title: Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective population-based study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Among older adults with DM, there seems to be a bidirectional association between hypoglycemia and dementia.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, California 94121, USA. kristine.yaffe@ucsf.edu
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.forename: Cherie M
authors.initials: CM
authors.lastname: Falvey
authors.forename: Nathan
authors.initials: N
authors.lastname: Hamilton
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Simonsick
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Shorr
authors.forename: Andrea
authors.initials: A
authors.lastname: Metti
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
mesh_terms: D000367:Age Factors; D000368:Aged; D053327:Apolipoprotein E4 / Q000235:genetics; D044383:Black People / Q000706:statistics & numerical data; D003704:Dementia / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data
chemical_list: D053327:Apolipoprotein E4