Skip to main content
Top
Published in: BMC Endocrine Disorders 1/2020

Open Access 01-12-2020 | Diabetes | Research article

Risk of mini-mental state examination (MMSE) decline in the elderly with type 2 diabetes: a Chinese community-based cohort study

Authors: Lei Zhao, Chao Han, Zheng Zheng, Shuang Ling Xiu, Piu Chan

Published in: BMC Endocrine Disorders | Issue 1/2020

Login to get access

Abstract

Background

We aimed to investigate the correlation of factors involved in the change of Mini-Mental State Examination (MMSE) and type 2 diabetes in the elderly.

Methods

This study was a secondary analysis of a prospective cohort study. Type 2 diabetes patients aged > 55 years were recruited and assigned into three groups based on their glycated hemoglobin (HbA1c) levels: HbA1c < 7, 7% ≤ HbA1c < 8% and HbA1c ≥8%. MMSE decline was considered the endpoint. Factors related to MMSE decline were identified by univariate and multivariate regression analyses.

Results

Altogether, 1519 subjects were included, 883 in the Low group, 333 in the Median group, and 303 in the High group. Age ≥ 75 years, education below elementary school level, not participating in seminars or consultation on healthcare, physical activity less than 30 min/day, cerebrovascular disease history, MMSE score at baseline, and HBA1c ≥8% were associated with cognitive decline by univariate and multivariate analysis. When the other factors were adjusted for, HBA1c ≥8% was independently associated with the severity of cognitive decline (β = 0.58, 95%CI:0.06–1.11, P = 0.029) and the occurrence of cognitive decline (odds ratio (OR) = 1.55, 95%CI:1.13–2.12, P = 0.007).

