Abstract
Objectives
Diabetes and prediabetes contribute to an increased risk of cognitive decline and
dementia. Currently, it remains unclear whether elevated blood HbA1c levels, including
prediabetes levels, affect reversion from mild cognitive impairment (MCI) to normal
cognition. This study, therefore, aimed to examine the prospective associations of
diabetes and prediabetes with reversion from MCI to normal cognition among community-dwelling
older adults.
Design
Longitudinal cohort study with a 4-year follow-up.
Setting and Participants
Community-dwelling older adults with MCI, aged ≥65 years at baseline (n = 787).
Methods
Participants’ medical history of diabetes and blood HbA1c levels at baseline were
assessed, and they were classified as control, prediabetes, and diabetes. Objective
cognitive screening was performed using a multicomponent neurocognitive test at baseline
and follow-up. Reversion from MCI to normal cognition over 4 years was determined.
In the longitudinal analysis, we performed multiple imputations to adjust for a selection
bias and loss of information.
Results
The reversion rates of MCI in the control, prediabetes, and diabetes groups were 63.4%,
55.6%, and 42.9%, respectively, in the completed follow-up dataset, and 54.6%, 47.2%,
and 34.1%, respectively, in the imputed dataset. Multivariate logistic regression
showed that diabetes decreases the probability of MCI reversion both before and after
multiple imputations [odds ratio (OR) 0.37; 95% confidence interval (CI) 0.18–0.74
for before imputation, OR 0.37; 95% CI 0.19–0.72 for after imputation]. Furthermore,
prediabetes also showed significantly decreased probabilities of MCI reversion both
before and after multiple imputations (OR 0.57; 95% CI 0.34–0.94 for before imputation,
OR 0.60; 95% CI 0.37–0.97 for after imputation).
Conclusions and Implications
Diabetes and prediabetes could inhibit MCI reversion. Adequate glycemic control may
be effective in enhancing the reversion from MCI to normal cognition in a community
setting.
Keywords
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Article info
Publication history
Published online: March 30, 2021
Footnotes
The authors declare no conflicts of interest.
This work received financial support through the JSPS KAKENHI grant-in-aid for Scientific Research B (23300205), Young Scientists A (26702033), JSPS Research Fellow (20J01647), Early-Career Scientists (20K19442), the Health and Labor Sciences Research Grants (Comprehensive Research on Aging and Health) from the Japanese Ministry of Health, Labor, and Welfare (H23-tyoujyuippan-001), the Research Funding for Longevity Sciences from the National Center for Geriatrics and Gerontology (22–16 and 26–33), and the Funds from Obu City Local Government.
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© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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