The DOI matches its Crossref record; 89 of the 90 references it cites were found in a registry or an index; none of the 86 sources its claims cite is checked for support yet.
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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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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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Individuals with diabetes had a 1.2- to 1.5-fold greater change over time in measures of cognitive function than those without diabetes.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The odds of future dementia increased 1.6-fold (95% CI 1.4 -1.8).”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The definitions of dementia used in the included studies are sufficiently comparable to be combined in the review.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“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.”
What the sources say
- Not checked yetcites [46 -70]
Strength:plain· not yet calibratedn = 8,656Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“However, in contrast to the acute negative effect of hypoglycaemia on cognition, there is little evidence to support chronic cognitive impairment secondary to hypoglycaemia.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Rests on an assumption: The cognitive assessment instruments used across the included studies measure cognitive decline in a comparable way.
None of the sources cited for this claim have been checked yet.
In the paper
“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].”
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [52] Haan MN, Shemanski L, Jagust WJ, Manolio TA, Kuller L (1999) The role of APOE epsilon4 in modulating effects of other risk factors for cognitive decline in elderly persons. JAMA 282:40–46 source
- Not checked yetcites [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 yetcites [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
- Not checked yetcites [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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In these studies, diabetes status predicted an odds ratio for cognitive decline that ranged from 0.7 to 4.4.”
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Rests on an assumption: The cognitive assessment instruments used across the included studies measure cognitive decline in a comparable way.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Three studies reported a decline ranging from 1.3 to 1.4% per year in people with diabetes.”
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- Probably not a substantial claim. 12
- It may state two separate claims as one. 17
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Also stated in: § Search · p. 3 · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of these citations, 50 met the inclusion criteria and were fully reviewed and analysed.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedn = 8,656Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“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].”
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: The definitions of dementia used in the included studies are sufficiently comparable to be combined in the review.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seventeen studies divided the participants into two groups based on whether or not participants did or did not experience cognitive decline during follow-up.”
Strength:plain· not yet calibratedn = 17Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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].”
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
What the sources say
- Not checked yetcites [12] Horwitz RI, Feinstein AR (1979) Methodologic standards and contradictory results in case-control research. Am J Med 66:556–564 source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Only three studies explicitly reported that data were collected without the examiner being aware of the diabetes status of the participant [46, 51, 62].”
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Heterogeneity was assessed using the Q statistic [20].”
What the sources say
- Not checked yetcites [20] Laird NM, Mosteller F (1990) Some statistical methods for combining experimental results. Int J Technol Assess Health Care 6:5–30 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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].”
What the sources say
- Not checked yetcites [17] Tombaugh TN, McIntyre NJ (1992) The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935 source
- Not checked yetcites [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
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“ple with diabetes have a greater rate of decline in cognitive function and a greater risk of cognitive decline.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
In the paper
“Compared to non-diabetic individuals, diabetes increased the risk of vascular dementia and Alzheimer ' s dementia 1.3 and 4.4-fold, respectively.”
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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].”
What the sources say
- Not checked yetcites [81] Messier C (2004) Glucose improvement of memory: a review. Eur J Pharmacol 490:33–57 source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“These findings are supported by previous reviews of the available longitudinal studies [3, 4, 6].”
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [6] Stewart R, Liolitsa D (1999) Type 2 diabetes mellitus, cognitive impairment and dementia. Diabet Med 16:93–112 source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Indeed, a recent review of the effect of therapy concluded that no studies were appropriate for inclusion in meta analysis [4].”
What the sources say
- Not checked yetcites [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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“As these domains may be selectively impaired in people with diabetes the MMSE/3MS will underestimate the impact of diabetes on cognitive function [10].”
What the sources say
- Not checked yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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].”
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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].”
What the sources say
- Not checked yetcites [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
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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?
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In the citing paper
“Older adults with diabetes are at higher risk of cognitive decline and institutionalization (12,13).”
From 13. Older Adults: Standards of Care in Diabetes—2024 (2024) · cites this paper as [12]
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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BackgroundMethodInfluentialCognitive and psychosocial aspects of caring for elderly patients with diabetes
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BackgroundInfluentialLatino and Alzheimer’s: Social Determinants and Personal Factors Contributing to Disease Risk
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“growing body of scientific investigations indicating that diabetes is associated with an increased risk of developing cognitive impairment and dementia [31-33], the findings from the current study revealed that diabetic respondents had a higher score of cognitive function.”
ResultEffects of orthostatic hypotension on cognition in type 2 diabetes mellitus
Zhang, J., Chi, H., Wang, T., Shen, T., Wang, H., Yuan, X., & Li, Z. (2019) · Annals of Neurology · doi:10.1002/ana.25578 · Cited by 9
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BackgroundSex Differences in the Effect of Diabetes on Cerebral Glucose Metabolism
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“16 The risk has been estimated at 1.6 (95% CI 1.4, 1.8) that of nondiabetic individuals.”
InfluentialType 2 diabetes has a slow and insidious effect on cognition
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“Diabetes (Cukierman et al., 2005), insulin resistance (Luchsinger et al., 2004), hypertension (Elias et al., 1997; Launer et al., 2000), dyslipi- K. L. Hildreth (&) Division of Geriatric Medicine, University of Colorado School of Medicine, Mail Stop B-179, 12631 East 17th Avenue, Aurora, CO 80045,…”
BackgroundSupporting behaviour change in older people with type 2 diabetes
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BackgroundThe Role of Iron Overload in Diabetic Cognitive Impairment: A Review
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Glucose impairment and ghrelin gene variants are associated to cognitive dysfunction
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Investigation the Cognitive Impairment in Diabetes Mellitus Type 2 with Moca Test
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“It was reported that elderly DM patients have impaired cognition in comparison to age- matched controls [10,11].”
