title: Cardiovascular risk factors and cognitive decline in older people with type 2 diabetes.
abstract: OBJECTIVE
  The aim of this work was to assess the role of well-established cardiovascular risk factors in the late-life cognitive decline of patients with type 2 diabetes.
  
  
  METHODS
  Data from 831 participants (aged 60-75 years) attending the 4 year follow-up of the Edinburgh Type 2 Diabetes Study (ET2DS) were used. Smoking history (pack-years), BP, HbA1c, plasma glucose and cholesterol were determined at baseline clinics (single time measurements) and/or from serial data recorded on a clinical management database from diagnosis until recruitment ('historical' data). Principal component analysis derived a factor, g, of general ability from seven cognitive tests. Linear regression models of follow-up g were adjusted for baseline g to represent 4 year cognitive change. 'Accelerated late-life cognitive decline' was defined as scoring in the lowest tertile of '4 year cognitive change' regression scores. Analyses controlled for age and sex.
  
  
  RESULTS
  A baseline history of moderate/heavy smoking (≥ 10 pack-years) and a 1% increased historical HbA1c (equivalent to an increase by 11 mmol/mol) predicted a 64% (OR 1.64; 95% CI 1.14, 2.34; p = 0.007) and 21% (OR 1.21; 95% CI 1.00, 1.45; p = 0.046) increased risk of accelerated cognitive decline, respectively. When treated as continuous measures, higher pack-years, historical HbA1c and historical BP emerged as significant independent predictors of 4 year decline in g (standardised β range -0.07 to -0.14; all p ≤ 0.05).
  
  
  CONCLUSIONS
  Increased smoking and poorer glycaemic control (with relatively weaker findings for BP) during the life-course were independently associated with accelerated late-life cognitive decline. Where possible, evaluation is warranted of these risk factors as targets for intervention to reduce the burden of cognitive impairment in diabetes.
authors.affiliation: Centre for Population Health Sciences, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK, ifeinkohl@gmail.com.
authors.forename: Insa
authors.initials: I
authors.lastname: Feinkohl
authors.forename: Markéta
authors.initials: M
authors.lastname: Keller
authors.forename: Christine M
authors.initials: CM
authors.lastname: Robertson
authors.forename: Joanne R
authors.initials: JR
authors.lastname: Morling
authors.forename: Stela
authors.initials: S
authors.lastname: McLachlan
authors.forename: Brian M
authors.initials: BM
authors.lastname: Frier
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Deary
authors.forename: Mark W J
authors.initials: MW
authors.lastname: Strachan
authors.forename: Jackie F
authors.initials: JF
authors.lastname: Price
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D002784:Cholesterol / Q000097:blood; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin
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