Association between cognitive dysfunction and diabetes in patients over 65 years old: a cross-sectional study using propensity score matching

Authors

  • Liwen Zhai The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
  • Yao Yang The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
  • Jun Zhang 3Department of Rehabilitation Medicine, Hainan Cancer Hospital, Haikou, Hainan, China
  • Weiqian Hou The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
  • Yujie Yang School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
  • Dongfang Ding The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
  • Conghui Li The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
  • Yi Zhu The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China

DOI:

https://doi.org/10.2340/jrm.v56.18372

Keywords:

activities of daily living, cognitive function, cross-sectional study, diabetes, elderly

Abstract

Objectives: To investigate the association between diabetes and cognitive dysfunction in the elderly population, and examine the impact of cognitive dysfunction on level of activities of daily living (ADL) in patients with diabetes.

Methods: Data analysis was conducted on 2,951 individuals aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey cohort. Propensity score matching was utilized to mitigate selection bias. Multivariate binary logistic regression was performed to analyse the association between diabetes and cognitive dysfunction in the study subjects. In addition, the relationship between ADL and cognitive function in patients with diabetes was analysed using the Wilcoxon rank-sum test.

Results: A significant association (p = 0.017) was found between diabetes and the occurrence of cognitive dysfunction in older adults. Subgroup analyses revealed that diabetes patients with cognitive dysfunction exhibited a worse ADL dependence compared with those without cognitive dysfunction (p < 0.001).

Conclusion: These findings indicate that diabetes is associated with cognitive dysfunction in older adults. Meanwhile, there is an association between cognitive impairment and ADL level in subjects with diabetes. As such, healthcare professionals should pay close attention to the occurrence of cognitive dysfunction and ADL decline during diagnosis and treatment, and proactive prevention and intervention strategies should be implemented.

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References

Tu WJ, Zeng X, Liu Q. Aging tsunami coming: the main finding from China's seventh national population census. Aging Clin Exp Res 2022; 34: 1159-1163.

https://doi.org/10.1007/s40520-021-02017-4 DOI: https://doi.org/10.1007/s40520-021-02017-4

Zhang Y, Xiong Y, Yu Q, Shen S, Chen L, Lei X. The activity of daily living (ADL) subgroups and health impairment among Chinese elderly: a latent profile analysis. BMC Geriatr 2021; 21: 30.

https://doi.org/10.1186/s12877-020-01986-x DOI: https://doi.org/10.1186/s12877-020-01986-x

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2011; 34: 62-69.

https://doi.org/10.2337/dc11-S062 DOI: https://doi.org/10.2337/dc11-S062

Chen JF, Zhang YP, Han JX, Wang YD, Fu GF. Systematic evaluation of the prevalence of cognitive impairment in elderly patients with diabetes in China. Clin Neurol Neurosurg 2023; 225: 107557.

https://doi.org/10.1016/j.clineuro.2022.107557 DOI: https://doi.org/10.1016/j.clineuro.2022.107557

Formiga F, Badía-Tejero AM, Corsonello A, Ärnlöv J, Carlsson AC, Mattace-Raso F, et al. Diabetes and factors associated with cognitive and functional decline. The screening for CKD among older people across Europe (SCOPE) study. Aging Clin Exp Res 2023; 35: 2693-2701.

https://doi.org/10.1007/s40520-023-02536-2 DOI: https://doi.org/10.1007/s40520-023-02536-2

Leicht H, Heinrich S, Heider D, Bachmann C, Bickel H, van den Bussche H, et al. Net costs of dementia by disease stage. Acta Psychiatr Scand 2011; 124: 384-395.

https://doi.org/10.1111/j.1600-0447.2011.01741.x DOI: https://doi.org/10.1111/j.1600-0447.2011.01741.x

Sun L, Diao X, Gang X, Lv Y, Zhao X, Yang S, Gao Y, Wang G. Risk factors for cognitive impairment in patients with type 2 diabetes. J Diabetes Res 2020; 2020: 4591938.

