Sex-specific risk of impaired vascular cognitive impairment in elderly patients with diabetes

Abstract

Introduction: Globally, women with dementia have a higher disease burden than men with dementia. In addition, women with diabetes especially are at higher risk for cognitive impairment and dementia compared to men with diabetes. Differences in the influence of diabetes on the cerebral vasculature and brain structure may contribute to these sex-specific differences. We examined sex-specific patterns in the relationship between diabetes and brain structure, as well as diabetes and cognitive function. We aimed to investigate if women with diabetes have a higher incidence of cerebral vascular impairment compared to men, and whether this also translates in differences in cognitive function between men and women. Methods: In total, 893 patients [age 79 ± 6.6 years, 446 (50%) women] from the Amsterdam Ageing Cohort with available data on brain structure (assessed by an MRI or CT scan) and cognitive function and were included. All patients underwent a thorough standardized clinical and neuropsychological assessment (including tests on memory, executive functioning, processing speed, language). Brain structure abnormalities were quantified using visual scales, including lacunes, white matter hyperintensities, atrophy and microbleeds. Results: Cross-sectional multivariable regression analyses showed that diabetes was associated with increased incidence of cerebral lacunes and brain atrophy in women (OR 2.18 (1.00–4.72) but not in men. Furthermore, diabetes was associated with decreased executive function, processing speed and language in women [B −0.07 (0.00–0.13), −0.06 (0.02–0.10) and −0.07 (0.01–0.12) resp.] but not in men. These effects persisted when correcting for lifestyle factors, other cardiovascular diseases and cardiovascular risk factors, age and level of education. Discussion: in our cohort of elderly patients, diabetes is related to increased risk of having lacunes, brain atrophy and impaired cognitive function in women but not in men. Furthermore, diabetes is a significant risk factor for functional cognitive impairment in women, but not in men. Further research is required to understand the mechanisms behind this inequality, in terms of biological (sex) differences, as well as social (gender) differences, in order to achieve personalised care and improve preventive clinical practice for all patients.