Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies
Abstract
Aims/hypothesis We systematically reviewed and summarised prospective data relating diabetes status to changes in cognitive function over time.Methods Published reports of longitudinal studies that described assessment of cognitive function in people with diabetes were sought. Studies were included if they assessed cognitive function in participants with diabetes at the beginning and at follow-up. Studies were excluded if they had (1) a follow-up period of less than 1 year, (2) a rate of loss to follow-up in excess of 30%, or (3) described selected subgroups. Change in cognitive function was recorded as either the mean change in score and/or the proportion of individuals developing various degrees of change in cognitive function. A pooled estimate was calculated for the latter.Results Of 1,165 abstracts and titles initially identified, 25 articles met the inclusion and exclusion criteria. Individuals with diabetes had a 1.2- to 1.5-fold greater change over time in measures of cognitive function than those without diabetes. When assessed by the Mini-Mental State Exam and the Digit Symbol Span tests, a diagnosis of diabetes increased the odds of cognitive decline 1.2-fold (95% CI 1.05-1.4) and 1.7-fold (95% CI 1.3-2.3), respectively . The odds of future dementia increased 1.6-fold (95% CI 1.4-1.8).Conclusions/interpretation Compared to people without diabetes, people with diabetes have a greater rate of decline in cognitive function and a greater risk of cognitive decline. Cognitive dysfunction should therefore be added to the list of chronic complications of diabetes.
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Written from the paper’s full text.
TL;DR
This systematic overview of 25 prospective observational studies found that people with diabetes have greater cognitive decline and a higher risk of dementia than people without diabetes. The authors conclude that cognitive dysfunction should be added to the list of chronic complications of diabetes.
Key findings
- Among 25 included articles covering more than 8,656 people with diabetes and follow-up periods of 2 to 18 years, diabetes was associated with a 1.2- to 1.5-fold greater change over time in measures of cognitive function.
- Pooled estimates showed increased odds of cognitive decline on the MMSE/3MS (OR 1.2, 95% CI 1.05–1.4) and DSS (OR 1.7, 95% CI 1.3–2.3), and a 1.6-fold higher risk of future all-cause dementia (95% CI 1.4–1.8).
- For dementia subtypes, risks ranged from 1.2 to 2.3 for Alzheimer’s disease and from 2.2 to 3.4 for vascular dementia.
- In continuous DSS analyses, three studies reported a decline of 1.3 to 1.4% per year in people with diabetes; overall this decline was up to 1.5 times greater than in people without diabetes.
Methods
- Systematic review of longitudinal/prospective observational studies; Medline, EMBASE, and PsycINFO were searched, along with expert contact and bibliography review. Of 1,165 abstracts/titles, 50 were fully reviewed and 25 met inclusion/exclusion criteria.
- Inclusion required baseline and follow-up cognitive assessment, diabetes or glucose tolerance status, and English-language reporting; exclusions were follow-up under 1 year, loss to follow-up over 30%, or selected subgroups.
- Data were abstracted on age, diabetes definition, participant numbers, follow-up length, cognitive tools, and outcomes; pooled inverse variance-weighted log risk ratios with 95% CIs were calculated, with heterogeneity assessed by the Q statistic using Review Manager 4.2.
Limitations
- The paper states possible publication bias, though it argues this is unlikely because many included studies were prospective cohorts examining many risk factors; it also states that MMSE/3MS may underestimate diabetes effects because it poorly detects attention and processing speed.
- The paper states that included studies differed in definitions of clinically meaningful decline, diabetes identification, age groups, cognitive tools, statistical adjustment, baseline cognitive impairment, and follow-up completeness (73–92%), and that there is no evidence to date that diabetes management affects the rate or nature of cognitive dysfunction.
- Evident from the text: only three studies explicitly reported that data were collected without examiner awareness of diabetes status, and some pooled estimates relied on few studies, such as the DSS estimate based on two studies.
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- Findingown data§ Cognitive decline and dementia in diabetes -systematic overview of prospective observational studies · p. 1
Individuals with diabetes had a 1.2- to 1.5-fold greater change over time in measures of cognitive function than those without diabetes.
“Individuals with diabetes had a 1.2- to 1.5-fold greater change over time in measures of cognitive function than those without diabetes.”
Quote in the paperSubstantial claim - Findingown data§ Cognitive decline and dementia in diabetes -systematic overview of prospective observational studies · p. 1
The odds of future dementia increased 1.6-fold (95% CI 1.4-1.8) in people with diabetes.
“The odds of future dementia increased 1.6-fold (95% CI 1.4 -1.8).”
Quote in the paperSubstantial claim- Rests on an assumption: The definitions of dementia used in the included studies are sufficiently comparable to be combined in the review.
- Findingown data§ Cognitive decline and dementia in diabetes -systematic overview of prospective observational studies · p. 1
When assessed by the Digit Symbol Span tests, a diagnosis of diabetes increased the odds of cognitive decline 1.7-fold (95% CI 1.3-2.3).
“When assessed by the Mini-Mental State Exam and the Digit Symbol Span tests, a diagnosis of diabetes increased the odds of cognitive decline 1.2-fold (95% CI 1.05 -1.4) and 1.7-fold (95% CI 1.3 -2.3), respectively.”
Quote in the paperSubstantial claim - Findingown data§ Search · p. 3
The 25 remaining articles comprised data from more than 8,656 people with diabetes.
“The 25 remaining articles [46 -70] comprised data from more than 8,656 people with diabetes, with follow-up periods ranging from 2 to 18 years.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [46 -70]
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- Findingown data§ Cognitive decline and dementia in diabetes -systematic overview of prospective observational studies · p. 1
When assessed by the Mini-Mental State Exam, a diagnosis of diabetes increased the odds of cognitive decline 1.2-fold (95% CI 1.05-1.4).
