Diabetes is associated with increased risk
of multiple coexisting medical conditions
in older adults. In addition to the classic
cardiovascular and microvascular diseases,
a group of conditions termed geriatric
syndromes, described below, also occur at
higher frequency in older adults with diabetes
and may affect self-care abilities and
health outcomes including quality of life
Cognitive dysfunction. Alzheimer’s-type
and multi-infarct dementia are approximately
twice as likely to occur in those
with diabetes compared with age-matched
nondiabetic control subjects (59). The presentation
of cognitive dysfunction can vary
from subtle executive dysfunction to
overt dementia and memory loss. In the
ACCORD trial, for which referred participants
were felt to be capable of adhering
to a very complex protocol, 20% of those
in the ancillary trial of cognition were
found to have undiagnosed cognitive dysfunction
at baseline ( J. Williamson, personal
communication) (60). In this trial,
neither intensive glycemic control nor
blood pressure control to a target SBP
,120 mmHg was shown to prevent a decline
in brain function (61). Cross-sectional
studies have shown an association between
hyperglycemia and cognitive dysfunction
(62). Hypoglycemia is linked to cognitive
dysfunction in a bidirectional fashion: cognitive
impairment increases the subsequent
risk of hypoglycemia (60), and a history of
severe hypoglycemia is linked to the