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Abstract
Objective: We investigated the associations of diabetes and hypertension with imaging biomarkers (markers of neuronal injury and ischemic damage) and with cognition in a population-based cohort without dementia.
Methods: Participants (n = 1,437, median age 80 years) were evaluated by a nurse and physician and underwent neuropsychological testing. A diagnosis of cognitively normal, mild cognitive impairment (MCI), or dementia was made by an expert panel. Participants underwent MRI to determine cortical and subcortical infarctions, white matter hyperintensity (WMH) volume, hippocampal volume (HV), and whole brain volume (WBV). The medical records were reviewed for diabetes and hypertension in midlife or later.
Results: Midlife diabetes was associated with subcortical infarctions (odds ratio, 1.85 [95% confidence interval, 1.09–3.15]; p = 0.02), reduced HV (−4% [−7 to −1.0]; p = 0.01), reduced WBV (−2.9% [−4.1 to −1.6]), and prevalent MCI (odds ratio, 2.08; p = 0.01). The association between diabetes and MCI persisted with adjustment for infarctions and WMH volume but was attenuated after adjustment for WBV (1.60 [0.87–2.95]; p = 0.13) and HV (1.82 [1.00–3.32]; p = 0.05). Midlife hypertension was associated with infarctions and WMH volume and was marginally associated with reduced performance in executive function. Effects of late-life onset of diabetes and hypertension were few.
Conclusions: Midlife onset of diabetes may affect late-life cognition through loss of brain volume. Midlife hypertension may affect executive function through ischemic pathology. Late-life onset of these conditions had fewer effects on brain pathology and cognition.
GLOSSARY
- CI=
- confidence interval;
- FLAIR=
- fluid-attenuated inversion recovery;
- HV=
- hippocampal volume;
- MCI=
- mild cognitive impairment;
- MCSA=
- Mayo Clinic Study of Aging;
- MPRAGE=
- magnetization-prepared rapid-acquisition gradient echo;
- OR=
- odds ratio;
- RAGE=
- receptor for advanced glycation end-products;
- TIV=
- total intracranial volume;
- WBV=
- whole brain volume;
- WM=
- white matter;
- WMH=
- white matter hyperintensity
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received September 9, 2013.
- Accepted in final form December 16, 2013.
- © 2014 American Academy of Neurology
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