The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: the second longitudinal study on aging

BackgroundFor older adults without diabetes, cognitive functioning has been implicated as a predictor of death and functional disability for older adults and those with mild to severe cognitive impairment. However, little is known about the relationship between cognition functioning on mortality and the development of functional disability in late life for persons with diabetes. We examined the relative contribution of cognitive functioning to mortality and functional disability over a 2-year period in a sample of nationally representative older US adults with diabetes who were free from cognitive impairment through secondary data analyses of the Second Longitudinal Study of Aging (LSOA II).MethodsParticipants included 559 US adults (232 males and 327 females) ≥ 70 years old who had diabetes and who were free from cognitive impairment were examined using an adapted Telephone Interview of Cognitive Status (TICS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL).ResultsMultivariate logistic regression was conducted to investigate the independent contribution of cognitive functioning to three mutually exclusive outcomes of death and two measures of functional disability status. The covariates included in the model were participants' sex, age, race, marital status, educational level, duration of diabetes, cardiovascular disease (CVD) status, and self-rated health. Persons with diabetes who had the lowest levels of cognitive functioning relative to the highest level of cognitive functioning had a greater odds of dying (AOR = 0.80, 95% CI = 0.67–0.96) or becoming disabled (AOR = 0.87, 95% CI = 0.78–0.97) compared to those people who were disability free.ConclusionOlder adults with diabetes and low normal levels of cognition, yet within normal ranges, were approximately 20% more likely to die and 13% more likely to become disabled than those with higher levels of cognitive functioning over a 2-year period. Brief screening measures of cognitive functioning could be used to identify older adults with diabetes who are at increased risk for mortality and functional disability, as well as those who may benefit from interventions to prevent or minimize further disablement and declines in cognitive functioning.

[1]  M. K. James,et al.  The timing of change: patterns in transitions in functional status among elderly persons. , 1998, The journals of gerontology. Series B, Psychological sciences and social sciences.

[2]  P. Tun,et al.  Memory self-assessment and performance in aged diabetics and non-diabetics. , 1987, Experimental aging research.

[3]  Ronald C. Petersen,et al.  Mild cognitive impairment clinical trials , 2003, Nature Reviews Drug Discovery.

[4]  A. Mokdad,et al.  Fruit and vegetable consumption and diabetes mellitus incidence among U.S. adults. , 2001, Preventive medicine.

[5]  S. Shumaker,et al.  Type 2 diabetes mellitus and cognition: an understudied issue in women's health. , 2003, Journal of psychosomatic research.

[6]  Michael Witt,et al.  SUDAAN language manual, release 9.0: , 2003 .

[7]  F. Grodstein,et al.  Prospective study of type 2 diabetes and cognitive decline in women aged 70-81 years , 2004, BMJ : British Medical Journal.

[8]  R. Wallace,et al.  Measures of cognitive functioning in the AHEAD Study. , 1997, The journals of gerontology. Series B, Psychological sciences and social sciences.

[9]  Y. Stern,et al.  Functional deficits in patients with mild cognitive impairment: Prediction of AD , 2002, Neurology.

[10]  M. Marmot,et al.  Diabetes and cognitive function in a middle-aged cohort , 2005, Neurology.

[11]  J. Cauley,et al.  Diabetes and incidence of functional disability in older women. , 2002, Diabetes care.

[12]  A. Stuck,et al.  Risk factors for functional status decline in community-living elderly people: a systematic literature review. , 1999, Social science & medicine.

[13]  T. Songer.  Disability in Diabetes , 1996 .

[14]  W. W. Muir,et al.  Regression Diagnostics: Identifying Influential Data and Sources of Collinearity , 1980 .

[15]  C. Camp,et al.  Memory training in normal and demented elderly populations: the E-I-E-I-O model. , 1993, Experimental aging research.

[16]  D. Ghosh,et al.  Impact of antidiabetic medications on physical and cognitive functioning of older Mexican Americans with diabetes mellitus: a population-based cohort study. , 2003, Annals of epidemiology.

[17]  E. Korn,et al.  Analysis of Health Surveys: Korn/Analysis , 1999 .

[18]  D. Brogan,et al.  PITFALLS OF USING STANDARD STATISTICAL SOFTWARE PACKAGES FOR SAMPLE SURVEY DATA , 1997 .

