title: Predictors of cognitive decline in older individuals with diabetes.
abstract: OBJECTIVE
  The purpose of this study was to determine longitudinal predictors of cognitive decline in older individuals with diabetes who did not have dementia.
  
  
  METHODS
  Cognitive assessments were performed in 205 subjects with diabetes (mean age 75.3 years) and repeated a median 1.6 years later. The sample was drawn from an existing cohort study, and data on diabetes, cardiovascular risk factors, and complications were collected 7.6 +/- 1.1 years before and at the time of the initial cognitive assessment. Cognitive status was defined using the Clinical Dementia Rating (CDR) scale, and cognitive decline was defined by change in CDR.
  
  
  RESULTS
  The sample included 164 subjects with normal cognition (CDR 0) and 41 with cognitive impairment without dementia (CDR 0.5). At follow-up, 33 (16.1%) had experienced cognitive decline (4 new cases of dementia and 29 cognitive impairment without dementia). Only educational attainment predicted cognitive decline from the data collected 7.6 years before cognitive assessment. Univariate predictors of cognitive decline at the time of the first cognitive assessment included age, education, urinary albumin-to-creatinine ratio (ACR), and treatment with either ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). With multiple logistic regression controlling for age and education, cognitive decline was predicted by natural logarithm ACR (odds ratio 1.37 [95% CI 1.05-1.78], P = 0.021), whereas treatment with either ACEIs or ARBs was protective (0.28 [0.12-0.65], P = 0.003).
  
  
  CONCLUSIONS
  In this sample of older patients with diabetes, microalbuminuria was a risk factor for cognitive decline, whereas drugs that inhibit the renin-angiotensin system were protective. These observations require confirmation because of their considerable potential clinical implications.
authors.affiliation: 1School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. dbruce@cyllene.uwa.edu.au
authors.forename: David G
authors.initials: DG
authors.lastname: Bruce
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Davis
authors.forename: Genevieve P
authors.initials: GP
authors.lastname: Casey
authors.forename: Sergio E
authors.initials: SE
authors.lastname: Starkstein
authors.forename: Roger M
authors.initials: RM
authors.lastname: Clarnette
authors.forename: Osvaldo P
authors.initials: OP
authors.lastname: Almeida
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D048909:Diabetes Complications / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D003920:Diabetes Mellitus / Q000503:physiopathology* / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D012307:Risk Factors