The new research showed over the course of about a decade, elderly men and women with diabetes- primarily Type 2, the form of the disease related to obesity and inactivity- had greater drops in cognitive tests scores than other people of a similar age. The more poorly managed their disease, the greater the deterioration in mental function. The decline was not just in those with advanced diabetes. Researchers found that people who did not have diabetes at the beginning of the study but developed it later deteriorated at a greater extent than those without diabetes.
"What we've shown is a clear association with diabetes and cognitive aging in terms of the slope and the rate of decline on these cognitive tests," said. Dr. Kristine Yaffe, a professor of psychiatry and neurology at the University of California, San Francisco. "That's very powerful."
Nationwide, nearly one-third of Americans over the age of 65, roughly 11 million people, have diabetes. By 2034 15 million Medicare-eligible Americans will have diabetes.
Previous studies have shown that Type 2 diabetes correlates with a higher risk of Alzheimer's disease and dementia later in life. But how one leads to the other has been unknown. Findings have been inconsistent, but scientists have speculated that inflammation and vascular damage caused by chronic high blood sugar levels over many years may be the culprit.
The new study was published by Dr. Yaffe and her colleagues in the Archives of Neurology. They relied on extensive data from the Health, Aging, and Body Composition Project, or Health ABC, a long-running study of white and black older adults living in Pittsburgh and Tennessee. The researchers looked at 3,069 people, many in their 70s. At the beginning of the study, 23 percent of the people had diabetes. 5 percent later went on to develop the disease.
Over the course of the research, subjects were repeatedly given cognitive tests that looked at things like their memory, coordination, dexterity and ability to concentrate, as well as their overall mental health. At the start of the study, those who already had diabetes had slightly lower baseline scores than those who do not have the disease.
Nine years later, the gap in cognitive test scores widened dramatically between those with and those without diabetes. The differences remained even after results were adjusted for age, sex, race, and education.
The researchers then studied the effects of poor glucose control. They took measures of glycosylated hemoglobin, which provides a broad picture of blood sugar management over the course of many weeks. High measures of the compound, which indicate poorer control of blood glucose levels, were the best predictors of cognitive decline.
The findings suggest that more aggressive approaches to managing and especially preventing diabetes midlife or before may help stave off mental declines. Dr. Yaffe warned that doctors be cautious about lowering blood sugar levels too low as that would cause hypoglycemia.
"There's this idea that the better your glucose control, the better off you are in terms of trying to prevent complications of diabetes. But in older people it's a slippery slope. The elderly are more sensitive to hypoglycemia, they've got other medications that may interact, and they've got other conditions," Dr. Yaffe said. "When you lower their blood sugar levels too aggressively, you might do more harm than good."
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Memory is defined in psychology as the mental ability of an organism to retain and store as well as recall information.
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