Abstract

Background: Few prospective studies have assessed diabetes mellitus as a risk factor for incident Alzheimer disease (AD) and decline in cognitive function.Objective: To evaluate the association of diabetes mellitus with risk of AD and change in different cognitive systems.Design: Longitudinal cohort study.Participants: For up to 9 years, 824 older (those Ͼ55 years) Catholic nuns, priests, and brothers underwent detailed annual clinical evaluations.Main Outcome Measures: Clinically diagnosed AD and change in global and specific measures of cognitive function.Results: Diabetes mellitus was present in 127 (15.4%) of the participants.During a mean of 5.5 years of obser-vation, 151 persons developed AD.In a proportional hazards model adjusted for age, sex, and educational level, those with diabetes mellitus had a 65% increase in the risk of developing AD compared with those without diabetes mellitus (hazard ratio, 1.65; 95% confidence interval, 1.10-2.47).In random effects models, diabetes mellitus was associated with lower levels of global cognition, episodic memory, semantic memory, working memory, and visuospatial ability at baseline.Diabetes mellitus was associated with a 44% greater rate of decline in perceptual speed (P = .02),but not in other cognitive systems.Conclusions: Diabetes mellitus may be associated with an increased risk of developing AD and may affect cognitive systems differentially.