Clinical and Subclinical Macrovascular Disease as Predictors of Cognitive Decline in Older Patients With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study

On behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) Investigators; Insa Feinkohl; Marketa Keller; Christine M Robertson; Joanne R Morling; Rachel M Williamson; Lisa D Nee; Stela McLachlan; Naveed Sattar; Paul Welsh; Rebecca M Reynolds; Tom C Russ; Ian J Deary; Mark W J Strachan; Jackie F Price

doi:10.2337/dc12-2241

Clinical and Subclinical Macrovascular Disease as Predictors of Cognitive Decline in Older Patients With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study

On behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) Investigators, Insa Feinkohl, Marketa Keller, Christine M Robertson, Joanne R Morling, Rachel M Williamson, Lisa D Nee, Stela McLachlan, Naveed Sattar, Paul Welsh, Rebecca M Reynolds, Tom C Russ, Ian J Deary, Mark W J Strachan, Jackie F Price

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVEMacrovascular disease may contribute to increased risk of accelerated cognitive decline in patients with type 2 diabetes. We aimed to determine associations of measures of macrovascular disease with cognitive change in a cognitively healthy older population with type 2 diabetes.RESEARCH DESIGN AND METHODSEight-hundred thirty-one men and women (aged 60-75 years) attended two waves of the prospective Edinburgh Type 2 Diabetes Study (ET2DS). At baseline, clinical and subclinical macrovascular disease was measured, including cardiovascular event history, carotid intima-media thickness (cIMT), ankle brachial index (ABI), and serum N-terminal probrain natriuretic peptide (NT-proBNP). Seven neuropsychological tests were administered at baseline and after 4 years; scores were combined to a standardized general ability factor (g). Adjustment of follow-up g for baseline g assessed 4-year cognitive change. Adjustment for vocabulary (estimated premorbid ability) was used to estimate lifetime cognitive change.RESULTSMeasures of cognitive decline were significantly associated with stroke, NT-proBNP, ABI, and cIMT, but not with nonstroke vascular events. The association of stroke with increased estimated lifetime cognitive decline (standardized β, -0.12) and of subclinical markers with actual 4-year decline (standardized β, -0.12, 0.12, and -0.15 for NT-proBNP, ABI, and cIMT, respectively) reached the Bonferroni-adjusted level of statistical significance (P <0.006). Results altered only slightly on adjustment for vascular risk factors.CONCLUSIONSStroke and subclinical markers of cardiac stress and generalized atherosclerosis are associated with cognitive decline in older patients with type 2 diabetes. Further investigation into the potential use of subclinical vascular disease markers in predicting cognitive decline is warranted.

Original language	English
Pages (from-to)	2779-2786
Journal	Diabetes Care
Volume	36
Issue number	9
DOIs	https://doi.org/10.2337/dc12-2241
Publication status	Published - 11 Apr 2013

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10.2337/dc12-2241

Centre for Cognitive Ageing and Cognitive Epidemiology Phase 2.
Maclullich, A. (Principal Investigator)
1/09/13 → 31/08/19
Project: Research
RA2661 Centre for Cognitive Ageing and Cognitive Epidemiology Phase 2. Main Budget.
Deary, I. (Principal Investigator), Gale, C. (Co-investigator), Holmes, M. (Co-investigator), Logie, P. (Co-investigator), Maclullich, A. (Co-investigator), Porteous, D. (Co-investigator), Seckl, J. (Co-investigator), Starr, J. (Co-investigator), Wardlaw, J. (Co-investigator) & Okely, J. (Researcher)
1/09/13 → 31/08/19
Project: Research
MRC Centre for Cognitive Ageing and Cognitive Epidemiology
Deary, I. (Principal Investigator), Holmes, M. (Co-investigator), Logie, P. (Co-investigator), McCulloch, J. (Co-investigator), Porteous, D. (Co-investigator), Roberts, N. (Co-investigator), Seckl, J. (Co-investigator), Starr, J. (Co-investigator) & Wardlaw, J. (Co-investigator)
MRC
1/09/08 → 31/08/13
Project: Research

