title: Predictors of Cognitive Decline in Older Adult Type 2 Diabetes from the Veterans Affairs Diabetes Trial.
abstract: OBJECTIVE
  Cognitive decline disproportionately affects older adult type 2 diabetes. We tested whether randomized intensive (INT) glucose-lowering reduces the rate(s) of cognitive decline in adults with advanced type 2 diabetes (mean: age, 60 years; diabetes duration, 11 years) from the Veterans Affairs Diabetes Trial.
  
  
  METHODS
  A battery of neuropsychological tests [digit span, digit symbol substitution (DSym), and Trails-making Test-Part B (TMT-B)] was administered at baseline in ~1700 participants and repeated at year 5. Thirty-seven risk factors were evaluated as predictors of cognitive decline in multivariable regression analyses.
  
  
  RESULTS
  The mean age-adjusted DSym or TMT-B declined significantly in all study participants (P < 0.001). Randomized INT glucose-lowering did not significantly alter the rate of cognitive decline. The final model of risk factors associated with 5-year decline in age-adjusted TMT-B included as significant predictors: longer baseline diabetes duration (beta = -0.028; P = 0.0057), lower baseline diastolic blood pressure (BP; beta = 0.028; P = 0.002), and baseline calcium channel blocker medication use (beta = -0.639; P < 0.001). Higher baseline pulse pressure was significantly associated with decline in age-adjusted TMT-B suggesting a role for both higher systolic and lower diastolic BPs. Baseline thiazide diuretic use (beta = -0.549; P = 0.015) was an additional significant predictor of 5-year decline in age-adjusted digit symbol score. Post-baseline systolic BP-lowering was significantly associated (P < 0.001) with decline in TMT-B performance. There was a significant inverse association between post-baseline plasma triglyceride-lowering (P = 0.045) and decline in digit symbol substitution task performance.
  
  
  CONCLUSIONS
  A 5-year period of randomized INT glucose-lowering did not significantly reduce the rate of cognitive decline in older-aged adults with type 2 diabetes. Systolic and diastolic BPs as well as plasma triglycerides appeared as modifiable risk factors of the rate of cognitive decline in older adult type 2 diabetes.
authors.affiliation: Medical Service, Department of Veterans Affairs New Jersey Health Care System, Lyons, NJ, USA; Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Zimering
authors.affiliation: National Center for PTSD, VA Boston Healthcare System, Boston MA, USA; Boston University School of Medicine, Boston, MA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Knight
authors.affiliation: Hines Veterans Affairs Hospital , Hines, IL , USA.
authors.forename: Ling
authors.initials: L
authors.lastname: Ge
authors.affiliation: Hines Veterans Affairs Hospital , Hines, IL , USA.
authors.forename: Gideon
authors.initials: G
authors.lastname: Bahn
keywords: blood pressure; cognitive decline; diabetes duration; risk factors; type 2 diabetes mellitus