脑白质损害对轻度认知功能障碍患者神经心理学的影响

目的 探讨脑白质损害（WML）对轻度认知功能障碍（MCI）患者神经心理学的影响。方法 选取MCI患者和对照老年人各104例,按WML头颅CT表现分为无、轻度、中度及重度四型。比较伴发不同程度WML的MCI患者及对照老年人各项神经心理测验的差异。结果 MCI组较对照组的年龄高（P〈0.05）,伴发中度、重度WML及总WML的比例明显增多（P〈0.01）。伴发重度WML的MCI组认知功能受损最为明显,并与无WML的MCI组有显著性差异（P〈0.05）;伴发重度WML的对照组与无WML对照组的认知功能也有显著性差异（P〈0.05）。结论 WML达到一定程度时将加重老年人认知功能的损害。     

存在血管危险因素的老年人脑白质损害与认知功能障碍的关系

目的探讨存在血管危险因素老年人不同程度脑白质损害(WML)与认知障碍的关系。方法选择WML患者195例,根据WML程度分为轻度组(54例),中度组(63例),重度组(78例),另选健康体检者70例作为对照组。所有受试者行神经心理学测试,包括简易智能状态检查量表、蒙特利尔认知评估量表、听觉词语记忆、逻辑记忆、复杂图形记忆、Stroop色词测验、连线测验B、相似性、言语流畅、数字广度、搜钟和画钟测验。结果与对照组比较,随着WML程度加重,轻、中、重度组血管危险因素明显升高(P<0.05);轻度组记忆、注意、语言及部分执行功能评分明显较对照组差(P<0.05,P<0.01),重度组各项测验评分明显较其他各组差(P<0.01)。各项测验评分与WML严重程度评分呈负相关(P<0.01)。结论血管危险因素可加重WML;轻度WML即对认知功能有影响,重度WML表现广泛认知损害;认知障碍程度与WML严重程度呈正相关。     

老年颈动脉粥样硬化性狭窄与认知功能障碍的相关性

目的 研究颈动脉狭窄程度与认知功能障碍的关系.方法 采用颈动脉双源CT血管造影(DSCTA)技术检查判断颈动脉狭窄程度,应用MMSE、符号-数字转换模式测验、连线测验A等评估认知功能,比较不同程度颈动脉狭窄患者与认知功能障碍的关系.结果 本研究选择共297例,无狭窄91例;有狭窄206例,其中轻度狭窄83例、中度狭窄72例、重度狭窄51例.好发于颈内动脉颅外段,其发生率左侧大于右侧.轻度狭窄组与无狭窄组认知功能检测分数差异无显著性意义P＞0.05);中度狭窄组在符号数字转换、言语流畅性、数字广度测验较无狭窄组和轻度狭窄组显著下降(P＜0.05);重度狭窄组各项认知功能检测分数较无狭窄组和轻度狭窄组均有显著下降,较中度狭窄组在MMSE、画钟测验、数字广度测验和听觉词语延迟显著下降(P＜0.05).结论 颈动脉粥样硬化性狭窄与认知功能障碍明显相关,且显示颈动脉粥样硬化越严重,血管管腔越狭窄,认知功能受损越严重.     

不同类型脑小血管病伴发非痴呆血管性认知功能损害的研究

目的分析比较脑小血管病不同临床类型的非痴呆血管性认知功能的损害差异。方法纳入脑小血管病患者118例,包括52例腔隙性脑梗死灶(LI)和66例白质疏松(WML),健康对照组80例。对研究对象进行神经心理学测验,包括用蒙特利尔认知评估量表(MoCA)、简易智能状态检查表(MMSE)、语义分类流畅测验(动物)、简短Stroop测验、画钟实验、积木测验、数字广度顺背测验、数字符号测验、逻辑记忆亚测验、再生亚测验。结果与对照组比较,LI组和WML组Stroop测验评分升高,其他各项评分均降低(P<0.05)。LI组语义分类流畅测验(动物)、Stroop测验、数字符号测验、听觉词语学习测验(言语性记忆)、视觉再生亚测验(视觉性记忆)、MoCA、MMSE评分高于WML组(P<0.05)。结论 LI组和WML组患者血管性认知功能均受到损害,且总体上来说WML组患者更为严重。     

