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Diabetes and cognitive function in a middle-aged cohort

Findings from the Whitehall II study

From the Department of Epidemiology and Public Health, International Centre for Health and Society, London, UK.

Address correspondence and reprint requests to Dr. Meena Kumari, International Centre for Health and Society, Department of Epidemiology and Public Health, 1-19 Torrington Place, London WC1E 6BT, UK; e-mail: M.Kumari{at}ucl.ac.uk

Objective: To compare cognitive performance in those with diabetes, impaired glucose tolerance, and normoglycemia in a middle-aged cohort.

Methods: The authors analyzed data from a prospective occupational cohort study begun in 1985–1988 (baseline). Diabetes was classified from oral glucose tolerance tests that were performed in 1992–1993 (phase 3) and 1997–1999 (phase 5) and self reported diagnosis of diabetes from questionnaire at baseline, 1989 (phase 2), phase 3, 1995 (phase 4), and phase 5 of the study. A battery of cognitive tests (memory, Alice Heim 4 [AH 4], Mill Hill vocabulary test, phonemic fluency, and categorical fluency) were measured at phase 5 in 4,020 men and 1,627 women with a mean age of 56 and free of symptoms of stroke.

Results: At phase 5, a total of 208 (5%) men and 101 (6%) women had diabetes while 405 (10%) men and 192 (12%) women had impaired glucose tolerance. Those with diabetes were at increased risk of poor performance in AH 4 compared to those without (men: OR, 2.45; 95% CI, 1.77 to 3.38; women: OR, 1.83; 95% CI, 1.09 to 3.08). These effects were independent of age, social position, vascular problems, and health-related behaviors. Impaired glucose tolerance was not related to any measure of cognition.

Conclusions: Type 2 diabetes is associated with poor performance in some aspects of cognition in middle-aged men and women.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the November 22 issue to find the title link for this article.

The Whitehall II study was supported by grants from the Medical Research Council; Economic and Social Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; US, NIH: National Heart Lung and Blood Institute (RO1-HL36310); NIH: National Institutes of Aging (RO1-AG13196); NIH: Agency for Health Care Policy Research (RO1-HS06516); and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. M.M. is supported by an MRC Research Professorship.

Disclosure: The authors report no conflicts of interest.

Received August 25, 2004. Accepted in final form August 10, 2005.

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