title: Conversion of mild cognitive impairment to dementia among subjects with diabetes: a population-based study of incidence and risk factors with five years of follow-up.
abstract: Type 2 diabetes mellitus (T2DM) is associated with dementia. Mild cognitive impairment (MCI) is a key determinant in this association. It is not clear whether T2DM increases the risk of conversion from MCI to dementia. We plan to explore the relationship between T2DM-MCI and dementia and identify its potential risk factors. A prospective community-based cohort study was conducted from March 2010 to March 2014, including 634 participants with T2DM-MCI, 261 T2DM participants who were cognitively intact, and 585 MCI participants without diabetes. All cohort members received detailed annual evaluations to detect dementia onset during the 5 years of follow-up. The three cohorts were compared to assess differences in dementia onset. Furthermore, Cox proportional hazards regression was used to identify risk factors for dementia onset in the T2DM-MCI cohort. During follow-up, 152 and 49 subjects developed dementia in the MCI and cognitively-intact cohorts, amounting to an adjusted hazard ratio (HR) of 1.66 (95% CI 1.07-2.26). In a survival analysis of the cohorts, MCI accelerated the median progression to dementia by 2.74 years. In a multivariable analysis of the T2DM-MCI cohort, major risk factors for dementia were age >75 years and longer durations of diabetes, while significantly reduced risks of dementia were associated with oral hypoglycemic agents and HMG-CoA reductase inhibitors. Insulin was not associated with significantly changed risk. T2DM-MCI may aggravate the clinical picture as a concomitant factor. To minimize progression to dementia, it may be worthwhile to target several modifiable diabetes-specific features, such as the duration of disease, glycemic control, and antidiabetic agents.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Ma
authors.affiliation: Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.
authors.forename: Tianfeng
authors.initials: T
authors.lastname: Wu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
authors.forename: Rujuan
authors.initials: R
authors.lastname: Miao
authors.affiliation: Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.
authors.forename: Yan Yu
authors.initials: YY
authors.lastname: Xiao
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
authors.forename: Wenwen
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China.
authors.forename: Guowei
authors.initials: G
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D003704:Dementia / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents
keywords: Alzheimer's disease; cohort study; mild cognitive impairment; risk factors; type 2 diabetes mellitus