不同程度脑白质损害老年患者认知评分与神经解剖指标的关系

目的分析不同程度脑白质损害(WML)老年患者认知评分及神经解剖指标的特点及其相互关系。方法根据Fazekas分级标准将151例老年患者分为WML0级组62例、WML1级组46例、WML 2级组43例,分析各组患者蒙特利尔认知评估量表(MoCA)和神经解剖结构的差异及其相互关系。结果与WML 0级组和WML1级组比较,WML 2级组患者各项MoCA评分明显降低(P<0.01)。控制各项脑神经解剖结构指标后,WML分级与MoCA总分显著相关(r=-0.448,P=0.000)。WML2级组与WML 0级组比较,尾状核指数扩大、海马沟回比扩大、腔隙性脑梗死数目增多为独立危险因素。执行功能与皮质下萎缩(P<0.01)、颞叶萎缩及腔隙性脑梗死数目增多(P<0.05)显著相关。结论轻度WML患者认知功能及脑解剖结构无明显改变,中、重度WML患者多领域认知功能出现明显损害同时伴有广泛的脑萎缩,且WML导致的认知障碍独立于脑萎缩,提示额叶皮质-皮质下环路的破坏及对执行功能的影响是中、重度WML患者的显著特征。     

轻度阿尔茨海默病患者记忆障碍的临床研究

目的　探讨轻度阿尔茨海默病患者记忆障碍的临床特点及损害类型。　方法　轻度阿尔茨海默病患者 3 0例 ,轻度认知功能障碍患者 2 0例 ,健康老年人 2 0名 ;语言工作记忆和注意力测定应用韦氏数字广度测验进行 ;非陈述性记忆测定应用改良后SegwinGaddand型板测验 ;情节性记忆测定应用简历记忆访谈测验 ;词语性记忆测查应用临床记忆量表及ADAS cog量表。　结果　与健康老年人组比较 ,在记忆损害类型中 ,轻度阿尔茨海默病组及轻度认知功能障碍组语言工作记忆均受到损害 ,组间差异有显著性 (t =2 3 4 2 ,P <0 0 5) ;非陈述性记忆两组间差异无显著性 (t =1 653 ,P >0 0 5) ,且几乎不受损害。轻度阿尔茨海默病患者组与轻度认知功能障碍患者组之间 ,情节性记忆组间差异有显著性 (t =3 469,P <0 0 1) ,而词语性记忆中 (除即刻回忆、物品命名外 )组间差异有显著性 (t =2 618,P <0 0 5)。　结论　轻度阿尔茨海默病患者临床最早出现的并具特异性的记忆损害类型为情节性记忆和词语性记忆 ,且情节性记忆损害较词语性记忆损害更具特异性     

腔隙性脑梗死认知功能与脑白质病变胰岛素抵抗关系184例临床分析

目的探讨胰岛素抵抗(IR)、脑白质病变(WML)与腔隙性脑梗死患者的认知功能障碍的相关性。方法收集选择2011年5月至2011年10月中国医科大学附属盛京医院神经内科住院184例腔隙性脑梗死患者的临床资料,计算IR指数;评估其认知功能,在MRI上判断WML级别,对数据进行统计学分析。结果轻度认知功能损害(MCI)组中IR指数、糖化血红蛋白(HbA1c)、WML级别为差异有统计学意义的变量(P<0.05)。痴呆组中IR指数、年龄、WML级别为有统计学意义的变量,且较认知功能正常组差异有统计学意义(P<0.01)。WML组与非WML组在蒙特利尔认知评估量表(MoCA)总分、简易智能量表(MMSE)总分以及除抽象以外的两量表各分项认知功能得分之间的差异有统计学意义(P<0.01)。IR组与非IR组在MoCA总分、MMSE总分、语言、即刻记忆、语言和视空间能力之间的差异有统计学意义(P<0.05);抽象、注意力和计算力有明显差异(P<0.01)。结论 IR、HbA1c、WML级别是MCI的危险因素;IR、年龄、WML级别是痴呆的危险因素。WML会明显损害腔隙性脑梗死患者的视空间与执行、命名、语言、抽象、延迟回忆、定向力、即刻记忆、注意力和计算力功能。IR会导致腔隙性脑梗死患者即刻记忆、语言和视空间能力受损,并会明显损害其抽象能力、注意力和计算力。     