Conclusions

In elderly patients with type 2 diabetes, HbA1c ≥8% is an independent factor for cognitive decline and is also associated with the severity of the cognitive decline.
Literature
1.
go back to reference Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus--present and future perspectives. Nat Rev Endocrinol. 2011;8:228–36.CrossRef Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus--present and future perspectives. Nat Rev Endocrinol. 2011;8:228–36.CrossRef
2.
go back to reference Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14:88–98.CrossRef Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14:88–98.CrossRef
3.
go back to reference Kautzky-Willer A, Harreiter J, Pacini G. Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr Rev. 2016;37:278–316.CrossRef Kautzky-Willer A, Harreiter J, Pacini G. Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr Rev. 2016;37:278–316.CrossRef
4.
go back to reference Beavers KM, Leng I, Rapp SR, Miller ME, Houston DK, Marsh AP, et al. Effects of longitudinal glucose exposure on cognitive and physical function: results from the action for health in diabetes movement and memory study. J Am Geriatr Soc. 2017;65:137–45.CrossRef Beavers KM, Leng I, Rapp SR, Miller ME, Houston DK, Marsh AP, et al. Effects of longitudinal glucose exposure on cognitive and physical function: results from the action for health in diabetes movement and memory study. J Am Geriatr Soc. 2017;65:137–45.CrossRef
5.
go back to reference Dybjer E, Nilsson PM, Engstrom G, Helmer C, Nagga K. Pre-diabetes and diabetes are independently associated with adverse cognitive test results: a cross-sectional, population-based study. BMC Endocr Disord. 2018;18:91.CrossRef Dybjer E, Nilsson PM, Engstrom G, Helmer C, Nagga K. Pre-diabetes and diabetes are independently associated with adverse cognitive test results: a cross-sectional, population-based study. BMC Endocr Disord. 2018;18:91.CrossRef
6.
go back to reference Reijmer YD, van den Berg E, Ruis C, Kappelle LJ, Biessels GJ. Cognitive dysfunction in patients with type 2 diabetes. Diabetes Metab Res Rev. 2010;26:507–19.CrossRef Reijmer YD, van den Berg E, Ruis C, Kappelle LJ, Biessels GJ. Cognitive dysfunction in patients with type 2 diabetes. Diabetes Metab Res Rev. 2010;26:507–19.CrossRef
7.
go back to reference Rawlings AM, Sharrett AR, Schneider AL, Coresh J, Albert M, Couper D, et al. Diabetes in midlife and cognitive change over 20 years: a cohort study. Ann Intern Med. 2014;161:785–93.CrossRef Rawlings AM, Sharrett AR, Schneider AL, Coresh J, Albert M, Couper D, et al. Diabetes in midlife and cognitive change over 20 years: a cohort study. Ann Intern Med. 2014;161:785–93.CrossRef
8.
go back to reference 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;42:484–91.CrossRef 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;42:484–91.CrossRef
9.
go back to reference Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of Hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of diabetes (EASD). Diabetes Care. 2018;41:2669–701.CrossRef Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of Hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of diabetes (EASD). Diabetes Care. 2018;41:2669–701.CrossRef
10.
go back to reference Zheng F, Yan L, Yang Z, Zhong B, Xie W. HbA1c, diabetes and cognitive decline: the English longitudinal study of ageing. Diabetologia. 2018;61:839–48.CrossRef Zheng F, Yan L, Yang Z, Zhong B, Xie W. HbA1c, diabetes and cognitive decline: the English longitudinal study of ageing. Diabetologia. 2018;61:839–48.CrossRef
11.
go back to reference Saczynski JS, Jonsdottir MK, Garcia ME, Jonsson PV, Peila R, Eiriksdottir G, et al. Cognitive impairment: an increasingly important complication of type 2 diabetes: the age, gene/environment susceptibility--Reykjavik study. Am J Epidemiol. 2008;168:1132–9.CrossRef Saczynski JS, Jonsdottir MK, Garcia ME, Jonsson PV, Peila R, Eiriksdottir G, et al. Cognitive impairment: an increasingly important complication of type 2 diabetes: the age, gene/environment susceptibility--Reykjavik study. Am J Epidemiol. 2008;168:1132–9.CrossRef
12.
go back to reference Nguyen HT, Grzywacz JG, Arcury TA, Chapman C, Kirk JK, Ip EH, et al. Linking glycemic control and executive function in rural older adults with diabetes mellitus. J Am Geriatr Soc. 2010;58:1123–7.CrossRef Nguyen HT, Grzywacz JG, Arcury TA, Chapman C, Kirk JK, Ip EH, et al. Linking glycemic control and executive function in rural older adults with diabetes mellitus. J Am Geriatr Soc. 2010;58:1123–7.CrossRef
13.
go back to reference Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME, et al. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care. 2009;32:221–6.CrossRef Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME, et al. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care. 2009;32:221–6.CrossRef
14.
go back to reference Yaffe K, Falvey C, Hamilton N, Schwartz AV, Simonsick EM, Satterfield S, et al. Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia. Arch Neurol. 2012;69:1170–5.CrossRef Yaffe K, Falvey C, Hamilton N, Schwartz AV, Simonsick EM, Satterfield S, et al. Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia. Arch Neurol. 2012;69:1170–5.CrossRef
15.
go back to reference Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K. Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the rancho Bernardo study cohort. Arch Intern Med. 2004;164:1327–33.CrossRef Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K. Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the rancho Bernardo study cohort. Arch Intern Med. 2004;164:1327–33.CrossRef
16.