https://doi.org/10.1155/2020/4591938 DOI: https://doi.org/10.1155/2020/4591938

Cukierman T, Gerstein HC, Williamson JD. Cognitive decline and dementia in diabetes - systematic overview of prospective observational studies. Diabetologia 2005; 48: 2460-2469.

https://doi.org/10.1007/s00125-005-0023-4 DOI: https://doi.org/10.1007/s00125-005-0023-4

Zhang L, Yang J, Liao Z, Zhao X, Hu X, Zhu W, Zhang Z. Association between diabetes and cognitive function among people over 45 years old in China: a cross-sectional study. Int J Environ Res Public Health 2019; 16: 1294.

https://doi.org/10.3390/ijerph16071294 DOI: https://doi.org/10.3390/ijerph16071294

Zhou S, Chen S, Liu X, Zhang Y, Zhao M, Li W. Physical activity improves cognition and activities of daily living in adults with Alzheimer's disease: a systematic review and meta-analysis of randomized controlled trials. Int J Environ Res Public Health 2022; 19: 1216.

https://doi.org/10.3390/ijerph19031216 DOI: https://doi.org/10.3390/ijerph19031216

Formiga F, Moreno-González R, Corsonello A, Carlsson A, Ärnlöv J, Mattace-Raso F, et al. Diabetes, sarcopenia and chronic kidney disease; the screening for CKD among older people across Europe (SCOPE) study. BMC Geriatr 2022; 22: 254.

https://doi.org/10.1186/s12877-022-02916-9 DOI: https://doi.org/10.1186/s12877-022-02916-9

Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185: 914-919.

https://doi.org/10.1001/jama.1963.03060120024016 DOI: https://doi.org/10.1001/jama.1963.03060120024016

Medhi GK, Sarma J, Pala S, et al. Association between health related quality of life (HRQOL) and activity of daily living (ADL) among elderly in an urban setting of Assam, India. J Family Med Prim Care 2019; 8: 1760-1764.

https://doi.org/10.4103/jfmpc.jfmpc_270_19 DOI: https://doi.org/10.4103/jfmpc.jfmpc_270_19

Bello-Chavolla OY, Aguilar-Salinas CA and Avila-Funes JA. The type 2 diabetes-specific dementia risk score (DSDRS) is associated with frailty, cognitive and functional status amongst Mexican community-dwelling older adults. BMC Geriatr 2020; 20: 363.

https://doi.org/10.1186/s12877-020-01776-5 DOI: https://doi.org/10.1186/s12877-020-01776-5

Garrett SL, Sawyer P, Kennedy RE, McGuire D, Simon RP, Strothers HS 3rd, Allman RM. Racial and sex differences in associations between activities of daily living and cognition in community-dwelling older adults. J Am Geriatr Soc 2013; 61: 2174-2180.

https://doi.org/10.1111/jgs.12543 DOI: https://doi.org/10.1111/jgs.12543

American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021. Diabetes Care 2021; 44: 15-33.

https://doi.org/10.2337/dc21-S002 DOI: https://doi.org/10.2337/dc21-S002

Zhang Z. Gender differentials in cognitive impairment and decline of the oldest old in China. J Gerontol B Psychol Sci Soc Sci 2006; 61: 107-115.

https://doi.org/10.1093/geronb/61.2.S107 DOI: https://doi.org/10.1093/geronb/61.2.S107

An R, Liu GG. Cognitive impairment and mortality among the oldest-old Chinese. Int J Geriatr Psychiatry 2016; 31: 1345-1353.

https://doi.org/10.1002/gps.4442 DOI: https://doi.org/10.1002/gps.4442

Chen WC, Wang XY. Longitudinal associations between sleep duration and cognitive impairment in Chinese elderly. Front Aging Neurosci 2022; 14: 1037650.