“When assessed by the Mini-Mental State Exam and the Digit Symbol Span tests, a diagnosis of diabetes increased the odds of cognitive decline 1.2-fold (95% CI 1.05 -1.4) and 1.7-fold (95% CI 1.3 -2.3), respectively.”
Quote in the paperSubstantial claim
- Findingcitation§ Discussion · p. 7
There is little evidence to support chronic cognitive impairment secondary to hypoglycaemia.
“However, in contrast to the acute negative effect of hypoglycaemia on cognition, there is little evidence to support chronic cognitive impairment secondary to hypoglycaemia.”
Quote in the paperNot a substantial claim - Findingown data§ Measures of cognitive function · p. 5
Compared to people without diabetes, people with diabetes were 1.7 times more likely to experience cognitive decline as measured by the DSS (95% CI 1.3-2.3).
“Compared to people without diabetes, people with diabetes were 1.2 times more likely to experience cognitive decline as measured by the MMSE/3MS (95% CI 1.0 -1.4) and 1.7 times more likely to experience cognitive decline as measured by the DSS (95% CI 1.3 -2.3).”
Quote in the paperSubstantial claim- Rests on an assumption: The cognitive assessment instruments used across the included studies measure cognitive decline in a comparable way.
- Findingcitation§ Measures of cognitive function · p. 3
Six studies reported time-related changes as a continuous variable using either the MMSE or 3MS score in individuals with and without a history of diabetes.
“Table 2 lists the six studies that reported time-related changes as a continuous variable using either the MMSE or 3MS score in individuals with and without a history of diabetes [49, 51, 52, 54, 65, 69].”
Quote in the paperSubstantial claim0 of 6 sources checked- cites [49] Wu JH, Haan MN, Liang J, Ghosh D, Gonzalez HM, Herman WH (2003) Impact of antidiabetic medications on physical and cognitive functioning of older Mexican Americans with diabetes mellitus: a population-based cohort study. Ann Epidemiol 13:369–376 source
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- cites [51] Fontbonne A, Berr C, Ducimetiere P, Alperovitch A (2001) Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 24:366–370 source
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- cites [65] Hassing LB, Hofer SM, Nilsson SE et al (2004) Comorbid type 2 diabetes mellitus and hypertension exacerbates cognitive decline: evidence from a longitudinal study. Age Ageing 33:355–361 source
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- Findingown data§ Measures of cognitive function · p. 5
In six studies, diabetes status predicted an odds ratio for cognitive decline that ranged from 0.7 to 4.4.
“In these studies, diabetes status predicted an odds ratio for cognitive decline that ranged from 0.7 to 4.4.”
Quote in the paperNot a substantial claim- Rests on an assumption: The cognitive assessment instruments used across the included studies measure cognitive decline in a comparable way.
- Findingown data§ Measures of cognitive function · p. 3
Three studies reported a decline ranging from 1.3 to 1.4% per year in people with diabetes.
“Three studies reported a decline ranging from 1.3 to 1.4% per year in people with diabetes.”
Quote in the paperNot a substantial claim - Findingcitation§ Discussion · p. 7
Two included studies reported that participants with impaired fasting glucose or impaired glucose tolerance experience more cognitive decline than participants without.
“Moreover, two of the studies included in this review reported that participants with impaired fasting glucose or impaired glucose tolerance experience more cognitive decline than participants without, further supporting a link between cognitive decline and hyperglycaemia [51, 69, 70].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [51] Fontbonne A, Berr C, Ducimetiere P, Alperovitch A (2001) Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 24:366–370 source
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- cites [69] Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K (2004) 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 164:1327–1333 source
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- Findingown data§ Discussion · p. 7
Compared to people without diabetes, people with diabetes have a greater rate of decline in cognitive function.
“This systematic overview of prospective studies supports the conclusion that, compared to people without diabetes, people with diabetes have: (1) a greater rate of decline in cognitive function; (2) a 1.5-fold greater risk of cognitive decline; and (3) a 1.6-fold greater risk of future dementia.”
Quote in the paperSubstantial claim - Findingown data§ Measures of cognitive function · p. 5
Compared to people without diabetes, people with diabetes were 1.2 times more likely to experience cognitive decline as measured by the MMSE/3MS (95% CI 1.0-1.4).
“Compared to people without diabetes, people with diabetes were 1.2 times more likely to experience cognitive decline as measured by the MMSE/3MS (95% CI 1.0 -1.4) and 1.7 times more likely to experience cognitive decline as measured by the DSS (95% CI 1.3 -2.3).”
Quote in the paperSubstantial claim- Rests on an assumption: The cognitive assessment instruments used across the included studies measure cognitive decline in a comparable way.
- Findingown data§ Measures of cognitive function · p. 3
The ratio of the relative change in score from baseline in people with diabetes compared to those without diabetes ranged from 1.2 to 1.6.
“The ratio of the relative change in score from baseline in people with diabetes compared to those without diabetes ranged from 1.2 to 1.6.”
Quote in the paperSubstantial claim - Findingown data§ Discussion · p. 7
Compared to people without diabetes, people with diabetes have a 1.6-fold greater risk of future dementia.
“This systematic overview of prospective studies supports the conclusion that, compared to people without diabetes, people with diabetes have: (1) a greater rate of decline in cognitive function; (2) a 1.5-fold greater risk of cognitive decline; and (3) a 1.6-fold greater risk of future dementia.”
- Also stated in: § Measures of cognitive function · p. 6 · plain
“Overall, people with diabetes were 1.6 times more likely to develop all-cause dementia than people without diabetes (95% CI 1.4 -1.8).”
Quote in the paperSubstantial claim - Also stated in: § Measures of cognitive function · p. 6 · plain
- Findingown data§ Measures of cognitive function · p. 3
Individuals with diabetes experienced a consistently greater decline or lesser improvement in cognitive function than those without diabetes.
“Individuals with diabetes experienced a consistently greater decline or lesser improvement than those without diabetes.”