go back to reference Christman AL, Matsushita K, Gottesman RF, Mosley T, Alonso A, Coresh J, et al. Glycated haemoglobin and cognitive decline: the atherosclerosis risk in communities (ARIC) study. Diabetologia. 2011;54:1645–52.CrossRef Christman AL, Matsushita K, Gottesman RF, Mosley T, Alonso A, Coresh J, et al. Glycated haemoglobin and cognitive decline: the atherosclerosis risk in communities (ARIC) study. Diabetologia. 2011;54:1645–52.CrossRef
17.
go back to reference Rawlings AM, Sharrett AR, Albert MS, Coresh J, Windham BG, Power MC, et al. The Association of Late-Life Diabetes Status and Hyperglycemia with Incident Mild Cognitive Impairment and dementia: the ARIC study. Diabetes Care. 2019;42:1248–54.CrossRef Rawlings AM, Sharrett AR, Albert MS, Coresh J, Windham BG, Power MC, et al. The Association of Late-Life Diabetes Status and Hyperglycemia with Incident Mild Cognitive Impairment and dementia: the ARIC study. Diabetes Care. 2019;42:1248–54.CrossRef
18.
go back to reference Lu X, Li X, Zhao Y, Zheng Z, Guan S, Chan P. Contemporary epidemiology of gout and hyperuricemia in community elderly in Beijing. Int J Rheum Dis. 2014;17:400–7.CrossRef Lu X, Li X, Zhao Y, Zheng Z, Guan S, Chan P. Contemporary epidemiology of gout and hyperuricemia in community elderly in Beijing. Int J Rheum Dis. 2014;17:400–7.CrossRef
19.
go back to reference Li G, Shen Y, Chen C, Li S, Zhang W, Liu M. Mini Mental State Examination (MMSE) in different population test study. Chinese Mental Health J. 1989;4:148–51. Li G, Shen Y, Chen C, Li S, Zhang W, Liu M. Mini Mental State Examination (MMSE) in different population test study. Chinese Mental Health J. 1989;4:148–51.
20.
go back to reference Geijselaers SLC, Sep SJS, Stehouwer CDA, Biessels GJ. Glucose regulation, cognition, and brain MRI in type 2 diabetes: a systematic review. Lancet Diabetes Endocrinol. 2015;3:75–89.CrossRef Geijselaers SLC, Sep SJS, Stehouwer CDA, Biessels GJ. Glucose regulation, cognition, and brain MRI in type 2 diabetes: a systematic review. Lancet Diabetes Endocrinol. 2015;3:75–89.CrossRef
21.
go back to reference Rawlings AM, Sharrett AR, Mosley TH, Ballew SH, Deal JA, Selvin E. Glucose peaks and the risk of dementia and 20-year cognitive decline. Diabetes Care. 2017;40:879–86.CrossRef Rawlings AM, Sharrett AR, Mosley TH, Ballew SH, Deal JA, Selvin E. Glucose peaks and the risk of dementia and 20-year cognitive decline. Diabetes Care. 2017;40:879–86.CrossRef
22.
go back to reference Pandini G, Pace V, Copani A, Squatrito S, Milardi D, Vigneri R. Insulin has multiple antiamyloidogenic effects on human neuronal cells. Endocrinology. 2013;154:375–87.CrossRef Pandini G, Pace V, Copani A, Squatrito S, Milardi D, Vigneri R. Insulin has multiple antiamyloidogenic effects on human neuronal cells. Endocrinology. 2013;154:375–87.CrossRef
23.
go back to reference Strachan MW. R D Lawrence lecture 2010. The brain as a target organ in type 2 diabetes: exploring the links with cognitive impairment and dementia. Diabet Med. 2011;28:141–7.CrossRef Strachan MW. R D Lawrence lecture 2010. The brain as a target organ in type 2 diabetes: exploring the links with cognitive impairment and dementia. Diabet Med. 2011;28:141–7.CrossRef
24.
go back to reference Ceriello A, Esposito K, Piconi L, Ihnat MA, Thorpe JE, Testa R, et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes. 2008;57:1349–54.CrossRef Ceriello A, Esposito K, Piconi L, Ihnat MA, Thorpe JE, Testa R, et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes. 2008;57:1349–54.CrossRef
25.
go back to reference Li H, Jia J, Yang Z. Mini-mental state examination in elderly Chinese: a population-based normative study. J Alzheimers Dis. 2016;53:487–96.CrossRef Li H, Jia J, Yang Z. Mini-mental state examination in elderly Chinese: a population-based normative study. J Alzheimers Dis. 2016;53:487–96.CrossRef
26.
go back to reference Falk N, Cole A, Meredith TJ. Evaluation of suspected dementia. Am Fam Physician. 2018;97:398–405.PubMed Falk N, Cole A, Meredith TJ. Evaluation of suspected dementia. Am Fam Physician. 2018;97:398–405.PubMed
27.
go back to reference Ma L, Li Y. Cognitive function and insulin resistance in elderly patients with type 2 diabetes. Neurol Res. 2017;39:259–63.CrossRef Ma L, Li Y. Cognitive function and insulin resistance in elderly patients with type 2 diabetes. Neurol Res. 2017;39:259–63.CrossRef
28.
go back to reference Podolski N, Brixius K, Predel HG, Brinkmann C. Effects of regular physical activity on the cognitive performance of type 2 diabetic patients: a systematic review. Metab Syndr Relat Disord. 2017;15:481–93..CrossRef Podolski N, Brixius K, Predel HG, Brinkmann C. Effects of regular physical activity on the cognitive performance of type 2 diabetic patients: a systematic review. Metab Syndr Relat Disord. 2017;15:481–93..CrossRef
29.
go back to reference Feinkohl I, Keller M, Robertson CM, Morling JR, McLachlan S, Frier BM, et al. Cardiovascular risk factors and cognitive decline in older people with type 2 diabetes. Diabetologia. 2015;58:1637–45.CrossRef Feinkohl I, Keller M, Robertson CM, Morling JR, McLachlan S, Frier BM, et al. Cardiovascular risk factors and cognitive decline in older people with type 2 diabetes. Diabetologia. 2015;58:1637–45.CrossRef
30.
go back to reference Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective. Alzheimers Dement. 2015;11:718–26.CrossRef Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective. Alzheimers Dement. 2015;11:718–26.CrossRef
Metadata
Title
Risk of mini-mental state examination (MMSE) decline in the elderly with type 2 diabetes: a Chinese community-based cohort study
Authors
Lei Zhao
Chao Han
Zheng Zheng
Shuang Ling Xiu
Piu Chan
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2020
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/s12902-020-00606-4

Other articles of this Issue 1/2020

BMC Endocrine Disorders 1/2020 Go to the issue