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Original Investigation
July 22, 2013

Association Between Hypoglycemia and Dementia in a Biracial Cohort of Older Adults With Diabetes Mellitus

Author Affiliations
  • 1Department of Psychiatry, University of California, San Francisco
  • 2Department of Neurology, University of California, San Francisco
  • 3Department of Epidemiology and Biostatistics, University of California, San Francisco
  • 4San Francisco Veterans Affairs Medical Center, San Francisco, California
  • 5Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Baltimore, Maryland
  • 6Clinical Research Branch, National Institute on Aging, Baltimore, Maryland
  • 7Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 8Department of Aging and Geriatric Research, University of Florida, Gainesville
JAMA Intern Med. 2013;173(14):1300-1306. doi:10.1001/jamainternmed.2013.6176
Abstract

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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