Skeletal muscle mass loss linked to cognitive decline in older adults with type 2 diabetes
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Decreases in skeletal muscle mass are associated with cognitive decline in type 2 diabetes, particularly among older adults, according to a study published in Journal of Diabetes and Its Complications.
“Bio-impedance analysis measure of skeletal muscle mass decline over time was associated with a corresponding reduction in cognitive performance globally and in domains of immediate memory, delayed memory and visuospatial construction in patients with type 2 diabetes,” Su Chi Lim, MBBS, MRCP, FRCP, FAMS, PhD, deputy director of the Diabetes Centre and senior consultant in the department of medicine at the Admiralty Medical Centre in Singapore, and colleagues wrote. “The associations were independent of demographics, education, clinical covariates, presence of apolipoprotein E4 allele and medications. The association between skeletal muscle mass and Repeatable Battery for the Assessment of Neuropsychological Status total score appeared to be age dependent and was primarily observed among the older patients.”
Researchers recruited 453 participants from the Singapore Study of Macroangiopathy and Microvascular Reactivity in Type 2 Diabetes (SMART2D) cohort between September 2014 and January 2019 (mean age, 60.3 years; 55.2% men). Adults with type 2 diabetes who visited public hospital primary care diabetes clinics in the northern region of Singapore were included. Demographics, comorbidities and education were collected from questionnaires. Bio-impedance analysis was used to measure body composition. Skeletal muscle mass index was calculated as the total skeletal muscle mass divided by body weight times 100. The study cohort was stratified into tertiles by rate of annual change in skeletal muscle mass index, with the lowest tertile having an increase or small decline in skeletal muscle mass and the third tertile having the greatest decline. Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Physical activity was measured using the Global Physical Activity Questionnaire. The cohort was followed until May 2021.
During a median follow-up of 6.4 years, the cohort had a decline in cognition score of 0.38 points annually. After adjusting for confounders that included metformin and sulfonylurea use and low physical activity, adults in the tertile with most loss of skeletal muscle mass had the greatest loss in cognition score compared with those who lost the least amount of skeletal muscle mass (beta = –0.35; 95% CI, –0.65 to –0.06; P = .017).
When the cohort was stratified by age group, adults aged 65 years and older with the greatest loss of skeletal muscle mass had a greater cognition decline than those with the lowest skeletal muscle mass decrease (beta = –0.62; 95% CI, –1.14 to –0.1; P = .02). No difference in cognitive decline was observed among adults younger than 65 years.
Larger decreases in skeletal muscle mass were associated with a greater decline in the visuospatial construction domain (beta = –0.67; 95% CI, –1.3 to –0.04; P = .037) and the delayed memory domain (beta = –0.64; 95% CI, –1.16 to –0.13; P = .015) of the RBANS questionnaire in a fully adjusted model.
“Skeletal muscle mass decline should prompt the clinician to proactively check for accompanying cognitive decline in memory and visuospatial construction, and review measures to enhance aspects of self-care such as blood glucose monitoring and medication adherence,” the researchers wrote. “Subjective or objective cognitive decline could be monitored in a memory service embedded within a comprehensive multidisciplinary diabetes service.”
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