title: Insulin Resistance Predicts Cognitive Decline: An 11-Year Follow-up of a Nationally Representative Adult Population Sample.
abstract: The aim of this study was to examine whether insulin resistance, assessed by HOMA of insulin resistance (HOMA-IR), is an independent predictor of cognitive decline.
  
  
  
  The roles of HOMA-IR, fasting insulin and glucose, HbA1c, and hs-CRP as predictors of cognitive performance and its change were evaluated in the Finnish nationwide, population-based Health 2000 Health Examination Survey and its 11-year follow-up, the Health 2011 study (n= 3,695, mean age at baseline 49.3 years, 55.5% women). Categorical verbal fluency, word-list learning, and word-list delayed recall were used as measures of cognitive function. Multivariate linear regression analysis was performed and adjusted for previously reported risk factors for cognitive decline.
  
  
  
  Higher baseline HOMA-IR and fasting insulin levels were independent predictors of poorer verbal fluency performance (P= 0.0002 for both) and of a greater decline in verbal fluency during the follow-up time (P= 0.004 for both). Baseline HOMA-IR and insulin did not predict word-list learning or word-list delayed recall scores. There were no interactions between HOMA-IR and apolipoprotein E ε4 (APOEε4) genotype, hs-CRP, or type 2 diabetes on the cognitive tests. Fasting glucose and hs-CRP levels at baseline were not associated with cognitive functioning.
  
  
  
  Our results show that higher serum fasting insulin and insulin resistance predict poorer verbal fluency and a steeper decline in verbal fluency during 11 years in a representative sample of an adult population. Prevention and treatment of insulin resistance might help reduce cognitive decline later in life.
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland llekbl@utu.fi.
authors.forename: Laura L
authors.identifier: 0000-0002-5863-8088
authors.initials: LL
authors.lastname: Ekblad
authors.affiliation: Turku PET Centre, University of Turku, Turku, Finland.|Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.
authors.forename: Juha O
authors.initials: JO
authors.lastname: Rinne
authors.affiliation: National Institute for Health and Welfare, Turku, Finland.
authors.forename: Pauli
authors.initials: P
authors.lastname: Puukka
authors.affiliation: Turku City Hospital, University of Turku, Turku, Finland.|Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Laine
authors.affiliation: University of Eastern Finland, Kuopio, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Ahtiluoto
authors.affiliation: University of Eastern Finland, Kuopio, Finland.
authors.forename: Raimo
authors.initials: R
authors.lastname: Sulkava
authors.affiliation: Turku City Hospital, University of Turku, Turku, Finland.|Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden.
authors.forename: Matti
authors.initials: M
authors.lastname: Viitanen
authors.affiliation: National Institute for Health and Welfare, Turku, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Jula
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053327:Apolipoprotein E4 / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003071:Cognition; D060825:Cognitive Dysfunction / Q000097:blood / Q000175:diagnosis*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D053327:Apolipoprotein E4; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin