Background: Diabetes is a risk factor for cognitive impairment, but whether there is also a link between pre-diabetes\nand cognitive dysfunction is not yet fully established. The aim of this observational study was to investigate associations\nbetween pre-diabetes/diabetes and cognitive test results, and also between glucose levels measured during the Oral\nGlucose Tolerance Test (OGTT) and cognitive outcomes.\nMethods: During 2007--2012, in all 2994 people (mean age 72 years), residing in Malmo, Sweden, underwent a clinical\nexamination including the OGTT, cardiovascular measurements including carotid-femoral pulse wave velocity (c-f PWV)\nand two cognitive tests, the Mini Mental State Examination (MMSE), measuring global cognitive function, and A Quick\nTest of Cognitive Speed (AQT), measuring processing speed and executive functioning. Regression analyses were\nperformed to investigate associations between: (a) categories of normal or impaired glucose metabolism, and (b)\nOGTT measurements, respectively, as exposure variables and cognitive test results as outcomes. Adjustments were made\nfor demographics, lifestyle factors and cardiovascular risk factors.\nResults: Participants with pre-diabetes and diabetes scored slightly worse cognitive test results compared to the control\ngroup. Results of participants with a long disease duration of diabetes since the baseline examination 13 years earlier\nwere poorer (mean AQT test time 17.8 s slower than controls, p < 0.001). Linear associations were found between fasting\nand 2-h glucose and cognitive outcomes in the whole population, but also in a sub-analysis including only individuals\nwithout diabetes (for 2-h glucose and MMSE results: B = - 2.961, p = 0.005). Associations were stronger for older or less\nphysically active individuals. When adjusting for cardiovascular risk factors, most correlations were non-significant.\nConclusions: Pre-diabetes and diabetes are associated with minor deficits in global cognitive function, processing speed\nand executive functioning. Long-standing diabetes is associated with bigger deficits. There appears to be a continuous\ninverse correlation between glucose levels and cognitive test results, also for people without diabetes. Associations are\nstronger in older and less physically active individuals. Cardiovascular factors are important mediating factors in the\npathway between diabetes and cognitive dysfunction.
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