Quote in the paperSubstantial claim - Findingnone given§ Discussion · p. 7
The included studies reported a similar degree of cognitive decline despite differences in analytic approaches and cognitive assessment tools.
“Interestingly, the included studies reported a similar degree of cognitive decline, despite differences in analytic approaches and cognitive assessment tools.”
Quote in the paperNot a substantial claim - Findingown data§ Discussion · p. 7
Compared to people without diabetes, people with diabetes have a 1.5-fold greater risk of cognitive decline.
“This systematic overview of prospective studies supports the conclusion that, compared to people without diabetes, people with diabetes have: (1) a greater rate of decline in cognitive function; (2) a 1.5-fold greater risk of cognitive decline; and (3) a 1.6-fold greater risk of future dementia.”
Quote in the paperSubstantial claim - Findingown data§ Measures of cognitive function · p. 7
The test for heterogeneity for the pooled estimate of future dementia was chi square=4.02, df=4 (p=0.40), I2=0.6%.
“Test for heterogeneity: chi square=4.02, df =4 ( p =0.40), I 2 =0.6%”
Quote in the paperNot a substantial claim - Findingown data§ Discussion · p. 8
The overall estimated effect of the MMSE/3MS was smaller than the overall estimate obtained from studies that used the DSS.
“This possibility is supported by the fact that the overall estimated effect of the MMSE/3MS was smaller than the overall estimate obtained from studies that used the DSS.”
Quote in the paperSubstantial claim - Findingcitation§ Discussion · p. 8
There is no evidence to date that diabetes management affects the rate or nature of cognitive dysfunction.
“Despite this relationship, there is no evidence to date that diabetes management affects the rate or nature of cognitive dysfunction.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [4] Areosa Sastre A, Grimley Evans J (2005) Effect of the treatment of Type II diabetes mellitus on the development of cognitive impairment and dementia. The Cochrane Library, Issue 2, http://www.cochrane.org/cochrane/revabstr/AB003804.htm
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- Findingown data§ Measures of cognitive function · p. 5
The pooled odds ratio for the effect of diabetes on cognitive decline (assessed by a composite score) was 1.7 (95% CI 1.3-2.3).
“| Total (95% CI) | 394 | 5866 | 1.7 (1.3, 2.3) |”
Quote in the paperSubstantial claim - Findingcitation§ Measures of cognitive function · p. 6
Studies reporting the development of future dementia reported that people with diabetes had a higher risk of all-cause dementia than people without diabetes.
“Studies reporting the development of future dementia of these reported that people with diabetes had a higher risk of all-cause dementia than people without diabetes [56, 58, 64, 65, 67].”
Quote in the paperSubstantial claim0 of 5 sources checked- cites [56] Ott A, Stolk RP, van HF, Pols HA, Hofman A, Breteler MM (1999) Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology 53:1937–1942 source
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- cites [65] Hassing LB, Hofer SM, Nilsson SE et al (2004) Comorbid type 2 diabetes mellitus and hypertension exacerbates cognitive decline: evidence from a longitudinal study. Age Ageing 33:355–361 source
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- Findingown data§ Discussion · p. 8
Only two included studies reported that diabetes non-significantly reduced the risk for cognitive decline.
“Despite these differences, only two studies reported that diabetes non-significantly reduced the risk for cognitive decline.”
Quote in the paperNot a substantial claim - Study design and conductnone given§ Validity assessment · p. 3
Studies were similar with respect to four of the quality measures used.
“Studies were similar with respect to four of the quality measures used.”
Quote in the paperNot a substantial claim - Premisecitation§ Introduction · p. 1
Recent evidence from several epidemiological studies suggests that diabetes is a risk factor for cognitive dysfunction.
“Recent evidence from several epidemiological studies suggests that it is also a risk factor for cognitive dysfunction [3 -6].”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [3] Allen KV, Frier BM, Strachan MW (2004) The relationship between type 2 diabetes and cognitive dysfunction: longitudinal studies and their methodological limitations. Eur J Pharmacol 490:169–175 source
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- cites [4] Areosa Sastre A, Grimley Evans J (2005) Effect of the treatment of Type II diabetes mellitus on the development of cognitive impairment and dementia. The Cochrane Library, Issue 2, http://www.cochrane.org/cochrane/revabstr/AB003804.htm
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- cites [6] Stewart R, Liolitsa D (1999) Type 2 diabetes mellitus, cognitive impairment and dementia. Diabet Med 16:93–112 source
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- Premisereasoning§ Introduction · p. 1
Many of the studies suggesting diabetes is a risk factor for cognitive dysfunction were cross-sectional and unable to provide estimates of diabetes as a risk factor for future cognitive dysfunction.
“However, many of these studies were cross-sectional and were thus unable to provide estimates of diabetes as a risk factor for future cognitive dysfunction.”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [3] Allen KV, Frier BM, Strachan MW (2004) The relationship between type 2 diabetes and cognitive dysfunction: longitudinal studies and their methodological limitations. Eur J Pharmacol 490:169–175 source
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- cites [4] Areosa Sastre A, Grimley Evans J (2005) Effect of the treatment of Type II diabetes mellitus on the development of cognitive impairment and dementia. The Cochrane Library, Issue 2, http://www.cochrane.org/cochrane/revabstr/AB003804.htm
Not checked in the free run.
- cites [5] Lobo A, Launer LJ, Fratiglioni L et al (2000) Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic diseases in the elderly research group. Neurology 54(Suppl 5):S4–S9
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- cites [6] Stewart R, Liolitsa D (1999) Type 2 diabetes mellitus, cognitive impairment and dementia. Diabet Med 16:93–112 source
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- Premisecitation§ Introduction · p. 1
Only one of the review articles that summarised the available data on the relationship between diabetes and cognitive dysfunction provided a quantitative estimate.
“Indeed, only one [7] of the review articles that summarised the available data pertaining to this relationship [4, 6 -11] provided a quantitative estimate.”
