title: Plasma C-peptide levels and rates of cognitive decline in older, community-dwelling women without diabetes.
abstract: BACKGROUND
  Both type 2 diabetes and hyperinsulinemia have been related to diminished cognition. To address independent effects of increasing mid-life insulin secretion on late-life cognition, we prospectively examined the relation of plasma C-peptide levels to cognitive decline in a large sample of older women without diabetes or stroke.
  
  
  METHODS
  Plasma C-peptide levels were measured in 1187 "young-old" women (mean age=64 years) without diabetes in the Nurses' Health Study. Cognitive decline was assessed approximately 10 years later. Three repeated cognitive batteries were administered over an average of 4.4 years using telephone-based tests of general cognition, verbal memory, category fluency, and attention. Primary outcomes were general cognition (measured by the Telephone interview for Cognitive Status [TICS], as well as a global score averaging all tests) and a verbal memory score averaging four tests of word-list and paragraph recall. Linear mixed effects models were used to compute associations between C-peptide levels and rates of cognitive decline.
  
  
  RESULTS
  Higher C-peptide levels were associated with faster decline in global cognition and verbal memory. Compared to those in the lowest C-peptide quartile, multivariable-adjusted mean differences (95% CI) in rates of decline for women in the highest quartile were -0.03 (-0.06,-0.00) units/year for the global score, and -0.05 (-0.09,-0.02) units/year for verbal memory. Each one standard-deviation increase in C-peptide was associated with significantly faster decline on the TICS (p-trend=0.05), global score (p-trend=0.04) and verbal memory (p-trend=0.006).
  
  
  CONCLUSIONS
  Higher levels of insulin secretion in those without diabetes may be related to decline in general cognition and verbal memory.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. ookereke@partners.org
authors.forename: Olivia I
authors.initials: OI
authors.lastname: Okereke
authors.forename: Michael N
authors.initials: MN
authors.lastname: Pollak
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hankinson
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Selkoe
authors.forename: Francine
authors.initials: F
authors.lastname: Grodstein
mesh_terms: D000328:Adult; D000375:Aging / Q000097:blood*; D002096:C-Peptide / Q000097:blood*; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000097:blood* / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D012111:Residence Characteristics; D014481:United States / Q000453:epidemiology
chemical_list: D002096:C-Peptide