NIDDM and Blood Pressure as Risk Factors for Poor Cognitive Performance: The Framingham Study
Abstract
OBJECTIVE: To determine if NIDDM and blood pressure are risk factors for poor cognitive performance and if history and duration of NIDDM and blood pressure interact such that the risk of poor performance is greater for subjects with both NIDDM and hypertension. RESEARCH DESIGN AND METHODS: We used a large prospective cohort sample with 187 NIDDM subjects and 1,624 nondiabetic subjects who were followed for 28–30 years. Cognitive function was assessed using eight tests of learning, memory, visual organization, verbal fluency attention, concept formation, and abstract reasoning. A composite score was also calculated. Odds ratios were used to estimate the relative risk of performing below the lower 25th percentile of z scores on these tests. RESULTS: NIDDM and blood pressure interacted such that diagnosis and duration of NIDDM were associated with greater risk of poor performance on tests of visual memory and on the composite score for hypertensive subjects. Duration of NIDDM was associated with increased risk for poor performance on tests of verbal memory and concept formation. Insulin-treated NIDDM subjects were at higher risk for poor cognitive performance than those NIDDM subjects treated with oral agents or diet. Blood pressure level was associated independently with a measure of verbal fluency. CONCLUSIONS: History and duration of NIDDM and high blood pressure are significant risk factors for poor cognitive performance. Hypertensive people with NIDDM are at greatest risk for poor performance on tests measuring visual organization and memory.
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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.”
From Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies (2005) · cites this paper as [71]
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].”
From Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies (2005) · cites this paper as [71]
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“This was regrouped into five standard hierarchic levels: (1) no formal education, (2) lower secondary education, (3) higher secondary education, (4) university degree, (5) higher university degree.”
BackgroundCardiovascular risk factors and cerebral atrophy in a middle-aged cohort
Knopman, D. S., Mosley, T. H., Catellier, D., & Sharrett, A. R. (2005) · Neurology · doi:10.1212/01.wnl.0000176074.09733.a8 · Cited by 113 · see citing works
Alerting, orienting, and executive attention in older adults
Mahoney, J. R., Verghese, J., Goldin, Y., Lipton, R. B., & Holtzer, R. (2010) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617710000767 · Cited by 109 · see citing works
“Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases, as well as poor cognitive performance and cognitive decline (Elias et al., 1997; Elias, Elias, Robbins, & Budge, 2004; Raz, Rodrigue, Kennedy, & Acker, 2007).”
BackgroundKaffashian, S., Dugravot, A., Nabi, H., Batty, G. D., Brunner, E. J., Mika Kivimaki, B., & Singh‐Manoux, A. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr133 · Cited by 108 · see citing works
“Our finding for no greater decline in memory in those with higher CVD risk is consistent with a body of literature suggesting that frontally mediated cognitive functions, such as verbal fluency, may be more vulnerable to the pathophysiological processes linked to cardiovascular risk factors than other cognitive abilit…”
Cardiovascular risk factors and cognitive function
Grodstein, F. (2007) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2007.01.001 · Cited by 105 · see citing works
Low dose aspirin and cognitive function in the women's health study cognitive cohort
Kang, J. H., Cook, N., Manson, J., Buring, J. E., & Grodstein, F. (2007) · BMJ · doi:10.1136/bmj.39166.597836.be · Cited by 103 · see citing works
Mallorquí‐Bagué, N., Lozano‐Madrid, M., Toledo, E., Corella, D., Salas‐Salvadó, J., Cuenca‐Royo, A., Vioqué, J., Romaguera, D., Martínez, J. A., Wärnberǵ, J., et al. (2018) · Scientific Reports · doi:10.1038/s41598-018-33843-8 · Cited by 102 · see citing works
Minireview: Mechanisms by Which the Metabolic Syndrome and Diabetes Impair Memory
Meena Kumari, B., Brunner, E. J., & Fuhrer, R. (2000) · The Journals of Gerontology Series A · doi:10.1093/gerona/55.5.b228 · Cited by 102 · see citing works
Cardiovascular Health and Cognitive Function: The Maine-Syracuse Longitudinal Study
Crichton, G. E., Elias, M. F., Davey, A., & Alkerwi, A. (2014) · PLoS ONE · doi:10.1371/journal.pone.0089317 · Cited by 101 · see citing works
“SBP, hypertension, diabetes, cigarette smoking status, history of CVD, atrial fibrilation, and left ventricular hypertrophy were all associated with lower levels of cognitive performance for multiple cognitive domains in the Framingham Heart Study [1,47–49] as was the overall risk factor score.”
Self-citationCognitive dysfunction associated with metabolic syndrome
Taylor, V. H., & MacQUEEN, G. M. (2007) · Obesity Reviews · doi:10.1111/j.1467-789x.2007.00401.x · Cited by 102 · see citing works
“Similarly, both a Finnish study (53) and the Framingham study (54) reported an”
ResultEffects of Age and Hypertension Status on Cognition: The Veterans Affairs Normative Aging Study.