[19]  E. Ford,et al.  Leisure-Time Physical Activity Patterns in the U.S. Diabetic Population: Findings from the 1990 National Health Interview Survey—Health Promotion and Disease Prevention Supplement , 1995, Diabetes Care.

[20]  T. Bush,et al.  Self-report and medical record report agreement of selected medical conditions in the elderly. , 1989, American journal of public health.

[21]  F. Rist,et al.  Short-Term Effects of Improved Glycemic Control on Cognitive Function in Patients with Type 2 Diabetes , 2003, Gerontology.

[22]  E. Ford,et al.  Cognitive functioning as a predictor of functional disability in later life. , 2006, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[23]  Willem Hendrik Gispen,et al.  Cognition and synaptic plasticity in diabetes mellitus , 2000, Trends in Neurosciences.

[24]  G. Pelton,et al.  The impact of mild cognitive impairment on functional abilities in the elderly , 2002, Current psychiatry reports.

[25]  C. Fabrigoule,et al.  Disability and cognitive impairment in the elderly. , 1997, Disability and rehabilitation.

[26]  J. Stoker,et al.  The Department of Health and Human Services. , 1999, Home healthcare nurse.

[27]  J. L. Harrison,et al.  The Government Printing Office , 1968, American Journal of Pharmaceutical Education.

[28]  J. Foster,et al.  Cognitive impairment, physical disability and depressive symptoms in older diabetic patients: the Fremantle Cognition in Diabetes Study. , 2003, Diabetes research and clinical practice.

[29]  G. Mcclearn,et al.  Type 2 diabetes mellitus contributes to cognitive decline in old age: A longitudinal population-based study , 2004, Journal of the International Neuropsychological Society.

[30]  L. Fried,et al.  Agreement Between Self‐Report of Disease Diagnoses and Medical Record Validation in Disabled Older Women: Factors That Modify Agreement , 2004, Journal of the American Geriatrics Society.

[31]  Denise C. Park,et al.  Cognitive aging and everyday life. , 2000 .

[32]  D. Dunlop,et al.  Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions. , 2002, Archives of physical medicine and rehabilitation.

[33]  A J Girling,et al.  Cognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self-management and use of care services. All Wales Research into Elderly (AWARE) Study. , 2000, Diabetes research and clinical practice.

[34]  U. Sonn,et al.  Cognitive function and functional ability. A cross- sectional and longitudinal study at ages 85 and 95 in a non-demented population , 2001, Aging.

[35]  Edward L. Korn,et al.  Analysis of Health Surveys , 1999 .

[36]  R. Wallace,et al.  Additive and Interactive Effects of Comorbid Physical and Mental Conditions on Functional Health , 2003, Journal of aging and health.

[37]  S. Harlow,et al.  Agreement between questionnaire data and medical records. The evidence for accuracy of recall. , 1989, American journal of epidemiology.

[38]  E. Jacobs,et al.  Agreement of Self-Reported Medical History: Comparison of an In-Person Interview with a Self-Administered Questionnaire , 2003, European Journal of Epidemiology.

[39]  J Ormel,et al.  The assessment of ADL among frail elderly in an interview survey: self-report versus performance-based tests and determinants of discrepancies. , 1996, The journals of gerontology. Series B, Psychological sciences and social sciences.

[40]  J. Williamson,et al.  Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies , 2005, Diabetologia.

[41]  Hannie C. Comijs,et al.  The Impact of Change in Cognitive Functioning and Cognitive Decline on Disability, Well-Being, and the Use of Healthcare Services in Older Persons , 2005, Dementia and Geriatric Cognitive Disorders.

[42]  D. Singer,et al.  Decreased cognitive function in aging non-insulin-dependent diabetic patients. , 1984, The American journal of medicine.

[43]  J. Cummings,et al.  The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment , 2005, Journal of the American Geriatrics Society.

[44]  S. Furner,et al.  A Co-Twin Control Study of Physical Function in Elderly African American Women , 2004, Journal of aging and health.

[45]  D. Ghosh,et al.  Diabetes as a predictor of change in functional status among older Mexican Americans: a population-based cohort study. , 2003, Diabetes care.

[46]  S. Willis,et al.  Long-term effects of fluid ability training in old-old age , 1990 .

[47]  E D Richardson,et al.  Impairments in physical performance and cognitive status as predisposing factors for functional dependence among nondisabled older persons. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.