高龄糖尿病患者缺血性脑白质病变严重程度及其危险因素分析

目的探讨高龄(≥80岁)糖尿病患者缺血性脑白质病变(WML)严重程度及其相关危险因素分析。方法选择安徽医科大学第三附属医院神经内科及干部病房住院的行头颅MRI检查的缺血性WML患者202例,分为糖尿病组105例和非糖尿病组97例,糖尿病组根据年龄相关性脑白质改变(ARWMC)评分为WML轻度患者(1~4分)35例、中度患者(5~8分)46例和重度患者(≥9分)24例。收集患者临床基线资料,采用Kendall等级相关分析,采用多因素logistic回归分析WML相关危险因素。结果糖尿病组空腹血糖、餐后2 h血糖、ARWMC评分明显高于非糖尿病组,HDL-C水平明显低于非糖尿病组(P<0.05)。糖尿病组不同程度WML患者年龄、空腹血糖、餐后2 h血糖及糖化血红蛋白(HbA1c)水平比较,差异有统计学意义(P<0.05,P<0.01)。轻度、重度及重度患者随症状加重其空腹血糖、餐后2 h血糖及HbA1c水平明显升高(P<0.05)。与轻度患者比较,中度和重度患者年龄更高,重度患者糖尿病病程更长(P<0.05)。多因素logistic回归分析显示,年龄、HbA1c水平升高是缺血性WML严重程度的独立危险因素(95%CI=0.128~0.454,P=0.000;95%CI=1.941~5.623,P=0.000)。所有缺血性WML患者,年龄与WML严重程度呈正相关(P=0.000)。糖尿病患者年龄、HbA1c水平、糖尿病病程与缺血性WML严重程度呈正相关(P<0.05,P<0.01)。在校正高血压、血脂、尿酸水平等危险因素后,糖尿病病程与缺血性WML严重程度的无关(P=0.210)。结论年龄是缺血性WML的独立危险因素,在糖尿病患者中,HbA1c水平可能与缺血性WML严重程度相关。     

高龄缺血性脑白质损害患者的临床分析

目的探讨高龄缺血性脑白质损害患者的危险因素和临床特点。方法将248例>75岁的缺血性脑白质损害患者分为3组:轻度脑白质损害组(轻度损害组,88例)、中度脑白质损害组(中度损害组,104例)和重度脑白质损害组(重度损害组,56例)。采用logistic回归分析其危险因素,并对临床特征进行分析比较。结果轻度、中度和重度脑白质损害患者所占比例分别为35.5%、41.9%和22.6%;年龄和血压与脑白质损害程度相关;非特异性神经系统症状(34.7%)、运动功能减退(24.6%)和认知功能减退(21.4%)为主要就诊原因,差异显著(P<0.05)。结论年龄和高血压是脑白质损害的危险因素;运动和认知功能障碍是脑白质损害的重要临床特征。     

轻度血管性认知功能障碍执行功能特点的研究

目的探讨轻度血管性认知功能障碍(MVCI)患者执行功能特点.为临床诊断提供依据。方法选择患者58例,分为MVCI组21例、脑血管病无认知障碍组(CVD组)15侧、对照组22例。测查各组患者记忆力、注意力、语言能力、执行功能、视觉空间功能及头颅MRI。结果 MVCI组总体认知功能、执行功能较CVD组明显下降(P<0.01)。MVCI组画钟测验、画图、语言、连线A和B、Stroop字和色、阿尔茨海默病评价量表认知分表(ADAScog)总分和单词回忆分项的Z值低于对照组的1.5个标准差,简易智能状态检查、语言流畅性测验、数字符号转换、Stroop字和色、ADAS-cog单词辨认成绩Z值低于对照组的1～1.5标准差。而CVD组与对照组以上指标差异无统计学意义(P>0.05)。结论 MVCI患者存在执行功能异常。MVCI诊断标准有较高的一致性和准确性。     

The impact of clinical and demographic variables on cognitive performance in methamphetamine-dependent individuals in rural South Carolina