Quote in the paperSubstantial claim0 of 7 sources checked- cites [7] Awad N, Gagnon M, Messier C (2004) The relationship between impaired glucose tolerance, type 2 diabetes, and cognitive function. J Clin Exp Neuropsychol 26:1044–1080 source
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- cites [6] Stewart R, Liolitsa D (1999) Type 2 diabetes mellitus, cognitive impairment and dementia. Diabet Med 16:93–112 source
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- Study design and conductown data§ Validity assessment · p. 3
Loss to follow-up in the included studies ranged from 8 to 27%.
“Loss to follow-up ranged from 8 to 27%.”
Quote in the paperNot a substantial claim - Premisecitation§ Discussion · p. 7
Depression occurs more frequently in people with diabetes.
“Second, depression occurs more frequently in people with diabetes [73] and is difficult to differentiate clinically from dementia and early cognitive decline [74 -77].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [73] Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2001) The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 24:1069–1078 source
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- Premisecitation§ Discussion · p. 7
In one study that reported diabetes status of individuals lost to follow-up, diabetic participants had higher mortality and/or lower follow-up rates than those without diabetes.
“Indeed, in one study, which did report diabetes status of individuals lost to follow-up, diabetic participants had a higher mortality and/ or lower follow-up rates than those without diabetes [55].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [55] Tilvis RS, Kahonen-Vare MH, Jolkkonen J, Valvanne J, Pitkala KH, Strandberg TE (2004) Predictors of cognitive decline and mortality of aged people over a 10-year period. J Gerontol A Biol Sci Med Sci 59:268–274 source
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- Premisecitation§ Discussion · p. 7
Intensive treatment regimens associated with increased hypoglycaemic episodes in individuals with type 1 diabetes did not adversely affect cognition.
“Indeed, intensive treatment regimens that were associated with increased hypoglycaemic episodes in individuals with type 1 diabetes did not adversely affect cognition [78].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [78] Reichard P, Pihl M (1994) Mortality and treatment side-effects during long-term intensified conventional insulin treatment in the Stockholm diabetes intervention study. Diabetes 43:313–317 source
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- Premisecitation§ Discussion · p. 7
In the Framingham Study, people with diabetes were more likely to achieve scores below the 25th percentile on most cognitive tests than non-diabetic individuals.
“In the Framingham Study, 2,123 subjects aged 55 to 88 completed a neuropsychological test battery during either the 14th or 15th biennial examination. People with diabetes status were more likely to achieve scores below the 25th percentile on most tests than were non-diabetic individuals.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [71] Elias PK, Elias MF, D'Agostino RB et al (1997) NIDDM and blood pressure as risk factors for poor cognitive performance. The Framingham Study. Diabetes Care 20:1388–1395 source
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- Interpretationreasoning§ Discussion · p. 7
The included studies probably underestimated the impact of diabetes on cognitive function because they generally excluded cognitively impaired individuals at baseline.
“Furthermore, these studies probably underestimated the impact of diabetes on cognitive function because they generally excluded cognitively impaired individuals at baseline, and may therefore have ' selected for ' healthier individuals with lower risk of cognitive decline.”
Quote in the paperNot a substantial claim - Premisecitation§ Discussion · p. 7
Post mortem studies of senile plaques from brains of people with Alzheimer dementia found metabolic oxidation products associated with hyperglycaemia.
“Post mortem studies of senile plaques from the brains of people with Alzheimer dementia found metabolic oxidation products associated with hyperglycaemia [79, 80].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [79] Horie K, Miyata T, Yasuda T et al (1997) Immunohistochemical localization of advanced glycation end products, pentosidine, and carboxymethyllysine in lipofuscin pigments of Alzheimer's disease and aged neurons. Biochem Biophys Res Commun 236:327–332 source
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- Premisecitation§ Discussion · p. 7
Depression is difficult to differentiate clinically from dementia and early cognitive decline.
“Second, depression occurs more frequently in people with diabetes [73] and is difficult to differentiate clinically from dementia and early cognitive decline [74 -77].”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [74] Swainson R, Hodges JR, Galton CJ et al (2001) Early detection and differential diagnosis of Alzheimer's disease and depression with neuropsychological tasks. Dement Geriatr Cogn Disord 12:265–280 source
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- Premisecitation§ Discussion · p. 7
The Framingham study and the Adult Health Study support the findings of this overview.
“They are also supported by the large Framingham study [71] and the Adult Health Study [72].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [71] Elias PK, Elias MF, D'Agostino RB et al (1997) NIDDM and blood pressure as risk factors for poor cognitive performance. The Framingham Study. Diabetes Care 20:1388–1395 source
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- Interpretationreasoning§ Discussion · p. 7
A relationship between cognitive change and diabetes may be mediated through cerebrovascular disease.
“Thus, a relationship between cognitive change and diabetes may be mediated through cerebrovascular disease.”
Quote in the paperNot a substantial claim - Premisecitation§ Discussion · p. 7
At least one included study reported an association between diabetes and cognitive decline even after adjustment for depression.
“However, at least one of the studies [54] reported an association between diabetes and cognitive decline even after adjustment for depression.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [54] Gregg EW, Yaffe K, Cauley JA et al (2000) Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group. Arch Intern Med 160:174–180 source
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- Interpretationreasoning§ Discussion · p. 8
The results of the prospective studies summarised here suggest that cognitive dysfunction should be considered as yet another chronic consequence and disabling manifestation of diabetes.
“Nevertheless, the results of the prospective studies summarised here suggest that cognitive dysfunction should be considered as yet another chronic consequence and disabling manifestation of diabetes.”
Quote in the paperNot a substantial claim - Premisecitation§ Discussion · p. 8
The MMSE/3MS has a limited ability to detect changes in specific cognitive domains such as attention and processing speed.
