NIDDM AND BLOOD-PRESSURE AS RISK-FACTORS FOR POOR COGNITIVE PERFORMANCE - THE FRAMINGHAM-STUDY

OBJECTIVE - To determine if NIDDM and blood pressure are risk factors for poor cognitive performance and if history and duration of NIDDM an d blood pressure interact such that the risk of poor performance is gr eater for subjects with both NIDDM and hypertension. RESEARCH DESIGN A ND METHODS - We used a large prospective cohort sample with 187 NIDDM subjects and 1,624 nondiabetic subjects who were followed for 28-30 ye ars. Cognitive function was assessed using eight tests of learning, me mory, visual organization, verbal fluency, attention, concept formatio n, and abstract reasoning. A composite score was also calculated. Odds ratios were used to estimate the relative risk of performing below th e lower 25th percentile of z scores on these tests. RESULTS - NIDDM an d blood pressure interacted such that diagnosis and duration of NIDDM were associated with greater risk of poor performance on tests of visu al memory and on the composite score for hypertensive subjects. Durati on of NIDDM was associated with increased risk for poor performance on tests of verbal memory and concept formation. Insulin-treated NIDDM s ubjects were at higher risk for poor cognitive performance than those NIDDM subjects treated with oral agents or diet. Blood pressure level was associated independently with a measure of verbal fluency. CONCLUS IONS - History and duration of NIDDM and high blood pressure are signi ficant risk factors for poor cognitive performance. Hypertensive peopl e with NIDDM are at greatest risk for poor performance on tests measur ing visual organization and memory.