Frailty in older adults in the city of São Paulo: Prevalence and associated factors. Rev Bras Epidemiol. 2019; 21Suppl 02(Suppl 02):e180021. DOI: 10.1590/1980-549720180021.supl.2. View

Mattishent K, Loke Y . Bi-directional interaction between hypoglycaemia and cognitive impairment in elderly patients treated with glucose-lowering agents: a systematic review and meta-analysis. Diabetes Obes Metab. 2015; 18(2):135-41. DOI: 10.1111/dom.12587. View

Dagogo-Jack S . Pitfalls in the use of HbA₁(c) as a diagnostic test: the ethnic conundrum. Nat Rev Endocrinol. 2010; 6(10):589-93. DOI: 10.1038/nrendo.2010.126. View

Lei X, Smith J, Sun X, Zhao Y . Gender Differences in Cognition in China and Reasons for Change over Time: Evidence from CHARLS. J Econ Ageing. 2014; 4:46-55. PMC: 4269268. DOI: 10.1016/j.jeoa.2013.11.001. View

Hopkins R, Shaver K, Weinstock R . Management of Adults With Diabetes and Cognitive Problems. Diabetes Spectr. 2016; 29(4):224-237. PMC: 5111537. DOI: 10.2337/ds16-0035. View

Sonnega A, Faul J, Ofstedal M, Langa K, Phillips J, Weir D . Cohort Profile: the Health and Retirement Study (HRS). Int J Epidemiol. 2014; 43(2):576-85. PMC: 3997380. DOI: 10.1093/ije/dyu067. View

Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146-56. DOI: 10.1093/gerona/56.3.m146. View

Suemoto C, Ueda P, Beltran-Sanchez H, Lebrao M, Duarte Y, Wong R . Development and Validation of a 10-Year Mortality Prediction Model: Meta-Analysis of Individual Participant Data From Five Cohorts of Older Adults in Developed and Developing Countries. J Gerontol A Biol Sci Med Sci. 2016; 72(3):410-416. PMC: 6075520. DOI: 10.1093/gerona/glw166. View

10.

Turvey C, Wallace R, Herzog R . A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. Int Psychogeriatr. 2001; 11(2):139-48. DOI: 10.1017/s1041610299005694. View

11.

Lima-Costa M, Andrade F, de Souza Jr P, Neri A, de Oliveira Duarte Y, Castro-Costa E . The Brazilian Longitudinal Study of Aging (ELSI-Brazil): Objectives and Design. Am J Epidemiol. 2018; 187(7):1345-1353. PMC: 6031009. DOI: 10.1093/aje/kwx387. View

12.

Memoria C, Yassuda M, Nakano E, Forlenza O . Brief screening for mild cognitive impairment: validation of the Brazilian version of the Montreal cognitive assessment. Int J Geriatr Psychiatry. 2012; 28(1):34-40. DOI: 10.1002/gps.3787. View

13.

Collard R, Boter H, Schoevers R, Oude Voshaar R . Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012; 60(8):1487-92. DOI: 10.1111/j.1532-5415.2012.04054.x. View

14.

Cheng G, Huang C, Deng H, Wang H . Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J. 2012; 42(5):484-91. DOI: 10.1111/j.1445-5994.2012.02758.x. View

15.

Kulmala J, Nykanen I, Manty M, Hartikainen S . Association between frailty and dementia: a population-based study. Gerontology. 2013; 60(1):16-21. DOI: 10.1159/000353859. View

16.

Li W, Risacher S, Huang E, Saykin A . Type 2 diabetes mellitus is associated with brain atrophy and hypometabolism in the ADNI cohort. Neurology. 2016; 87(6):595-600. PMC: 4977372. DOI: 10.1212/WNL.0000000000002950. View

17.

Cochar-Soares N, de Carvalho D, de Andrade F, Castro-Costa E, de Oliveira C, Lima-Costa M . Does undiagnosed diabetes mitigate the association between diabetes and cognitive impairment? Findings from the ELSI-Brazil study. J Diabetes. 2020; 12(11):834-843. DOI: 10.1111/1753-0407.13074. View

18.

Mejia-Arango S, Wong R, Michaels-Obregon A . Normative and standardized data for cognitive measures in the Mexican Health and Aging Study. Salud Publica Mex. 2015; 57 Suppl 1:S90-6. PMC: 4698135. DOI: 10.21149/spm.v57s1.7594. View

19.

ElSayed N, Aleppo G, Aroda V, Bannuru R, Brown F, Bruemmer D . 6. Glycemic Targets: Standards of Care in Diabetes-2023. Diabetes Care. 2022; 46(Suppl 1):S97-S110. PMC: 9810469. DOI: 10.2337/dc23-S006. View

20.

Kirkman M, Jones Briscoe V, Clark N, Florez H, Haas L, Halter J . Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012; 60(12):2342-56. PMC: 4525769. DOI: 10.1111/jgs.12035. View