https://doi.org/10.3389/fnagi.2022.1037650 DOI: https://doi.org/10.3389/fnagi.2022.1037650

Zhang YR, Xu W, Zhang W, Wang HF, Ou YN, Qu Y, et al. Modifiable risk factors for incident dementia and cognitive impairment: an umbrella review of evidence. J Affect Disord 2022; 314: 160-167.

https://doi.org/10.1016/j.jad.2022.07.008 DOI: https://doi.org/10.1016/j.jad.2022.07.008

Richards M. The power of birth cohorts to study risk factors for cognitive impairment. Curr Neurol Neurosci Rep 2022; 22: 847-854.

https://doi.org/10.1007/s11910-022-01244-0 DOI: https://doi.org/10.1007/s11910-022-01244-0

Zhang Q, Wu Y, Han T, Liu E. Changes in cognitive function and risk factors for cognitive impairment of the elderly in China: 2005-2014. Int J Environ Res Public Health 2019; 16: 2847.

https://doi.org/10.3390/ijerph16162847 DOI: https://doi.org/10.3390/ijerph16162847

Yin S, Yang Q, Xiong J, Li T, Zhu X. Social support and the incidence of cognitive impairment among older adults in China: findings from the Chinese Longitudinal Healthy Longevity Survey study. Front Psychiatry 2020; 11: 254.

https://doi.org/10.3389/fpsyt.2020.00254 DOI: https://doi.org/10.3389/fpsyt.2020.00254

Morley JE. Cognition and chronic disease. J Am Med Dir Assoc 2017; 18: 369-371.

https://doi.org/10.1016/j.jamda.2017.02.010 DOI: https://doi.org/10.1016/j.jamda.2017.02.010

Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46: 399-424.

https://doi.org/10.1080/00273171.2011.568786 DOI: https://doi.org/10.1080/00273171.2011.568786

Austin PC. Some methods of propensity-score matching had superior performance to others: results of an empirical investigation and Monte Carlo simulations. Biom J 2009; 51: 171-184.

https://doi.org/10.1002/bimj.200810488 DOI: https://doi.org/10.1002/bimj.200810488

Haroon NN, Austin PC, Shah BR, Wu J, Gill SS, Booth GL. Risk of dementia in seniors with newly diagnosed diabetes: a population-based study. Diabetes Care 2015; 38: 1868-1875.

https://doi.org/10.2337/dc15-0491 DOI: https://doi.org/10.2337/dc15-0491

Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K. Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort. Arch Intern Med 2004; 164: 1327-1333.

https://doi.org/10.1001/archinte.164.12.1327 DOI: https://doi.org/10.1001/archinte.164.12.1327

Hassing LB, Grant MD, Hofer SM, Pedersen NL, Nilsson SE, Berg S, et al. Type 2 diabetes mellitus contributes to cognitive decline in old age: a longitudinal population-based study. J Int Neuropsychol Soc 2004; 10: 599-607.

https://doi.org/10.1017/S1355617704104165 DOI: https://doi.org/10.1017/S1355617704104165

Neth BJ, Craft S. Insulin resistance and Alzheimer's disease: bioenergetic linkages. Front Aging Neurosci 2017; 9: 345.

https://doi.org/10.3389/fnagi.2017.00345 DOI: https://doi.org/10.3389/fnagi.2017.00345

O'Grady JP, Dean DC 3rd, Yang KL, Canda CM, Hoscheidt SM, Starks EJ, et al. Elevated insulin and insulin resistance are associated with altered myelin in cognitively unimpaired middle-aged adults. Obesity (Silver Spring) 2019; 27: 1464-1471.

https://doi.org/10.1002/oby.22558 DOI: https://doi.org/10.1002/oby.22558

Canal MP, Nini KA, Baez MV. Impaired fasting glucose, oxidative distress, and cognitive impairment. Is this the starting point on DBT cognitive decline? Front Aging Neurosci 2022; 14: 911331.

