Mortality Links: Diabetes and Cognition #AcademicAchievements

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Diabetes is a major chronic condition that among older Hispanics or Latino populations is not only highly prevalent but deeply interconnected with declines in cognitive function and increased mortality risk 😟. A large longitudinal study, using data like the Health and Retirement Study from 1995-2014, examined older US Hispanic adults (age 50+) to understand just how cognitive impairment (ranging from mild cognitive impairment, or MCI, to dementia) and diabetes together impact risk of death. The study found that among Hispanics with diabetes, individuals with mild cognitive impairment had about a 1.61-fold increased hazard of mortality compared to those with normal cognition, while those with dementia had a 2.14-fold increased risk. Among Hispanics without diabetes, the risks were even higher: mild cognitive impairment was associated with ~1.87-fold mortality and dementia with ~3.25-fold mortality compared to cognitively normal peers. These findings held even after adjusting for sociodemographic factors, lifestyle, comorbidities, etc. The implication is that cognitive decline is strongly predictive of mortality whether or not diabetes is present, but diabetes modifies the distribution of cognitive impairment and its prevalence.

The study shows that about 35% of the older Hispanic sample had diabetes, and among those with diabetes, rates of cognitive impairment (both MCI and dementia) were higher: roughly 28.2% had mild cognitive impairment and 8.8% had dementia among diabetics, compared to 22.3% and 4.8% respectively among non-diabetics. Importantly, the proportion of individuals with normal cognitive function was lower among diabetics (~63.0%) versus non-diabetics (~72.9%). So diabetes not only increases mortality risk directly but is associated with a shift in cognitive‐status profiles toward more impairment.

Beyond associations, the study estimated how diabetes impacts life expectancy with and without cognitive impairment: those with diabetes tend to experience onset of cognitive decline earlier, lose more years lived in cognitively healthy states, and have shorter total life expectancy. For instance, in related work, being diabetic at age 50 yielded shorter cognitively healthy life years by 4-6 years for women, 4-6 years for men, compared to non-diabetics. A large part of the life‐years lost are cognitively healthy years rather than years lived with impairment: diabetes reduces total life expectancy (LE) by 5-7 years and cognitive healthy LE by 4-6 years. Those with diabetes also tend to develop cognitive impairment 3-4 years earlier than those without. So the burden is both earlier onset and greater magnitude of decline.

Pathophysiologically, diabetes can contribute to cognitive decline via multiple mechanisms: chronic hyperglycemia, microvascular damage, cerebrovascular disease (including stroke), inflammation, oxidative stress, vascular risk factors, etc. Behavioral and socio-environmental mediators are also at play: educational attainment, lifestyle (physical activity, smoking), comorbid conditions like hypertension, heart disease, etc., as well as access to healthcare and socioeconomic status. Among Hispanics, many are foreign‐born, have lower levels of education, and may have more challenges with healthcare access, which can exacerbate both diabetes control and cognitive assessment or treatment.

An important concept examined in these studies is the “Hispanic paradox” — the epidemiological observation that Hispanics often have mortality rates lower than or comparable to non-Hispanic Whites despite lower socioeconomic status and higher prevalence of risk factors. This study’s findings suggest that cognitive impairment significantly raises mortality risk among older Hispanics both with and without diabetes, and that while the paradox may still exist in some health outcomes, cognitive decline plus diabetes seems to largely erode any mortality advantage in those subgroups. Thus, cognitive function becomes a key factor that may help explain variations in mortality beyond what is predicted by diabetes status alone.

Clinically, the findings argue for routine cognitive screening among older Hispanic adults, especially those with diabetes. Because even mild impairment is associated with substantially increased mortality risk, early detection is critical to allow intervention—be that better glycemic control, management of cardiovascular risks, lifestyle changes, social support, or cognitive rehabilitative strategies. Also, culturally tailored interventions are particularly needed: models of care that are sensitive to language, migration history, education, family structure, and community resources. Health providers should not merely treat diabetes in isolation but consider the broader cognitive health, comorbidities, and social determinants of health in this population.

In policy and public health planning, diabetes prevention and management programs targeting Hispanic communities should integrate cognitive health outcomes. Given that those with diabetes lose more cognitively healthy life years, programs that delay onset of cognitive impairment—through early diabetes detection, tight glycemic control, addressing hypertension, promoting education, nutrition and physical activity—can have large impact not only on quality of life but mortality. Because many older Hispanics have less formal education, community-based education, accessible health literacy programs, and support systems may help buffer the risk.

The study also has limitations that are worth noting: cognitive impairment was assessed via standard cognitive tests (immediate & delayed recall, serial 7s, backward counting), but diagnoses of MCI and dementia were based on those rather than clinical diagnosis in all cases; comorbidities are often self‐reported; there may be under‐reporting of disease or misclassification; immigrant‐specific factors (acculturation, stress, discrimination, neighborhood effects) were not fully measured; data may not fully capture quality of life or functional status; also, mortality may co-occur with dropout/missing data which could bias estimates.

Overall, the key message is that among older US Hispanics, cognitive impairment increases mortality risk substantially, whether or not one has diabetes; but diabetes increases the risk of cognitive impairment, accelerates onset, and shortens years lived with healthy cognition. Thus, combining efforts to fight diabetes with cognitive health promotion will be essential to improving survival and well-being in this population.

If one wanted to apply or nominate this work for recognition, or explore related academic achievements in this area, you might consider resources or nominations through platforms such as Academic Achievements or specifically their award nomination page Academic Achievements Award Nomination. The research above could be a strong candidate for such nominations. Indeed, data and findings like this align with the mission often recognized by Academic Achievements for impactful scientific work.

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