Published reports of longitudinal studies describing assessments of cognitive function in people with diabetes were sought by systematically searching various biomedical databases, talking to experts, and examining the bibliographies of relevant articles. Identification of material and inclusion/exclusion criteria This systematic overview was therefore undertaken to summarise the available prospective studies and to develop an estimate of the magnitude of the risk of incident cognitive dysfunction in people with diabetes. Such an estimate is of value to both clinicians and researchers. Indeed, only one of the review articles that summarised the available data pertaining to this relationship provided a quantitative estimate. Moreover, differences in the analytical approaches and the wide variety of outcome measure used in longitudinal studies have led to varying estimates of the magnitude and importance of the relationship between diabetes and 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. Recent evidence from several epidemiological studies suggests that it is also a risk factor for cognitive dysfunction. It is well established that diabetes is an independent risk factor for eye, kidney and neurological diseases as well as for cardiovascular morbidity and mortality. For example, in a recent Canadian study the prevalence of dementia (the most severe form of clinically diagnosed cognitive dysfunction) was estimated to be 8% for persons above 65 years of age and 34% for those aged 85 or older. Cognitive dysfunction represents another serious problem and is rising in prevalence worldwide, especially among the elderly. This prevalence rises with age for example in the year 2000 12% of people aged 65 to 70 and 15% of people over age 80 were known to have diabetes. The global prevalence of established diabetes was estimated to be 2.8% in 2000 and is projected to be 4.4% by 2030. Cognitive dysfunction should therefore be added to the list of chronic complications of diabetes.ĭiabetes is a growing problem throughout the world. Conclusions/interpretationĬompared to people without diabetes, people with diabetes have a greater rate of decline in cognitive function and a greater risk of cognitive decline. The odds of future dementia increased 1.6-fold (95% CI 1.4–1.8). 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. Individuals with diabetes had a 1.2- to 1.5-fold greater change over time in measures of cognitive function than those without diabetes. Of 1,165 abstracts and titles initially identified, 25 articles met the inclusion and exclusion criteria. A pooled estimate was calculated for the latter. 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. 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. Studies were included if they assessed cognitive function in participants with diabetes at the beginning and at follow-up. Published reports of longitudinal studies that described assessment of cognitive function in people with diabetes were sought. We systematically reviewed and summarised prospective data relating diabetes status to changes in cognitive function over time.
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