“This instrument (which was designed as a tool for assessing global cognitive function) has a limited ability to detect changes in specific cognitive domains such as attention and processing speed [17, 82].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [17] Tombaugh TN, McIntyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935 source
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- Interpretationreasoning§ Discussion · p. 8
The consistency of the results despite differences in studies highlights the robustness of the conclusion that diabetes is a risk factor for cognitive decline.
“The consistency of our results, despite the differences in the studies, highlights the robustness of the conclusion that diabetes is indeed a risk factor for cognitive decline.”
Quote in the paperSubstantial claim - Premisecitation§ Discussion · p. 7
Prospective epidemiological studies show a relationship between cognitive decline and clinical markers associated with hyperglycaemia (e.g., use of glucose-lowering medication, diabetes duration, diabetes complications).
“Finally, prospective epidemiological studies also show a relationship between cognitive decline and clinical markers associated with hyperglycaemia, e.g. use of glucose-lowering medication, diabetes duration and diabetes complications [46, 48, 49, 54, 56, 64].”
Quote in the paperSubstantial claim0 of 6 sources checked- cites [46] Logroscino G, Kang JH, Grodstein F (2004) Prospective study of type 2 diabetes and cognitive decline in women aged 70–81 years. BMJ 328:548 source
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- cites [48] Wu JH, Haan MN, Liang J, Ghosh D, Gonzalez HM, Herman WH (2003) Impact of diabetes on cognitive function among older Latinos: a population-based cohort study. J Clin Epidemiol 56:686–693 source
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- cites [49] Wu JH, Haan MN, Liang J, Ghosh D, Gonzalez HM, Herman WH (2003) Impact of antidiabetic medications on physical and cognitive functioning of older Mexican Americans with diabetes mellitus: a population-based cohort study. Ann Epidemiol 13:369–376 source
Not checked in the free run.
- cites [54] Gregg EW, Yaffe K, Cauley JA et al (2000) Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group. Arch Intern Med 160:174–180 source
Not checked in the free run.
- cites [56] Ott A, Stolk RP, van HF, Pols HA, Hofman A, Breteler MM (1999) Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology 53:1937–1942 source
Not checked in the free run.
- cites [64] MacKnight C, Rockwood K, Awalt E, McDowell I (2002) Diabetes mellitus and the risk of dementia, Alzheimer's disease and vascular cognitive impairment in the Canadian Study of Health and Aging. Dement Geriatr Cogn Disord 14:77–83 source
Not checked in the free run.
- Classified as probably not a substantial claim. 12
- May combine two claims. 17
Classified as probably not a substantial claim.
Findingown data§ Cognitive decline and dementia in diabetes -systematic overview of prospective observational studies · p. 1Of 1,165 abstracts and titles initially identified, 25 articles met the inclusion and exclusion criteria.
“Of 1,165 abstracts and titles initially identified, 25 articles met the inclusion and exclusion criteria.”
- Also stated in: § Search · p. 3 · plain
“The 25 remaining articles [46 -70] comprised data from more than 8,656 people with diabetes, with follow-up periods ranging from 2 to 18 years.”
Quote in the paperSubstantial claim- Also stated in: § Search · p. 3 · plain
Classified as probably not a substantial claim.
Findingown data§ Search · p. 3Of the citations obtained, 50 met the inclusion criteria and were fully reviewed and analysed.
“Of these citations, 50 met the inclusion criteria and were fully reviewed and analysed.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ Search · p. 3Follow-up periods in the included studies ranged from 2 to 18 years.
“The 25 remaining articles [46 -70] comprised data from more than 8,656 people with diabetes, with follow-up periods ranging from 2 to 18 years.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Findingown data§ Measures of cognitive function · p. 5Six studies used the MMSE or 3MS and two studies used the DSS to classify participants into those who did and did not experience cognitive decline.
“Table 3, and Figs. 1 and 2 list and display results from the six studies that used the MMSE or 3MS [47 -51, 54, 62, 69] and the two studies that used the DSS [51, 54] to classify participants into those who did and did not experience cognitive decline.”
Quote in the paperSubstantial claim0 of 8 sources checked- cites [47] Nguyen HT, Black SA, Ray LA, Espino DV, Markides KS (2002) Predictors of decline in MMSE scores among older Mexican Americans. J Gerontol A Biol Sci Med Sci 57:M181–M185 source
Not checked in the free run.
- cites [48] Wu JH, Haan MN, Liang J, Ghosh D, Gonzalez HM, Herman WH (2003) Impact of diabetes on cognitive function among older Latinos: a population-based cohort study. J Clin Epidemiol 56:686–693 source
Not checked in the free run.
- cites [49] Wu JH, Haan MN, Liang J, Ghosh D, Gonzalez HM, Herman WH (2003) Impact of antidiabetic medications on physical and cognitive functioning of older Mexican Americans with diabetes mellitus: a population-based cohort study. Ann Epidemiol 13:369–376 source
Not checked in the free run.
- cites [50] Haan MN, Mungas DM, Gonzalez HM, Ortiz TA, Acharya A, Jagust WJ (2003) Prevalence of dementia in older Ltinos: the influence of type 2 diabetes mellitus, stroke and genetic factors. J Am Geriat Soc 51:169–177 source
Not checked in the free run.
- cites [51] Fontbonne A, Berr C, Ducimetiere P, Alperovitch A (2001) Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 24:366–370 source
Not checked in the free run.
- cites [54] Gregg EW, Yaffe K, Cauley JA et al (2000) Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group. Arch Intern Med 160:174–180 source
Not checked in the free run.
- cites [62] Stewart R, Prince M, Mann A (2003) Age, vascular risk, and cognitive decline in an older, British, African-Caribbean population. J Am Geriat Soc 51:1547–1553 source
Not checked in the free run.
- cites [69] Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K (2004) 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 164:1327–1333 source
Not checked in the free run.
May combine two claims.
Findingcitation§ Measures of cognitive function · p. 3One study reported an improvement in score of 1.2% in people with diabetes, which was approximately half of the improvement experienced by the non-diabetic participants.