Brady, C. B., Spiro, A., & Gaziano, J. M. (2005) · Neuropsychology · doi:10.1037/0894-4105.19.6.770 · Cited by 95 · see citing works
“…without medical comorbidities, such as cardiovascular disease, diabetes mellitus, stroke, or dementia (on the basis of their NAS medical examination and history; see below) to control for the confounding effects of other medical conditions (e.g., diabetes; P. K. Elias et al., 1997) on cognition.”
Effect of age and glucoregulation on cognitive performance
Messier, C., Tsiakas, M., Gagnon, M., Desrochers, A., & Awad, N. (2003) · Neurobiology of Aging · doi:10.1016/s0197-4580(03)00004-6 · Cited by 94 · see citing works
Kim, H., Noh, J., Noh, Y., Oh, S., Koh, S. B., & Kim, C. (2019) · Frontiers in Public Health · doi:10.3389/fpubh.2019.00375 · Cited by 90 · see citing works
Diabetes mellitus, hypertension and medial temporal lobe atrophy: the LADIS study
Korf, E. S. C., van Straaten, E. C. W., de Leeuw, F., van der Flier, W. M., Barkhof, F., Pantoni, L., Basile, A. M., Inzitari, D., Erkinjuntti, T., Wahlund, L., et al. (2007) · Diabetic Medicine · doi:10.1111/j.1464-5491.2007.02049.x · Cited by 93 · see citing works
The Impact of Medical Illness on Executive Function
Schillerstrom, J. E., Horton, M. S., & Royall, D. R. (2005) · Psychosomatics · doi:10.1176/appi.psy.46.6.508 · Cited by 87 · see citing works
Intersection between metabolic dysfunction, high fat diet consumption, and brain aging
Uranga, R. M., Bruce‐Keller, A. J., Morrison, C. D., Fernandez‐Kim, S. O., Ebenezer, P. J., Zhang, L., Dasuri, K., & Keller, J. N. (2010) · Journal of Neurochemistry · doi:10.1111/j.1471-4159.2010.06803.x · Cited by 87 · see citing works
“Interestingly, data from the Framingham study has demonstrated a link between type-2 diabetes and lower cognition scores (Elias et al. 1997), and hyperglycemia has been found to negatively influence cognitive impairment in population-based studies (Franceschi et al. 1984; Robertson-Tchabo et al.…”
BackgroundDiabetes and brain aging: Epidemiologic evidence
Launer, L. J. (2005) · Current Diabetes Reports · doi:10.1007/s11892-005-0069-1 · Cited by 85 · see citing works
Vascular factors in dementia: an overview
DeCarli, C. S. (2004) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2004.09.005 · Cited by 87 · see citing works
Evans, J. G., & Sastre, A. A. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003804 · Cited by 87 · see citing works
Cardiovascular Risk Factors and Cognitive Function in Adults 30–59 Years of Age (NHANES III)
Pavlik, V., Hyman, D. J., & Doody, R. S. (2004) · Neuroepidemiology · doi:10.1159/000081049 · Cited by 85 · see citing works
Lutsey, P. L., Bengtson, L. G. S., Punjabi, N. M., Shahar, E., Mosley, T. H., Gottesman, R. F., Wruck, L. M., MacLehose, R. F., & Alonso, A. (2016) · Sleep · doi:10.5665/sleep.5434 · Cited by 86 · see citing works
Dore, G. A., Elias, M. F., Robbins, M. A., Elias, P. K., & Nagy, Z. (2009) · Diabetologia · doi:10.1007/s00125-009-1497-2 · Cited by 81 · see citing works
“Diabetes mellitus has been associated with decrements in cognitive performance and dementia in cross-sectional and longitudinal studies [1–4].”
BackgroundSelf-citation
- Authors
- Elias, P. K., Elias, M. F., D'Agostino, R. B., Cupples, L. A., Wilson, P. W., Silbershatz, H., & Wolf, P. A.
- Affiliations
- Boston University (US)
- University of Maine (US)
- Department of Mathematics, Statistics and Consulting Unit, Boston University Boston, Massachusetts
- National Heart, Lung, and Blood Institute (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1997-09-01
- Volume
- 20
- Issue
- 9
- Pages
- 1388-1395
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2057702509
- Cited by
- 368
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 15 · 2021: 6 · 2020: 10 · 2019: 8 · 2018: 7 · 2017: 13 · 2016: 17 · 2015: 13 · 2014: 20 · 2013: 21 · 2012: 14
- FWCI
- 5.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (5-R37-AG03055-14, R37AG003055, 2-R01-AG08122-07, R01-AG0646-02, R01AG008122)
- National Institute of Neurological Disorders and Stroke
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, hypertension, blood pressure, cognitive performance, cognitive decline, risk factors, diabetes duration, insulin therapy, oral antidiabetic drugs, visual memory, verbal memory, verbal fluency, Framingham Heart Study
- MeSH terms
- Aged, Aged, 80 and over, Blood Pressure, Cognition, Cognition Disorders, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Prospective Studies, Reference Values, Risk Factors, Cohort Studies, Confidence Intervals, Odds Ratio
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