DIABETES AS A RISK FACTOR FOR COGNITIVE DECLINE IN OLDER PATIENTS F. Limongi, A. Marseglia, S. Maggi, M. Noale, G. Romanato, P. Siviero, G. Crepaldi CNR, Institute of Neuroscience, Padova (Italy) MGSD 2011 Casablanca, Morocco Prospective studies found that people with diabetes have a greater rate of decline in cognitive function; a 1.5-fold greater risk of cognitive decline; and a 1.6-fold greater risk of future dementia; Moreover, diabetes and Alzheimer’s Disease share some common features such as increased prevalence with aging, a genetic predisposition, and comparable pathological features in the islet and brain; The aim of the present work is to assess the role of type 2 diabetes as a risk factor for cognitive decline

MATERIAL AND METHODS The analyses are based on the Italian Longitudinal Study on Aging (ILSA): Sex-specific analyses were carried out. The difference between the mean values observed in the diabetic group versus the non-diabetic group was evaluated by the GLM procedure. The mean scores on the 3 tests, at baseline and follow-ups, were compared between diabetics and non-diabetics according to the GLM. Mean changes in each test, between baseline and follow-ups, were assessed by a GLM corrected for baseline scores; Logistic regression models were then constructed to assess the influence of diabetes and of glycated hemoglobin on cognitive decline in the MMSE, Prose Memory Test and Matrix Test, at both follow-ups, adjusting for other variables and baseline scores. Sample (Maggi et al, 1994) :  5,632 free-dwelling and institutionalised individuals  aged  resident in 8 centers  randomly selected from the local anagraphic lists, equal allocation by sex and 5-year-age groups  with two phases  Screening phase, with personal interview, laboratory test, diagnostic tests (neurological tests, GDS, ADL, IADL, spirometry, retinography, electrocardiography) and cognitive assessment: Mini Mental State Examination, Prose memory Test and Attention Matrix Test.  Clinical confirmation by geriatrician or neurologist for those subjects screened positive for heart failure, angina, arrhythmia, hypertension, myocardial infarction, diabetes, stroke, parkinsonism, distal symmetric neuropathy of lower limbs, dementia. MILANO GENOVA FIRENZE PADOVA FERMO NAPOLI CATANIA BARI

RESULTS At baseline, diabetic women had significantly worse scores on all cognitive tests compared to non-diabetic women, but did not show worsening over time; At baseline men with diabetes did not show worse scores on cognitive tests compared to non-diabetic males; Diabetes in men was associated with a risk of cognitive decline over time, particularly in attention; A poor glycaemic control was associated with poorer performance on Prose memory tests at follow-up in both sexes.

CONCLUSIONS The impact of diabetes on cognitive status might differ in older men and women, probably because of a survival effect, with a higher mortality at a younger age among diabetic men; The metabolic and cardiovascular abnormalities associated with diabetes might be responsible for the cognitive decline, at different rates and ages, in men and women; The association between a poor glycaemic control and the risk of cognitive decline is extremely important, since impairment in even a single domain may favour progressive and overall decline in cognitive capacities; A routine assessment of diabetes complications in the elderly should include cognitive evaluation in both sexes.