“However, one study reported an improvement in score of 1.2% in people with diabetes; nevertheless this improvement was approximately half of the improvement experienced by the non-diabetic participants [51].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [51] Fontbonne A, Berr C, Ducimetiere P, Alperovitch A (2001) Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 24:366–370 source
Not checked in the free run.
May combine two claims.
Findingown data§ Measures of cognitive function · p. 3Four studies used the DSS as a continuous variable to assess cognitive function and three reported an adverse effect of diabetes on cognitive function over time.
“Four studies used the DSS as a continuous variable (Table 2) to assess cognitive function and three reported an adverse effect of diabetes on cognitive function over time.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data§ Measures of cognitive function · p. 5Five of six studies using a composite of other cognitive measures reported that participants with diabetes had a higher risk of developing cognitive decline than those without diabetes; in three of these the lower limit of the 95% confidence interval exceeded 1.
“Five of these studies reported that participants with diabetes had a higher risk of developing cognitive decline than those without diabetes; in three of these the lower limit of the 95% confidence interval exceeded 1 (i.e. it was statistically significant).”
Quote in the paperSubstantial claim- Rests on an assumption: The definitions of dementia used in the included studies are sufficiently comparable to be combined in the review.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ Measures of cognitive function · p. 5Seventeen studies divided the participants into two groups based on whether or not participants experienced cognitive decline during follow-up.
“Seventeen studies divided the participants into two groups based on whether or not participants did or did not experience cognitive decline during follow-up.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data§ Measures of cognitive function · p. 5Eight studies reported a variety of other cognitive tests, most of them reporting greater or equal cognitive change for the diabetic participants, and some but not all of the tests detected a significant difference between the groups with and without diabetes.
“Eight studies reported a variety of other cognitive tests, most of them reporting greater or equal cognitive change for the diabetic participants (Table 1) [46, 49, 51, 58, 63, 66, 69, 70]. Some, but not all of the tests detected a significant difference between the groups with and without diabetes.”
Quote in the paperNot a substantial claim0 of 8 sources checked- cites [46] Logroscino G, Kang JH, Grodstein F (2004) Prospective study of type 2 diabetes and cognitive decline in women aged 70–81 years. BMJ 328:548 source
Not checked in the free run.
- cites [49] Wu JH, Haan MN, Liang J, Ghosh D, Gonzalez HM, Herman WH (2003) Impact of antidiabetic medications on physical and cognitive functioning of older Mexican Americans with diabetes mellitus: a population-based cohort study. Ann Epidemiol 13:369–376 source
Not checked in the free run.
- cites [51] Fontbonne A, Berr C, Ducimetiere P, Alperovitch A (2001) Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 24:366–370 source
Not checked in the free run.
- cites [58] Leibson CL, Rocca WA, Hanson VA et al (1997) Risk of dementia among persons with diabetes mellitus: a population-based cohort study. Am J Epidemiol 145:301–308 source
Not checked in the free run.
- cites [63] Robertson-Tchabo EA, Arenberg D, Tobin JD, Plotz JB (1986) A longitudinal study of cognitive performance in noninsulin dependent (type II) diabetic men. Exp Gerontol 21:459–467 source
Not checked in the free run.
- cites [66] Arvanitakis Z, Wilson RS, Bienias JL, Evans DA, Bennett DA (2004) Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function. Arch Neurol 61:661–666 source
Not checked in the free run.
- cites [69] Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K (2004) 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 164:1327–1333 source
Not checked in the free run.
- cites [70] Yaffe K, Blackwell T, Kanaya AM, Davidowitz BA, Barrett-Connor E, Krueger K (2004) Diabetes, impaired fasting glucose, and development of cognitive impairment in older women. Neurology 63:658–663 source
Not checked in the free run.
May combine two claims.
Findingcitation§ Measures of cognitive function · p. 5In three studies reporting a composite cognitive score, individuals with diabetes had a greater absolute annual decline in score than those without diabetes, but the differences only achieved statistical significance in one study.
“In these studies, individuals with diabetes had a greater absolute annual decline in score than those without diabetes; however, the differences only achieved statistical significance in one study [70].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [70] Yaffe K, Blackwell T, Kanaya AM, Davidowitz BA, Barrett-Connor E, Krueger K (2004) Diabetes, impaired fasting glucose, and development of cognitive impairment in older women. Neurology 63:658–663 source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductcitation§ Validity assessment · p. 2The selected studies were analysed according to previously published methodological criteria [12] to determine if they reported predetermined selection, diabetes definition, outcome definition, same cognitive instrument, blinding, and loss to follow-up.
“The selected studies were analysed according to previously published methodological criteria [12] to determine if they reported: (1) a predetermined method for selection of the participants; (2) the definition of diabetes mellitus; (3) the definition of the outcome; (4) use of the same cognitive assessment instrument in the two groups; (5) that data were collected unaware of the diabetes status (b”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Horwitz RI, Feinstein AR (1979) Methodologic standards and contradictory results in case-control research. Am J Med 66:556–564 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown data§ Validity assessment · p. 3Only three studies explicitly reported that data were collected without the examiner being aware of the diabetes status of the participant.
“Only three studies explicitly reported that data were collected without the examiner being aware of the diabetes status of the participant [46, 51, 62].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [46] Logroscino G, Kang JH, Grodstein F (2004) Prospective study of type 2 diabetes and cognitive decline in women aged 70–81 years. BMJ 328:548 source
Not checked in the free run.
- cites [51] Fontbonne A, Berr C, Ducimetiere P, Alperovitch A (2001) Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 24:366–370 source
Not checked in the free run.
- cites [62] Stewart R, Prince M, Mann A (2003) Age, vascular risk, and cognitive decline in an older, British, African-Caribbean population. J Am Geriat Soc 51:1547–1553 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitation§ Statistical analysis · p. 3Heterogeneity was assessed using the Q statistic.