https://doi.org/10.3389/fnagi.2022.911331 DOI: https://doi.org/10.3389/fnagi.2022.911331

Biessels GJ, Despa F. Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications. Nat Rev Endocrinol 2018; 14: 591-604.

https://doi.org/10.1038/s41574-018-0048-7 DOI: https://doi.org/10.1038/s41574-018-0048-7

Lyu Q, Guan CX, Kong LN, Zhu JL. Prevalence and risk factors of cognitive frailty in community-dwelling older adults with diabetes: a systematic review and meta-analysis. Diabet Med 2023; 40: 14935.

https://doi.org/10.1111/dme.14935 DOI: https://doi.org/10.1111/dme.14935

Brewster KK, Hu MC, Wall MM, Brown PJ, Zilcha-Mano S, Roose SP, et al. Age-related hearing loss, neuropsychological performance, and incident dementia in older adults. J Alzheimers Dis 2021; 80: 855-864.

https://doi.org/10.3233/JAD-200908 DOI: https://doi.org/10.3233/JAD-200908

Bento-Torres NV, Bento-Torres J, Tomás AM, Costa VO, Corrêa PG, Costa CN, et al. Influence of schooling and age on cognitive performance in healthy older adults. Braz J Med Biol Res 2017; 50: 5892.

https://doi.org/10.1590/1414-431x20165892 DOI: https://doi.org/10.1590/1414-431x20165892

Gates GA, Mills JH. Presbycusis. Lancet 2005; 366: 1111-1120.

https://doi.org/10.1016/S0140-6736(05)67423-5 DOI: https://doi.org/10.1016/S0140-6736(05)67423-5

Zhang J, Li LW, McLaughlin SJ. Psychological well-being and cognitive function among older adults in China: a population-based longitudinal study. J Aging Health 2022; 34: 173-183.

https://doi.org/10.1177/08982643211036226 DOI: https://doi.org/10.1177/08982643211036226

Ryff CD. Psychological well-being revisited: advances in the science and practice of eudaimonia. Psychother Psychosom 2014; 83: 10-28.

https://doi.org/10.1159/000353263 DOI: https://doi.org/10.1159/000353263

Xue H, Huang C, Zhu Q, Zhou S, Ji Y, Ding X, et al. Relationships among cognitive function, frailty, and health outcome in community-dwelling older adults. Front Aging Neurosci 2021; 13: 790251.

https://doi.org/10.3389/fnagi.2021.790251 DOI: https://doi.org/10.3389/fnagi.2021.790251

Son C, Park JH. Ecological effects of VR-based cognitive training on ADL and IADL in MCI and AD patients: a systematic review and meta-analysis. Int J Environ Res Public Health 2022; 19: 15875.

https://doi.org/10.3390/ijerph192315875 DOI: https://doi.org/10.3390/ijerph192315875

Exalto LG, Biessels GJ, Karter AJ, Huang ES, Katon WJ, Minkoff JR, Whitmer RA. Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study. Lancet Diabetes Endocrinol 2013; 1: 183-190.

https://doi.org/10.1016/S2213-8587(13)70048-2 DOI: https://doi.org/10.1016/S2213-8587(13)70048-2

Biessels GJ, Whitmer RA. Cognitive dysfunction in diabetes: how to implement emerging guidelines. Diabetologia 2020; 63: 3-9.

https://doi.org/10.1007/s00125-019-04977-9 DOI: https://doi.org/10.1007/s00125-019-04977-9

Additional Files

Published

2024-02-21

How to Cite

Zhai, L., Yang, Y., Zhang, J., Hou, W., Yang, Y., Ding, D., … Zhu, Y. (2024). Association between cognitive dysfunction and diabetes in patients over 65 years old: a cross-sectional study using propensity score matching. Journal of Rehabilitation Medicine, 56, jrm18372. https://doi.org/10.2340/jrm.v56.18372

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