About 9,000 adults were randomized to receive tight or less-tight systolic blood pressure control. They were followed for about 5 years for cognition and dementia outcomes.
Although the primary outcome was almost significant, the secondary outcomes were truly significant for improvement of mild cognitive impairment or probable dementia with intensive systolic blood pressure <120 mmHg over those who achieved sBP <140 mmHg.
While further trials are needed to clarify the above findings, there appears to be no harm of lowering the sBP down to <120 mmHg in this study.
The aim of the study was to evaluate longitudinal associations between HbA1c levels, diabetes status and subsequent cognitive decline over a 10 year follow-up period. Cognitive function was assessed at baseline and reassessed every 2 years.
HbA1c was significantly associated with an increased rate of decline in global cognitive, memory and executive function. Similarly, memory, executive function and orientation showed an increased rate of cognitive decline with diabetes.
Future studies are required to determine the effects of maintaining optimal glucose control on the rate of cognitive decline in people with diabetes.
Over 2,500 adults aged 70-80 without baseline dementia were followed for 9 years. Patients with subclinical hyperthyroidism and very low TSH, as defined by TSH < 0.10, were found to be at high risk of cognitive decline. On the contrary, subclinical hypothyroidism and subclinical hyperthyroid with TSH 0.1-0.5 were not associated with an increased incidence of dementia.
Although findings are associative, and not causative, it would still be reasonable to avoid “advanced” subclinical hyperthyroidism in adults >70 years of age. Low dose methimazole could be useful in these individuals assuming absence of medication adverse effects.
About 15,000 middle aged adults were followed for 25 years. The following characteristics were associated with higher rates of dementia: diabetes, prehypertension, hypertension, smoking, APOE ε4 genotype, black race, older age and lower educational level. These are important findings to share and discuss with relevant patients.
Higher fasting insulin levels and increased insulin resistance predict future memory decline as measured by verbal fluency. About 4,000 individuals, average age 50, were followed for 11 years. These findings imply the need of addressing insulin resistance early rather then later, when prediabetes or diabetes emerge.
One of the challenges of managing older adults with diabetes is the individualization of care in people with multiple comorbid conditions. Although macrovascular and microvascular complications of diabetes are well recognized, there is a lack of awareness regarding other conditions such as cognitive dysfunction, depression, and physical disabilities.
Cognitive dysfunction is of particular importance because of its impact on self-care and quality of life. In this Perspective, I discuss common and practical questions faced by clinicians managing diabetes in older adults who also have cognitive dysfunction.