Cite this

On behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) Investigators, Feinkohl, I., Keller, M., Robertson, C. M., Morling, J. R., Williamson, R. M., Nee, L. D., McLachlan, S., Sattar, N., Welsh, P., Reynolds, R. M., Russ, T. C., Deary, I. J., Strachan, M. W. J., & Price, J. F. (2013). Clinical and Subclinical Macrovascular Disease as Predictors of Cognitive Decline in Older Patients With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study. Diabetes Care, 36(9), 2779-2786. https://doi.org/10.2337/dc12-2241

@article{19234e429970485c81474c651fd1db88,

title = "Clinical and Subclinical Macrovascular Disease as Predictors of Cognitive Decline in Older Patients With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study",

abstract = "OBJECTIVEMacrovascular disease may contribute to increased risk of accelerated cognitive decline in patients with type 2 diabetes. We aimed to determine associations of measures of macrovascular disease with cognitive change in a cognitively healthy older population with type 2 diabetes.RESEARCH DESIGN AND METHODSEight-hundred thirty-one men and women (aged 60-75 years) attended two waves of the prospective Edinburgh Type 2 Diabetes Study (ET2DS). At baseline, clinical and subclinical macrovascular disease was measured, including cardiovascular event history, carotid intima-media thickness (cIMT), ankle brachial index (ABI), and serum N-terminal probrain natriuretic peptide (NT-proBNP). Seven neuropsychological tests were administered at baseline and after 4 years; scores were combined to a standardized general ability factor (g). Adjustment of follow-up g for baseline g assessed 4-year cognitive change. Adjustment for vocabulary (estimated premorbid ability) was used to estimate lifetime cognitive change.RESULTSMeasures of cognitive decline were significantly associated with stroke, NT-proBNP, ABI, and cIMT, but not with nonstroke vascular events. The association of stroke with increased estimated lifetime cognitive decline (standardized β, -0.12) and of subclinical markers with actual 4-year decline (standardized β, -0.12, 0.12, and -0.15 for NT-proBNP, ABI, and cIMT, respectively) reached the Bonferroni-adjusted level of statistical significance (P <0.006). Results altered only slightly on adjustment for vascular risk factors.CONCLUSIONSStroke and subclinical markers of cardiac stress and generalized atherosclerosis are associated with cognitive decline in older patients with type 2 diabetes. Further investigation into the potential use of subclinical vascular disease markers in predicting cognitive decline is warranted.",

author = "{On behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) Investigators} and Insa Feinkohl and Marketa Keller and Robertson, {Christine M} and Morling, {Joanne R} and Williamson, {Rachel M} and Nee, {Lisa D} and Stela McLachlan and Naveed Sattar and Paul Welsh and Reynolds, {Rebecca M} and Russ, {Tom C} and Deary, {Ian J} and Strachan, {Mark W J} and Price, {Jackie F}",

year = "2013",

month = apr,

day = "11",

doi = "10.2337/dc12-2241",

language = "English",

volume = "36",

pages = "2779--2786",

journal = "Diabetes Care",

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publisher = "American Diabetes Association Inc.",

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On behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) Investigators, Feinkohl, I, Keller, M, Robertson, CM, Morling, JR, Williamson, RM, Nee, LD, McLachlan, S, Sattar, N, Welsh, P, Reynolds, RM , Russ, TC , Deary, IJ, Strachan, MWJ & Price, JF 2013, 'Clinical and Subclinical Macrovascular Disease as Predictors of Cognitive Decline in Older Patients With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study', Diabetes Care, vol. 36, no. 9, pp. 2779-2786. https://doi.org/10.2337/dc12-2241

Clinical and Subclinical Macrovascular Disease as Predictors of Cognitive Decline in Older Patients With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study. / On behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) Investigators; Feinkohl, Insa; Keller, Marketa et al.
In: Diabetes Care, Vol. 36, No. 9, 11.04.2013, p. 2779-2786.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Clinical and Subclinical Macrovascular Disease as Predictors of Cognitive Decline in Older Patients With Type 2 Diabetes

