Journal of affective disorders · 2025
Impact of diabetes on cognitive function in middle-aged and older adults: A longitudinal study.
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Wang Xiaoyu, Tian Wenze, Zhao Zheng-Hui
Аннотация
OBJECTIVE: This study investigated diabetes' impact on cognitive dysfunction in middle-aged/older adults (≥45 years) and explored underlying mechanisms, including the mediating role of Activities of Daily Living (ADL) and moderating effects of sleep, depression, and exercise.
METHODS: Using unbalanced panel data from the China Health and Retirement Longitudinal Study (CHARLS, Waves 1-5; N = 16,856), linear mixed-effects models and Cox regression assessed diabetes-related cognitive decline. Mediation/moderation analyses tested mechanisms, and subgroup analyses examined heterogeneity by age, diabetes status, obesity, and residence.
RESULTS: Diabetes demonstrated a significant negative association with cognitive function (β = -0.140, p < 0.01). ADL mediated 10.87 % of this adverse effect. Moderator analyses revealed excessive sleep (>9 h) exacerbated diabetes-related cognitive decline more substantially than insufficient sleep (<6 h) (β = -0.517 vs. -0.242, p < 0.01), and depressive symptoms amplified cognitive detriment (β = -0.020, p < 0.01). Conversely, regular physical exercise (β = 0.171, p < 0.1) and intergenerational co-residence (β = 0.207, p < 0.1) significantly attenuated diabetes-induced cognitive impairment. Subgroup analyses identified heightened vulnerability among individuals with diabetes (β = -0.222, p < 0.05), younger seniors (60-79 years), non-abdominally obese participants, and those living in spacious accommodations (per capita >40 m2).
CONCLUSIONS: Diabetes adversely impacts cognitive function partially through ADL impairment. However, maintaining regular sleep patterns, emotional well-being, and consistent physical exercise may mitigate this association. Intergenerational co-residence also showed protective potential. Implementing targeted lifestyle interventions addressing these modifiable factors-particularly in identified high-risk subgroups like diabetics and younger seniors-could help ameliorate cognitive decline in middle-aged and older adults with diabetes.
METHODS: Using unbalanced panel data from the China Health and Retirement Longitudinal Study (CHARLS, Waves 1-5; N = 16,856), linear mixed-effects models and Cox regression assessed diabetes-related cognitive decline. Mediation/moderation analyses tested mechanisms, and subgroup analyses examined heterogeneity by age, diabetes status, obesity, and residence.
RESULTS: Diabetes demonstrated a significant negative association with cognitive function (β = -0.140, p < 0.01). ADL mediated 10.87 % of this adverse effect. Moderator analyses revealed excessive sleep (>9 h) exacerbated diabetes-related cognitive decline more substantially than insufficient sleep (<6 h) (β = -0.517 vs. -0.242, p < 0.01), and depressive symptoms amplified cognitive detriment (β = -0.020, p < 0.01). Conversely, regular physical exercise (β = 0.171, p < 0.1) and intergenerational co-residence (β = 0.207, p < 0.1) significantly attenuated diabetes-induced cognitive impairment. Subgroup analyses identified heightened vulnerability among individuals with diabetes (β = -0.222, p < 0.05), younger seniors (60-79 years), non-abdominally obese participants, and those living in spacious accommodations (per capita >40 m2).
CONCLUSIONS: Diabetes adversely impacts cognitive function partially through ADL impairment. However, maintaining regular sleep patterns, emotional well-being, and consistent physical exercise may mitigate this association. Intergenerational co-residence also showed protective potential. Implementing targeted lifestyle interventions addressing these modifiable factors-particularly in identified high-risk subgroups like diabetics and younger seniors-could help ameliorate cognitive decline in middle-aged and older adults with diabetes.