“Heterogeneity was assessed using the Q statistic [20].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] Laird NM, Mosteller F (1990) Some statistical methods for combining experimental results. Int J Technol Assess Health Care 6:5–30 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ Common measures of cognitive function · p. 2The MMSE is a valid screening tool for detecting dementia and its ability to detect changes in cognitive function for non-demented individuals has been documented mainly in the elderly.
“The validity of the MMSE as a screening tool for detecting dementia has been extensively studied [17]; its ability to detect changes in cognitive function for non-demented individuals has been documented mainly in the elderly [18].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [17] Tombaugh TN, McIntyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935 source
Not checked in the free run.
- cites [18] Brayne C, Spiegelhalter DJ, Dufouil C et al (1999) Estimating the true extent of cognitive decline in the old. J Am Geriatr Soc 47:1283–1288 source
Not checked in the free run.
May combine two claims.
Interpretationown data§ Cognitive decline and dementia in diabetes -systematic overview of prospective observational studies · p. 1Compared to people without diabetes, people with diabetes have a greater rate of decline in cognitive function and a greater risk of cognitive decline.
“ple with diabetes have a greater rate of decline in cognitive function and a greater risk of cognitive decline.”
Quote in the paperSubstantial claim- Rests on an assumption: The definitions of dementia used in the included studies are sufficiently comparable to be combined in the review.
- Rests on an assumption: The cognitive assessment instruments used across the included studies measure cognitive decline in a comparable way.
- Rests on an assumption: The included studies' participants with diabetes are representative of people with diabetes generally.
May combine two claims.
Premisecitation§ Discussion · p. 7In the Adult Health Study, diabetes increased the risk of vascular dementia 1.3-fold and Alzheimer's dementia 4.4-fold compared to non-diabetic individuals.
“Compared to non-diabetic individuals, diabetes increased the risk of vascular dementia and Alzheimer ' s dementia 1.3 and 4.4-fold, respectively.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [72] Yamada M, Kasagi F, Sasaki H, Masunari N, Mimori Y, Suzuki G (2003) Association between dementia and midlife risk factors: the Radiation Effects Research Foundation Adult Health Study. J Am Geriat Soc 51:410–414 source
Not checked in the free run.
May combine two claims.
Premisecitation§ Discussion · p. 7Experimental studies in animal models and in humans without diabetes have shown that poor glucose regulation after a glucose challenge test is associated with poorer performance on a variety of cognitive tests, with a more pronounced effect in older age groups.
“Experimental studies in animal models and in humans without diabetes have shown that poor glucose regulation after a glucose challenge test was associated with poorer performance on a variety of cognitive tests, the effect being more pronounced in the older age group [81].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [81] Messier C (2004) Glucose improvement of memory: a review. Eur J Pharmacol 490:33–57 source
Not checked in the free run.
May combine two claims.
Interpretationreasoning§ Discussion · p. 7Most of the included studies did not include information on people who died or who were lost to follow-up, and this may have led to underestimation of the effect of diabetes on cognitive decline.
“Another factor suggesting that the reports underestimated the effect of diabetes on cognitive decline is the fact that most of the studies did not include information on people who died or who were lost to follow-up, when follow-up success itself could well be linked to good cognitive function.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ Discussion · p. 7Previous reviews of available longitudinal studies support the findings of this overview.
“These findings are supported by previous reviews of the available longitudinal studies [3, 4, 6].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [3] Allen KV, Frier BM, Strachan MW (2004) The relationship between type 2 diabetes and cognitive dysfunction: longitudinal studies and their methodological limitations. Eur J Pharmacol 490:169–175 source
Not checked in the free run.
- cites [4] Areosa Sastre A, Grimley Evans J (2005) Effect of the treatment of Type II diabetes mellitus on the development of cognitive impairment and dementia. The Cochrane Library, Issue 2, http://www.cochrane.org/cochrane/revabstr/AB003804.htm
Not checked in the free run.
- cites [6] Stewart R, Liolitsa D (1999) Type 2 diabetes mellitus, cognitive impairment and dementia. Diabet Med 16:93–112 source
Not checked in the free run.
Classified as probably not a substantial claim.
Premisecitation§ Discussion · p. 8A recent review of the effect of therapy concluded that no studies were appropriate for inclusion in meta-analysis.
“Indeed, a recent review of the effect of therapy concluded that no studies were appropriate for inclusion in meta analysis [4].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [4] Areosa Sastre A, Grimley Evans J (2005) Effect of the treatment of Type II diabetes mellitus on the development of cognitive impairment and dementia. The Cochrane Library, Issue 2, http://www.cochrane.org/cochrane/revabstr/AB003804.htm
Not checked in the free run.
May combine two claims.
Interpretationreasoning§ Discussion · p. 8Because attention and processing speed may be selectively impaired in people with diabetes, the MMSE/3MS will underestimate the impact of diabetes on cognitive function.
“As these domains may be selectively impaired in people with diabetes the MMSE/3MS will underestimate the impact of diabetes on cognitive function [10].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] Strachan MW, Deary IJ, Ewing FM, Frier BM (1997) Is type II diabetes associated with an increased risk of cognitive dysfunction? A critical review of published studies. Diabetes Care 20:438–445 source
Not checked in the free run.
May combine two claims.
Study design and conductown data§ Discussion · p. 8The included studies differed with respect to definition of clinically meaningful decline, identification of diabetes, age groups, cognitive assessment tools, statistical adjustment for confounders, degree of baseline cognitive impairment, and completeness of follow-up (73-92%).
“The study is also limited by the differences in the studies included with respect to: (1) the definition of a clinically meaningful decline in cognitive function; (2) identification of people with and without diabetes; (3) age groups that were studied; (4) cognitive assessment tools employed; (5) degree of statistical adjustment for confounders; (6) degree of cognitive impairment permitted in stud”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ Discussion · p. 8In one study, the non-significant reduced risk was only noted in young participants, while findings in older participants were consistent with other studies.
