Sex differences in risk factors for cognitive decline and de
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The association between diabetes and cognitive decline (CD) and dementia has been well?documented. This study estimated the associations between risk factors and CD/dementia, and the sex differences in these risk factors in individuals with type 2 diabetes, while accounting for the competing risk of death.

The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial of 11,140 individuals with type 2 diabetes was used to estimate the odds of CD/dementia using multinomial logistic regression.

-- During a median five?year follow?up, 1,827 participants (43.2% women) had CD/dementia (1,718 with CD only; 21 with dementia only; 88 with CD and dementia), and 929 (31.0% women) died without CD/dementia.

-- Women had a lower odds of CD/dementia than men; older age, higher total cholesterol, HbA1c, waist circumference, waist?to?height ratio, moderately increased ACR (Albumin?Creatinine Ratio), stroke/transient ischemic attack and retinal disease were each associated with greater odds of CD/dementia; higher years at education completion, baseline cognitive function, taller stature and current alcohol use were inversely associated.

-- Higher waist circumference and presence of anxiety/depression were associated with greater OR for CD/dementia in women than men.

Conclusively, several risk factors were associated with CD/dementia. Higher waist circumference and mental health symptoms were more strongly associated with CD/dementia in women than men. Further studies should examine the mechanisms which underlie these sex differences.