INS NYC 2024 Program

Poster	Poster Session 06 Program Schedule 02/15/2024 04:00 pm - 05:15 pm Room: Shubert Complex (Posters 1-60) Poster Session 06: Aging \| MCI \| Neurodegenerative Disease - PART 2 Final Abstract #18 Subtle Cognitive Differences in Cognitively Unimpaired Older Veterans with and without Type 2 Diabetes Alin Alshaheri Durazo, VA San Diego/San Diego State University, San Diego, United States Katherine Bangen, VA San Diego/UC San Diego, San Diego, United States Britney Luu, VA San Diego/San Diego State University, San Diego, United States Mary Ellen Garcia, VA San Diego, San Diego, United States Peter Rantins, VA San Diego/San Diego State University, San Diego, United States Sunder Mudaliar, VA San Diego/UC San Diego, San Diego, United States Mark Bondi, VA San Diego/UC San Diego, San Diego, United States Kelsey Thomas, VA San Diego/UC San Diego, San Diego, United States Category: Aging Keyword 1: diabetes Keyword 2: neuropsychological assessment Keyword 3: aging (normal) Objective: Type 2 diabetes (T2D) is a known risk factor for cognitive decline, including dementia. While T2D can negatively impact performance across multiple cognitive domains, these studies do not necessarily exclude individuals with mild cognitive impairment (MCI) and dementia. Therefore, it is unknown what the earliest subtle cognitive difficulties are to emerge prior to cognitive impairment consistent with MCI/dementia in T2D. Further, little work on cognitive profiles of T2D has specifically examined older Veterans despite the high rate of T2D in this population (~25%). Participants and Methods: This study included 198 Veterans (mean age=65.85, SD=9.16) who underwent a comprehensive neuropsychological evaluation at the VA San Diego Healthcare System and were found to be cognitively unimpaired via consensus. Participants completed measures of language, attention, processing speed, visuospatial functioning, executive functioning, learning, and memory. Data were coded via retrospective review of consecutive medical records stratified by T2D status. T2D was based on diagnosis in the medical record or an HbA1c of ≥6.5%. Veterans with (n=72) and without (n=126) T2D were compared on the normed standard scores of individual neuropsychological measures using independent samples t-tests. Follow-up linear regressions within Veterans with T2D only explored the extent to which higher HbA1c (i.e., marker of severity/control) was associated with lower cognitive scores. Results: T2D groups did not differ on age, education, sex, or WRAT-4 Reading, but T2D had higher rates of hypertension and hyperlipidemia. Across neuropsychological measures, the T2D group performed worse on DKEFS Letter Fluency (p=.009), WAIS-IV Digit Span (p=.030), Wisconsin Card Sorting Test (Total Categories, p=.022; Total Errors, p=.017; Set Loss Errors, p=.012), and the California Verbal Learning Test (Trials 1-5, p=.002; Short Delay Cued Recall, p=.021; Long Delay Free Recall, p=.020; and Long Delay Cued Recall, p=.037) relative to Veterans without T2D. Within Veterans with T2D, continuous HbA1c was not associated with performance on any of the neuropsychological measures. Conclusions: Results show that, even within cognitively unimpaired older Veterans, T2D can impact one’s cognitive profile. On average, the profile of Veterans with T2D was more consistent with subtle difficulties in attention, executive functioning, and learning than a profile of rapid forgetting or language difficulties. These results are in-line with prior work showing T2D is associated with faster progression to MCI/dementia, and have important implications given the complexities of managing T2D. The lack of associations between HbA1c and cognition within T2D highlights that the extent of one’s T2D control is not necessarily associated with very subtle cognitive difficulties. This is consistent with recent research suggesting that the HbA1c target for older adults may be relaxed without increasing dementia risk. Future studies will examine other factors that are likely to play a more significant role in the association with cognition, including duration of T2D, midlife T2D severity, and types of medications as well as whether results are unique to T2D and retained when adjusting for other vascular risks.