Inconsistencies in reports on methamphetamine (METH) associated cognitive dysfunction may be attributed, at least in part, to the diversity of study sample features (eg, clinical and demographic characteristics). The current study assessed cognitive function in a METH-dependent population from rural South Carolina, and the impact of demographic and clinical characteristics on performance. Seventy-one male (28.2%) and female (71.8%) METH-dependent subjects were administered a battery of neurocognitive tests including the Test of Memory Malingering (TOMM), Shipley Institute of Living Scale, Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Grooved Pegboard Test, California Verbal Learning Test (CVLT), and Wisconsin Card Sorting Test (WCST). Demographic and clinical characteristics (eg, gender, frequency of METH use) were examined as predictors of performance. Subjects scored significantly lower than expected on one test of attention and one of fine motor function, but performed adequately on all other tests. There were no predictors of performance on attention; however, more frequent METH use was associated with better performance for males and worse for females on fine motor skills. The METH-dependent individuals in this population exhibit very limited cognitive impairment. The marked differences in education, Intellectual Quotient (IQ), and gender in our sample when compared to the published literature may contribute to these findings. Characterization of the impact of clinical and/or demographic features on cognitive deficits could be important in guiding the development of treatment interventions.     

Relationship of white matter lesions on brain computed tomography and cognitive function in elderly subjects with mild cognitive impairment

White matter lesions (WML) are frequently disclosed on elderly people computed tomography (CT) brain scan. OBJECTIVE: To evaluate the relationship between WML and cognitive functions of patients suffering from Mild Cognitive Impairment (MCI). METHODS: We studied the association between WML on CT brain scan and cognitive functions in 136 consecutive elderly subjects attending a geriatric outpatient clinic, suffering from MCI. The global cognitive assessment was based on Mini Mental State Examination (MMSE), a validated comprehensive battery of neuropsychological tests, the Cognitive Efficiency Profile (CEP), a CT brain scan and a complete biological screening. WML on CT brain scan was evaluated by a blinded investigator. RESULTS: In this population, 75 +/- 8 years of age, (women 60%, and hypertension 54%), 33% of subjects had WML on CT brain scan. Patients with WML were significantly older (OR=1.27; IC 95%=1.04 - 1.22), had more frequently a past history of hypertension (OR=2.71; IC 95%=1.06 - 6.96) and more frequently lacunae associated with WML (OR=4.48; IC 95%=1.18 - 16.99). Subjects with WML had significantly poorer cognitive functions than those without WML (CEP score/100=62.33 +/- 13.58 versus 71.87 +/- 14.19, p<0.01 and MMSE score/30=27.02 +/- 2.34 versus 27.97 +/- 1.89, p<0.01) CONCLUSION: Our results showed a relationship between WML on CT brain scan and the depth of cognitive dysfunction among MCI patients. Further long term prospective studies have to be performed to determinate if WML are involved in transitions between MCI and Alzheimer' s disease.     

Do subjective cognitive complaints correlate with cognitive impairment in systemic lupus erythematosus? A Danish outpatient study

This study examined the prevalence of cognitive impairment and its association with depressive symptoms and self-reported cognitive complaints in Danish outpatients with systemic lupus erythematosus (SLE). Fifty-seven consecutive female SLE-outpatients were examined with a comprehensive neuropsychological test-battery, a 20-item self-administered Perceived Deficits Questionnaire (PDQ) and a self-rated depression scale (Major Depression Inventory). Twenty-two patients (38.5%) were classified as cognitively impaired, mostly with deficits in executive functions and attention. Among cognitively impaired patients only 18.2% had significantly higher PDQ scores than the normal range. PDQ scores were highly correlated to depressive symptoms (r = 0.67, p < 0.001). Only two neuropsychological tests were significantly correlated with subjective cognitive complaints. When these variables and self-rated depression score were entered into a regression model both depression score and Symbol Digit Modalities Test performances were significantly associated with the PDQ score. In conclusion, cognitive impairments were common in this group of (mild) SLE outpatients, but the level of significant subjective cognitive complaints was low even among patients with cognitive impairment. Affective status may influence subjective experience of cognitive functions even more than cognitive functioning itself, and absence of subjective cognitive complaints did not exclude the presence of cognitive impairments.     

The relationship between changes in normal-range systolic blood pressure and cognitive function in middle-aged healthy women.