“In one study, this finding was only noted in young participants, while findings in older participants were consistent with the results from the other studies [62].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [62] Stewart R, Prince M, Mann A (2003) Age, vascular risk, and cognitive decline in an older, British, African-Caribbean population. J Am Geriat Soc 51:1547–1553 source
Not checked in the free run.
May combine two claims.
Study design and conductreasoning§ Discussion · p. 8It is unlikely that a lack of an association with diabetes would lead to non-publication because many of the analysed studies were prospective cohort studies examining many risk factors, not just diabetes.
“However, many of the studies analysed by us were prospective cohort studies, which examined many risk factors for cognitive decline, and not just diabetes. This makes it unlikely that a lack of an association with diabetes would lead to non-publication.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ Discussion · p. 8In the other study, the non-significant reduced risk was only noted for women and only in certain cognitive tests, and the large confidence interval and wide variability suggest a larger sample size could have altered the results.
“In the other study, this finding was only noted for women, and only in certain cognitive tests. The large confidence interval and wide variability of scores between tests reported in this study suggest that a larger sample size could possibly have altered the results [69].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [69] Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K (2004) 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 164:1327–1333 source
Not checked in the free run.
The paper relies on this without support.
The definitions of dementia used in the included studies are sufficiently comparable to be combined in the review.
“The definition of dementia used in each study was accepted for this review.”
The paper relies on this without support.
The cognitive assessment instruments used across the included studies measure cognitive decline in a comparable way.
“Cognitive function was measured using a variety of simple cognitive tests [9, 13, 14].”
The paper relies on this without support.
The included studies' participants with diabetes are representative of people with diabetes generally.
“The 25 remaining articles [46 -70] comprised data from more than 8,656 people with diabetes, with follow-up periods ranging from 2 to 18 years.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Older adults with diabetes are at higher risk of cognitive decline and institutionalization.
“Older adults with diabetes are at higher risk of cognitive decline and institutionalization (12,13).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [12]
The Discussion (p. 7) concludes that people with diabetes have a greater rate and risk of cognitive decline than people without diabetes; the Discussion (p. 8) notes that findings in older participants were consistent with this conclusion. Our copy does not report a higher risk of institutionalization (searched for institutionalization, institutionalisation, and related care settings), so that part is unsupported by this source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredType 2 diabetes has been demonstrated to be related to accelerated cognitive decline.
“Type 2 diabetes (T2D) has been demonstrated to be related to accelerated cognitive decline (3) and increased risk of dementia (4)”
From Type 2 Diabetes and Antidiabetic Medications in Relation to Dementia Diagnosis (2014) · cites this paper as [3]
Cross-sectional studies have shown an association between hyperglycemia and cognitive dysfunction.
“Cross-sectional studies have shown an association between hyperglycemia and cognitive dysfunction62.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [62]
Evidence for impairments in peripheral insulin signalling in patients with AD was presented more than 25 years ago, and the incidence of AD is increased in patients with metabolic impairments such as diabetes; some cognitive domains have been consistently found to be affected in type 2 diabetes.
“Evidence for impairments in peripheral insulin signalling in patients with AD was presented more than 25 years ago, 138 and the incidence of AD is known to be increased in patients with metabolic impairments such as diabetes 139,140 ; fittingly, some cognitive domains have been consistently found to be affected in type 2 diabetes (eg, memory, psychomotor speed, executive function).113”
From Intranasal insulin (2021) · cites this paper as [139]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Fig. 3 non-diabetes-group total does not sum to its available counts
MinorThe four numerical non-diabetes-group counts displayed in Fig. 3 sum to 11,497, not the reported total of 10,044; the remaining study's count is marked NA.
Reported 10044 · recomputed 11497
“| Total (95% CI) | 2723 | 10044 | 1.6 (1.4, 1.8) |”
Gregg comparison-group count differs between Table 3 and Fig. 1
MinorFig. 1 lists 584 participants without diabetes for Gregg et al., whereas Table 3 lists 5,844 for the same study. The Fig. 1 total is consistent with 5,844, not 584.
“| Gregg et al [54] | 402 | 584 | 1.0 (0.8, 1.4) |”
“| MMSE/3MS | [54] | 65 - 99 (F) | History | 6 | 402 | 5844 | ≥ 11.5% a | 1.0 (0.8 - 1.4) e |”
Fig. 3 diabetes-group total does not sum to its study counts
MinorThe five diabetes-group counts displayed in Fig. 3 sum to 3,585, not the reported total of 2,723.
Reported 2723 · recomputed 3585
“| Total (95% CI) | 2723 | 10044 | 1.6 (1.4, 1.8) |”
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- Authors
- Cukierman, T., Gerstein, H. C., & Williamson, J. D.
- Affiliations
- Population Health Research Institute (CA)
- Wake Forest University Health Sciences (US)
- Corresponding author
- Cukierman, T.
- Venue
- Diabetologia
- Published
- 2005-11-08
- Volume
- 48
- Issue
- 12
- Pages
- 2460-2469
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2046949772
- Cited by
- 1,049
- References
- 90
- Citations by year
- 2026: 23 · 2025: 47 · 2024: 37 · 2023: 56 · 2022: 72 · 2021: 58 · 2020: 62 · 2019: 70 · 2018: 54 · 2017: 61 · 2016: 65 · 2015: 67 · 2014: 77 · 2013: 64 · 2012: 43
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- diabetes mellitus, cognitive decline, dementia, cognitive function, Mini-Mental State Examination, Digit Symbol Substitution Test, chronic complications of diabetes, longitudinal cohort
- MeSH terms
- Cognition, Cognition Disorders, Dementia, Diabetes Mellitus, Follow-Up Studies, Humans, Intelligence Tests, Longitudinal Studies, Neuropsychological Tests, Prospective Studies, Risk Factors, Odds Ratio, Diabetes Complications
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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