Poster

02/15/2024
04:00 pm - 05:15 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 06: Aging | MCI | Neurodegenerative Disease - PART 2

Final Abstract #18

Subtle Cognitive Differences in Cognitively Unimpaired Older Veterans with and without Type 2 Diabetes

Alin Alshaheri Durazo, VA San Diego/San Diego State University, San Diego, United States
Katherine Bangen, VA San Diego/UC San Diego, San Diego, United States
Britney Luu, VA San Diego/San Diego State University, San Diego, United States
Mary Ellen Garcia, VA San Diego, San Diego, United States
Peter Rantins, VA San Diego/San Diego State University, San Diego, United States
Sunder Mudaliar, VA San Diego/UC San Diego, San Diego, United States
Mark Bondi, VA San Diego/UC San Diego, San Diego, United States
Kelsey Thomas, VA San Diego/UC San Diego, San Diego, United States

Category: Aging

Keyword 1: diabetes
Keyword 2: neuropsychological assessment
Keyword 3: aging (normal)

Objective:

Type 2 diabetes (T2D) is a known risk factor for cognitive decline, including dementia. While T2D can negatively impact performance across multiple cognitive domains, these studies do not necessarily exclude individuals with mild cognitive impairment (MCI) and dementia. Therefore, it is unknown what the earliest subtle cognitive difficulties are to emerge prior to cognitive impairment consistent with MCI/dementia in T2D. Further, little work on cognitive profiles of T2D has specifically examined older Veterans despite the high rate of T2D in this population (~25%).

Participants and Methods:

This study included 198 Veterans (mean age=65.85, SD=9.16) who underwent a comprehensive neuropsychological evaluation at the VA San Diego Healthcare System and were found to be cognitively unimpaired via consensus. Participants completed measures of language, attention, processing speed, visuospatial functioning, executive functioning, learning, and memory. Data were coded via retrospective review of consecutive medical records stratified by T2D status. T2D was based on diagnosis in the medical record or an HbA1c of ≥6.5%. Veterans with (n=72) and without (n=126) T2D were compared on the normed standard scores of individual neuropsychological measures using independent samples t-tests. Follow-up linear regressions within Veterans with T2D only explored the extent to which higher HbA1c (i.e., marker of severity/control) was associated with lower cognitive scores.

Results:

T2D groups did not differ on age, education, sex, or WRAT-4 Reading, but T2D had higher rates of hypertension and hyperlipidemia. Across neuropsychological measures, the T2D group performed worse on DKEFS Letter Fluency (p=.009), WAIS-IV Digit Span (p=.030), Wisconsin Card Sorting Test (Total Categories, p=.022; Total Errors, p=.017; Set Loss Errors, p=.012), and the California Verbal Learning Test (Trials 1-5, p=.002; Short Delay Cued Recall, p=.021; Long Delay Free Recall, p=.020; and Long Delay Cued Recall, p=.037) relative to Veterans without T2D. Within Veterans with T2D, continuous HbA1c was not associated with performance on any of the neuropsychological measures.

Conclusions:

Results show that, even within cognitively unimpaired older Veterans, T2D can impact one’s cognitive profile. On average, the profile of Veterans with T2D was more consistent with subtle difficulties in attention, executive functioning, and learning than a profile of rapid forgetting or language difficulties. These results are in-line with prior work showing T2D is associated with faster progression to MCI/dementia, and have important implications given the complexities of managing T2D. The lack of associations between HbA1c and cognition within T2D highlights that the extent of one’s T2D control is not necessarily associated with very subtle cognitive difficulties. This is consistent with recent research suggesting that the HbA1c target for older adults may be relaxed without increasing dementia risk. Future studies will examine other factors that are likely to play a more significant role in the association with cognition, including duration of T2D, midlife T2D severity, and types of medications as well as whether results are unique to T2D and retained when adjusting for other vascular risks.