Little is known about the effect of normal-range blood pressure (BP) on cognitive function. In previous studies investigating the relationship between BP and cognitive function in elderly subjects, underlying cerebrovascular damage has complicated the interpretation of results. To reveal the relationship between BP levels that were within an absolutely normal range and cognitive function, we examined cognitive function in normotensive, healthy middle-aged women. BP levels were measured on three separate occasions at 1-month intervals, and the subjects exhibiting normotension (< 140/90 mmHg) throughout the evaluation period were recruited as normotensive subjects. Cognitive function was assessed using subtests of the Wechsler Adult Intelligence Scale-Revised. The study demonstrated that, among the subtests examined, the scores on the Digit Symbol Test, an index of psychomotor performance, had a significant correlation with normotensive-range systolic blood pressure (SBP) (r=-0.51, p<0.05); this relation was negative-that is, higher but still normal-range SBP levels were associated with impaired Digit Symbol Test scores. In addition, the relationship adjusted by age and educational level was also significant (partial correlation = -0.56, p<0.05). In contrast, diastolic BP was not related to the Digit Symbol Test (r = -0.33, p = 0.13). Furthermore, the Digit Symbol Test was not influenced by blood glucose or serum cholesterol levels. These findings suggested that, even within the normotensive range, lower levels of SBP might be protective against impairment of psychomotor speed in middle-aged women.     

Prevalence and impact of incompetence of internal jugular valve on postoperative cognitive dysfunction in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy

Internal jugular vein (IJV) is the main pathway of cerebral venous drainage and its valves prevent regurgitation of blood to the brain. IJV valve incompetence (IJVVI) is known to be associated with cerebral dysfunctions. It occurs more often in male over 50 years old, conditions elevating intra-abdominal or intra-thoracic pressure. In robot-assisted laparoscopic radical prostatectomy (RALRP), elderly male undergoes surgery in Trendelenburg position with pneumoperitoneum applied. Therefore, we assessed the IJVVI during RALRP and its influence on postoperative cognitive function. 57 patients undergoing RALRP were enrolled. Neurocognitive tests including Mini-Mental State Examination (MMSE), Auditory Verbal Learning Test, Digit Symbol Substitution Test, Color Word Stroop Test, digit span test, and grooved pegboard test were performed the day before and 2 days after surgery. During surgery, IJVVI was assessed with ultrasonography in supine position with and without pneumoperitoneum, and Trendelenburg position with pneumoperitoneum. 50 patients underwent sonographic assessment and 41 patients completed neurocognitive examination. A total of 27 patients presented IJVVI, 19 patients in supine position without pneumoperitoneum, 7 patients in supine position with pneumoperitoneum and 1 patient in Trendelenburg position with pneumoperitoneum. In neurocognitive tests, patients with IJVVI showed statistically significant decline of score in MMSE postoperatively (p < 0.05). IJVVI occurred in 38% in supine position but the incidence was increased to 54% after Trendelenburg position and pneumoperitoneum. Patients with IJVVI did not show significant differences in cognitive function tests except MMSE. Clinical and neurological significance of physiologic changes associated RALRP should be studied further.     

Nonsteroidal Anti-Inflammatory Drugs, Aspirin, and Cognitive Function in the Baltimore Longitudinal Study of Aging

OBJECTIVES: To examine the relations between the use of nonaspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin and age-related change in multiple domains of cognitive function in community-dwelling individuals without dementia.
DESIGN: Longitudinal, with measures obtained on one to 18 occasions over up to 45 years.
SETTING: General community.
PARTICIPANTS: A volunteer sample of up to 2,300 participants from the Baltimore Longitudinal Study of Aging free of diagnosed dementia.
MEASUREMENTS: At each visit, reported NSAID or aspirin use (yes/no) and tests of verbal and visual memory, attention, perceptuo-motor speed, confrontation naming, executive function, and mental status.
RESULTS: Mixed-effects regression models revealed that NSAID use was associated with less prospective decline on the Blessed Information-Memory-Concentration (I-M-C) Test, a mental status test weighted for memory and concentration ( P <.001), and Part B of the Trail Making Test, a test of perceptuo-motor speed and mental flexibility ( P <.05). In contrast, aspirin use was related to greater prospective decline on the Blessed I-M-C Test ( P <.05) and the Benton Visual Retention Test, a test of visual memory ( P <.001).
CONCLUSION: Consistent with studies of incident dementia, NSAID users without dementia displayed less prospective decline in cognitive function, but on only two cognitive measures. In contrast, aspirin use was associated with greater prospective cognitive decline on select measures, potentially reflecting its common use for vascular disease prophylaxis. Effect sizes were small, calling into question clinical significance, although overall public health significance may be meaningful.     