ResultRisk Factors and Prevention in Alzheimer’s Disease and Dementia
Grande, G., Vetrano, D. L., & Mangialasche, F. (2018) · Springer eBooks · doi:10.1007/978-3-319-72938-1_6 · Cited by 7
Youth-Onset Type 2 Diabetes and the Developing Brain
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Cognitive Dysfunction in Diabetes Mellitus
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“Although high BMI, history of stroke, hypertension, and diabetes are known risk factors for cognitive impairment (Cukierman et al., 2005; Elias et al., 2003; Patel et al., 2002), these associations did not reach statistical significance in our study, possibly because of its relatively limited sample size.”
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“In addition, a growing amount of epidemiological evidence provides a convincing argument supporting a significant association between T2DM, mild cognitive impairment (MCI) and AD, and further suggests that T2DM is a significant risk factor for developing AD (Stewart and Liositsa 1999; Cukierman et al. 2005).”
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DIABETES MELLITUS AND THE RISK OF DEMENTIA A Population-based Study
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Diabetes, the brain, and cognition
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“Depending on the tests used for measuring cognition and the severity and duration of T2DM, the incidence of cognitive impairment may be increased by 20%–100%.(1) Subtle changes in executive function are the first impairments to be noted, followed by the development of mild cognitive impairment and dementia.”
MethodCrosstalk of kidney and brain in diabetes-related cognitive impairment and therapeutic strategies
Xu, C., Miao, H., Chen, Y., & Liao, L. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1562518 · Cited by 7
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“Epidemiological studies have demonstrated that patients with diabetes are more susceptible to cognitive dysfunction compared with the general middle-aged and elderly populations (7, 8).”
BackgroundXu, J., Li, C., Fan, R., Yin, J., Xie, L., Peng, X., Tao, J., Xu, W., Zhang, S., Shi, X., et al. (2025) · Cell Communication and Signaling · doi:10.1186/s12964-024-02019-5 · Cited by 9
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“In addition, in diabetic patients, high HbA1c levels are associated with decreased memory and complex psychomotor performance, suggesting that inadequate glucose control may be associated with worsening cognitive function [27].”
Meta-analysis of Telemonitoring to Improve HbA1c Levels: Promises for Stroke Survivors
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“Diabetes on its own causes insidious damage to the brain as small-vessel disease, and neuropsychological studies have shown that poor long-term glycemic control has a deleterious effect on cognition [18,19].”
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The influence of chromosome 4 on metabolism and spatial memory in SHR and SLA16 rat strains
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Changes in Brain 14-3-3 Proteins in Response to Insulin Resistance Induced by a High Palatable Diet
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“High risk of dementia or significant cognitive decline has been associated to both insulin resistance alone and type 2 diabetes mellitus (T2DM) [17, 18].”
BackgroundDiabetes Mellitus and Cognitive Decline – Prevention Should Not Be Delayed!
Sinclair, A. J., & Vellas, B. J. (2018) · The Journal of Prevention of Alzheimer s Disease · doi:10.14283/jpad.2018.9 · Cited by 6
“However, a large number of prospective longitudinal studies have formed a platform to shed light on these intriguing relationships (7-9).”
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Neurocognitive Dysfunction in Old Diabetes
Umegaki, H. (2012) · Advances in experimental medicine and biology · doi:10.1007/978-1-4614-5441-0_33 · Cited by 6
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Mild Cognitive Dysfunction Does Not Affect Diabetes Mellitus Control in Minority Elderly Adults
Palta, P., Golden, S. H., Teresi, J. A., Palmas, W., Weinstock, R. S., Shea, S., Manly, J. J., & Luchsinger, J. A. (2014) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13129 · Cited by 6
“5 times as great as that of individuals without diabetes mellitus.(3) Executive function and memory declines are the most frequently reported cognitive deficits in the setting of diabetes mellitus.”
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“Nach den Resultaten einer Reihe von longitudinalen Studien haben Patienten mit Diabetes ein 1,5- bis 2-fach erhöhtes Risiko für 7 „cognitive decline“ in einem Bebachtungszeitraum von 2–8 Jahren, die jährliche Verschlechterung kognitiver Leistungen ist um 20–50% gegenüber Nicht-Diabetespatienten erhöht [3, 6].”
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“There is also an increased likelihood in the older adult population to develop both dementia and diabetes, with research showing that people with diabetes have a greater rate of decline in cognitive function and an increased risk of dementia [27].”
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“With the rising number of diabetic patients, diabetes-associated cognitive dysfunction (DACD) has become a focus of research [3,4].”
InfluentialKanthi, A., Singh, D., Kaligal, C., Mahadevappa, V., & Krishna, D. (2024) · Clinical EEG and Neuroscience · doi:10.1177/15500594241249511 · Cited by 5
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Diabetes mellitus und kognitive Störungen
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“[7] Cukierman T, Gerstein HC, Williamson JD.”
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“Type 2 diabetes mellitus (T2DM) is a metabolic disorder that increases the risk of cognitive impairment.(1,2) T2DM has been associated with alterations in the blood–brain barrier,(3,4) neuronal damage,(5) and arterial stiffness,(6) thus affecting cerebral metabolism and perfusion.”
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Newer Glucose-Lowering Therapies in Older Adults with Type 2 Diabetes
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Cognitive Dysfunction in Diabetes Mellitus
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Dementia and diabetes: Casual or causal relationship?
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Metadata
- 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 › Oncology › 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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