The impact of diabetes on cognitive impairment and its progression to dementia

Abstract Introduction Diabetes is a well‐established risk factor for dementia, but its impact on the prodromal phase of dementia is unclear. Methods Cohorts of older adults who were cognitively healthy (n = 1840) or had cognitive impairment‐no dementia (CIND; n = 682) were followed over 12 years to detect incident CIND and dementia, respectively. Results Poorly controlled diabetes (glycated hemoglobin [HbA1c] ≥7.5%; reference = normoglycemia) was associated with double the risk of CIND (Cox regression multi‐adjusted hazard ratio [HR] 2.01, 95% confidence interval [CI] 1.13‐3.58) and triple the risk CIND progressing to dementia (HR 2.87, 95% CI 1.20‐6.85). Co‐morbid diabetes and heart disease doubled the risk of incident CIND and dementia, although neither disease conferred a significant risk of either outcome alone. Elevated systemic inflammation contributed to the diabetes‐associated increased dementia risk. Conclusions Diabetes characterized by poor glycemic control or cardiovascular complications is related to a greater risk of the development and progression of cognitive impairment. Inflammation may play a role in these relationships.