title: Diabetes is Associated with Worse Executive Function in Both Eastern and Western Populations: Shanghai Aging Study and Mayo Clinic Study of Aging.
abstract: OBJECTIVE
  It remains unknown whether the association between diabetes mellitus (DM) and cognitive function differs in Eastern and Western populations. This study aimed to elucidate whether DM is associated with worse cognitive performance in both populations.
  
  
  METHODS
  The Shanghai Aging Study (SAS) and the Mayo Clinic Study of Aging (MCSA) are two population-based studies with similar design and methodology in Shanghai, China and Rochester, MN, USA. Non-demented participants underwent cognitive testing, and DM was assessed from the medical record. Separate analyses were performed in SAS and MCSA regarding the association between DM and cognitive performance.
  
  
  RESULTS
  A total of 3,348 Chinese participants in the SAS and 3,734 American subjects in the MCSA were included. Compared with MCSA subjects, SAS participants were younger, less educated, and had lower frequency of vascular disease, APOE ɛ4 carriers and obesity. Participants with DM (compared to non-DM participants) performed significantly worse on all the cognitive domains in both the SAS and MCSA. After adjustment for age, gender, education, and vascular covariates, DM was associated with worse performance in executive function (β=-0.15, p = 0.001 for SAS, and β=-0.10, p = 0.008 for MCSA) in the total sample and in the cognitively normal sub-sample. Furthermore, DM was associated with poor performance in visuospatial skills, language, and memory in the SAS, but not in the MCSA.
  
  
  CONCLUSIONS
  Diabetes is associated with cognitive dysfunction and, in particular, exerts a negative impact on executive function regardless of race, age, and prevalence of vascular risk factors.
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China.
authors.forename: Qianhua
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Divisions of Epidemiology and Biomedical Statistics & Informatics, Mayo Clinic, Rochester, Minnesota, USA.|Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Rosebud O
authors.initials: RO
authors.lastname: Roberts
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Ding
authors.affiliation: Divisions of Epidemiology and Biomedical Statistics & Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Cha
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China.
authors.forename: Qihao
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China.
authors.forename: Haijiao
authors.initials: H
authors.lastname: Meng
authors.affiliation: Department of Health Statistics, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Luo
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Machulda
authors.affiliation: Divisions of Epidemiology and Biomedical Statistics & Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: V
authors.initials: V
authors.lastname: Shane Pankratz
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China.
authors.forename: Bei
authors.initials: B
authors.lastname: Wang
authors.affiliation: Divisions of Epidemiology and Biomedical Statistics & Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Teresa J H
authors.initials: TJ
authors.lastname: Christianson
authors.affiliation: Divisions of Epidemiology and Biomedical Statistics & Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jeremiah A
authors.initials: JA
authors.lastname: Aakre
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Knopman
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Boeve
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Hong
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Petersen
mesh_terms: D000368:Aged; D000375:Aging; D001057:Apolipoproteins E / Q000235:genetics; D002681:China; D003072:Cognition Disorders / Q000209:etiology*; D015331:Cohort Studies; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D009483:Neuropsychological Tests; D014481:United States
chemical_list: D001057:Apolipoproteins E
keywords: Cognition; cross-sectional studies; diabetes mellitus; executive function