Diabetes and cognitive decline in elderly African Americans: A 15-year follow-up study

Alette M. Wessels, Kathleen A. Lane, Sujuan Gao, Kathleen S. Hall, Frederick W. Unverzagt, Hugh C. Hendrie

Research output: Contribution to journalArticle

37 Scopus citations


Background: Diabetes mellitus is associated with an increased risk for cognitive impairment and vascular factors seem to play a role in this relationship. In a sample involving elderly African Americans, we tested the hypothesis that diabetes accelerates cognitive decline and explored possible mediating mechanisms within a follow-up period of 15 years. Methods: A total of 1702 subjects, of whom 441 had diabetes, were given the community screening interview for dementia to measure cognitive functioning at six different time points spread over a 15-year follow-up period. Mixed effects models with repeated measures were used to examine the association of diabetes and vascular risk factors with cognitive scores over time. Results: African American subjects with diabetes reported having a significant accelerated cognitive decline as compared with those without diabetes (P =.046), when controlling for basic demographics and baseline comorbid conditions (heart disease, hypertension, stroke, and depression). Adjusting for incident heart disease, and especially stroke, weakened this association (P =.098), thereby indicating a mediating effect of stroke on the association between diabetes and cognitive decline. However, when incident stroke was incorporated into the model, the effect for participants with diabetes increased greatly (P =.007). Conclusions: Diabetes, mediated by cerebrovascular pathology, accelerates cognitive decline within a follow-up period of 15 years in a sample comprising African Americans.

Original languageEnglish (US)
Pages (from-to)418-424
Number of pages7
JournalAlzheimer's and Dementia
Issue number4
StatePublished - Jul 1 2011


  • Cerebrovascular disease
  • Cognitive decline
  • Diabetes
  • Elderly African American
  • Longitudinal study

ASJC Scopus subject areas

  • Health Policy
  • Epidemiology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Developmental Neuroscience
  • Clinical Neurology

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