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José A. Luchsinger, MD; Christiane Reitz, MD; Bindu Patel, MPH; Ming-Xin Tang, PhD; Jennifer J. Manly, PhD; Richard Mayeux, MD

Arch Neurol. 2007;64(4):570-575.

Background  Type 2 diabetes mellitus is an important risk factor for Alzheimer disease and is more prevalent in elderly minority persons compared with non-Hispanic white persons.

Objective  To determine whether diabetes is related to a higher risk of mild cognitive impairment (MCI), a transitional stage between normal cognition and Alzheimer disease, in a multiethnic cohort with a high prevalence of diabetes.

Design  Longitudinal cohort study.

Setting  Northern Manhattan in New York, NY.

Participants  We studied persons without prevalent MCI or dementia at baseline and with at least 1 follow-up interval. Of 1772 participants with a complete neuropsychological evaluation, 339 (19.1%) were excluded because of prevalent dementia, 304 were excluded because of prevalent MCI (17.2%), and 211 were excluded because of loss to follow-up (11.9%), resulting in a final sample of 918 participants for longitudinal analyses.

Main Outcome Measures  We related diabetes defined by self-report to incident all-cause MCI, amnestic MCI, and nonamnestic MCI. We conducted multivariate analyses with proportional hazards regression adjusting for age, sex, years of education, ethnic group, apolipoprotein E (APOE) 4 allele, hypertension, low-density lipoprotein level, current smoking, heart disease, and stroke.

Results  A total of 334 persons had incident MCI, 160 (47.9%) had amnestic MCI, and 174 (52.1%) had nonamnestic MCI. Diabetes was related to a significantly higher risk of all-cause MCI and amnestic MCI after adjustment for all covariates. Diabetes was also related to a higher risk of nonamnestic MCI, but this association was appreciably attenuated after adjustment for socioeconomic variables and vascular risk factors. The risk of MCI attributable to diabetes was 8.8% for the whole sample and was higher for African American persons (8.4%) and Hispanic persons (11.0%) compared with non-Hispanic white persons (4.6%), reflecting the higher prevalence of diabetes in minority populations in the United States.

Conclusion  Diabetes is related to a higher risk of amnestic MCI in a population with a high prevalence of this disorder.

Author Affiliations: Taub Institute for Research of Alzheimer's Disease and the Aging Brain (Drs Luchsinger, Tang, Manly, and Mayeux and Ms Patel), Gertrude H. Sergievsky Center (Drs Luchsinger, Reitz, Manly, and Mayeux), and Departments of Biostatistics (Dr Tang) and Epidemiology (Drs Luchsinger and Mayeux), Joseph P. Mailman School of Public Health; and Departments of Medicine (Dr Luchsinger), Neurology (Drs Manly and Mayeux), and Psychiatry (Dr Mayeux), College of Physicians and Surgeons, Columbia University, New York, NY.

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