T2 - The Edinburgh Type 2 Diabetes Study

AU - On behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) Investigators

AU - Feinkohl, Insa

AU - Keller, Marketa

AU - Robertson, Christine M

AU - Morling, Joanne R

AU - Williamson, Rachel M

AU - Nee, Lisa D

AU - McLachlan, Stela

AU - Sattar, Naveed

AU - Welsh, Paul

AU - Reynolds, Rebecca M

AU - Russ, Tom C

AU - Deary, Ian J

AU - Strachan, Mark W J

AU - Price, Jackie F

PY - 2013/4/11

Y1 - 2013/4/11

N2 - OBJECTIVEMacrovascular disease may contribute to increased risk of accelerated cognitive decline in patients with type 2 diabetes. We aimed to determine associations of measures of macrovascular disease with cognitive change in a cognitively healthy older population with type 2 diabetes.RESEARCH DESIGN AND METHODSEight-hundred thirty-one men and women (aged 60-75 years) attended two waves of the prospective Edinburgh Type 2 Diabetes Study (ET2DS). At baseline, clinical and subclinical macrovascular disease was measured, including cardiovascular event history, carotid intima-media thickness (cIMT), ankle brachial index (ABI), and serum N-terminal probrain natriuretic peptide (NT-proBNP). Seven neuropsychological tests were administered at baseline and after 4 years; scores were combined to a standardized general ability factor (g). Adjustment of follow-up g for baseline g assessed 4-year cognitive change. Adjustment for vocabulary (estimated premorbid ability) was used to estimate lifetime cognitive change.RESULTSMeasures of cognitive decline were significantly associated with stroke, NT-proBNP, ABI, and cIMT, but not with nonstroke vascular events. The association of stroke with increased estimated lifetime cognitive decline (standardized β, -0.12) and of subclinical markers with actual 4-year decline (standardized β, -0.12, 0.12, and -0.15 for NT-proBNP, ABI, and cIMT, respectively) reached the Bonferroni-adjusted level of statistical significance (P <0.006). Results altered only slightly on adjustment for vascular risk factors.CONCLUSIONSStroke and subclinical markers of cardiac stress and generalized atherosclerosis are associated with cognitive decline in older patients with type 2 diabetes. Further investigation into the potential use of subclinical vascular disease markers in predicting cognitive decline is warranted.

AB - OBJECTIVEMacrovascular disease may contribute to increased risk of accelerated cognitive decline in patients with type 2 diabetes. We aimed to determine associations of measures of macrovascular disease with cognitive change in a cognitively healthy older population with type 2 diabetes.RESEARCH DESIGN AND METHODSEight-hundred thirty-one men and women (aged 60-75 years) attended two waves of the prospective Edinburgh Type 2 Diabetes Study (ET2DS). At baseline, clinical and subclinical macrovascular disease was measured, including cardiovascular event history, carotid intima-media thickness (cIMT), ankle brachial index (ABI), and serum N-terminal probrain natriuretic peptide (NT-proBNP). Seven neuropsychological tests were administered at baseline and after 4 years; scores were combined to a standardized general ability factor (g). Adjustment of follow-up g for baseline g assessed 4-year cognitive change. Adjustment for vocabulary (estimated premorbid ability) was used to estimate lifetime cognitive change.RESULTSMeasures of cognitive decline were significantly associated with stroke, NT-proBNP, ABI, and cIMT, but not with nonstroke vascular events. The association of stroke with increased estimated lifetime cognitive decline (standardized β, -0.12) and of subclinical markers with actual 4-year decline (standardized β, -0.12, 0.12, and -0.15 for NT-proBNP, ABI, and cIMT, respectively) reached the Bonferroni-adjusted level of statistical significance (P <0.006). Results altered only slightly on adjustment for vascular risk factors.CONCLUSIONSStroke and subclinical markers of cardiac stress and generalized atherosclerosis are associated with cognitive decline in older patients with type 2 diabetes. Further investigation into the potential use of subclinical vascular disease markers in predicting cognitive decline is warranted.

U2 - 10.2337/dc12-2241

DO - 10.2337/dc12-2241

M3 - Article

C2 - 23579182

SN - 0149-5992

VL - 36

SP - 2779

EP - 2786

JO - Diabetes Care

JF - Diabetes Care

IS - 9

ER -

Clinical and Subclinical Macrovascular Disease as Predictors of Cognitive Decline in Older Patients With Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study

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Projects

Centre for Cognitive Ageing and Cognitive Epidemiology Phase 2.

RA2661 Centre for Cognitive Ageing and Cognitive Epidemiology Phase 2. Main Budget.

MRC Centre for Cognitive Ageing and Cognitive Epidemiology

Cite this