title: Glucoregulation has greater impact on cognitive performance than macro-vascular disease in men with type 2 diabetes: data from the Caerphilly study.
abstract: OBJECTIVE
  To compare vascular and glucose related mechanisms of type 2 diabetes on cognitive performance.
  
  
  METHODS
  A cross-sectional observational study of type 2 diabetes defined by non insulin dependant self-report diabetes or fasting blood glucose < or = 7.0 mmol/l of 2205 men eligible for the third phase of the Caerphilly Collaborative Heart Disease Study. Men were aged 55-69 years at time of testing. Tests of cognitive function included NART (crystallised IQ), AH4 (fluid IQ), verbal fluency (executive function) Cambridge Cognitive Examination (CAMCOG) and Mini Mental State Examination (MMSE) (global function), four choice serial reaction time (psychomotor function) and memory. Men with prior stroke were omitted from the analysis.
  
  
  RESULTS
  Men with diabetes showed cognitive deficits for verbal fluency, National Adult Reacting Test (NART) and AH4. Adjusting for vascular risk factors had minimal effect. Including blood glucose removed the deficit for verbal fluency and NART but the effect on AH4 score (-2.58; 95% CI: -5.0, -0.1, p = 0.039) was retained. More detailed analyses of AH4 score on men with diabetes showed a curvilinear relationship indicating that men with both low and high glucose levels had worse performance (AH4 = -66 + 80 log(e) glucose - 18 log(e )glucose(2); 95% CI: -29, -6; p=0.002).
  
  
  CONCLUSIONS
  These data identify a direct effect of glucose regulation on cognitive performance associated with diabetes in a population sample. These data suggest that an effect of glucose regulation on cognitive performance in diabetes is distinct from any effect of macro-vascular disease.
authors.affiliation: Department of Epidemiology, Statistics and Public Health, Cardiff University, Heath Park, Cardiff, CF14 4XN, United Kingdom. Gallacher@cardiff.ac.uk
authors.forename: John E J
authors.initials: JE
authors.lastname: Gallacher
authors.forename: Janet
authors.initials: J
authors.lastname: Pickering
authors.forename: Peter C
authors.initials: PC
authors.lastname: Elwood
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Bayer
authors.forename: John W
authors.initials: JW
authors.lastname: Yarnell
authors.forename: Yoav
authors.initials: Y
authors.lastname: Ben-Shlomo
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003072:Cognition Disorders / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012307:Risk Factors
chemical_list: D001786:Blood Glucose