Cognitive function in Japanese elderly with type 2 diabetes mellitus

The current study was conducted to investigate the cognitive function in Japanese elderly with type 2 diabetes mellitus (DM). Participants included 69 diabetic and 27 nondiabetic subjects (60 to 85 years old). The cognitive functional tests conducted were the Mini-Mental State Examination (MMSE), Word Lists Recall (immediate, delayed), Digit Symbol Test (Wechsler Adult Intelligence Scale-Revised [WAIS-R]), and the Stroop Color Word Test. Hemoglobin A1c (HbA1c) was measured as the index of glycemic control, and information about recent hypoglycemic episodes was gathered by using questionnaires. Student's t test showed that DM subjects had significantly lower scores in the MMSE (P<.01) and Digit Symbol Test (P<.05) than non-DM subjects. The scores of the Digit Symbol Test in diabetes subjects had a significant negative relationship with HbA1c (r=-.433; P<.001), and insulin-use had a significant relationship with the scores of the MMSE and Digit Symbol Test. Subjects in the DM group were further divided by insulin use. Comparison of insulin-treated DM subjects, non-insulin-treated DM subjects, and nondiabetic subjects by analysis of variance followed by Bonferroni's post hoc test showed that insulin-treated DM subjects had significantly lower scores in the MMSE and Digit Symbol Tests than both non-insulin-treated DM subjects (P<.05) and nondiabetic subjects (P<.01). Our study suggests that Japanese elderly DM subjects, especially those with insulin treatment, have poor cognitive function.     

Decreased white matter lesion volume and improved cognitive function after liver transplantation

Focal T2-weighted white matter lesions (WML) on brain magnetic resonance imaging (MRI), mimicking those seen in cerebrovascular small-vessel disease described in patients with persistent hepatic encephalopathy, decreased in volume with the improvement of hepatic encephalopathy. This outcome has been interpreted as a decrease in the edema that it is proposed to be involved in the pathogenesis of hepatic encephalopathy. We designed a study to further investigate potential changes in focal WML in the brains of patients with cirrhosis following liver transplantation and to study the relationship between these changes and overall cognitive function. We used MRI to measure the volume of supratentorial focal WML and a neuropsychological examination to assess cognitive function before and after liver transplantation in 27 patients with cirrhosis without signs of overt hepatic encephalopathy. Baseline MRI identified focal T2-weighted lesions in 19 patients (70.3%). The presence of WML was associated with older age but not with vascular risk factors, severity of liver function, or psychometric tests. A significant reduction in lesion volume was observed after liver transplantation (from a median of 1.306 cm(3) to 0.671 cm(3), P = 0.001). This decrease correlated with an improvement in an index of global cognitive function (r = -0.663; P < 0.001). This evolution indicates that lesion volume is partially related to a reversible type of tissue damage, which is compatible with brain edema. CONCLUSION: Focal WML probably induced by age-related microvascular injury can decrease their volume with liver transplantation. The associated improvement of cognitive function supports a relationship between brain edema and minimal hepatic encephalopathy.     

Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group

BACKGROUND: The long-term effect of type 2 diabetes on cognitive function is uncertain. OBJECTIVE: To determine whether older women with diabetes have an increased risk of cognitive impairment and cognitive decline. DESIGN: Prospective cohort study. SETTING: Four research centers in the United States (Baltimore, Md; Portland, Ore; Minneapolis, Minn; and the Monongahela Valley, Pennsylvania). PARTICIPANTS: Community-dwelling white women 65 years and older (n = 9679). MEASUREMENTS: Physician-diagnosed diabetes and other aspects of health history were assessed by interview. Three tests of cognitive function, the Digit Symbol test, the Trails B test, and a modified version of the Mini-Mental State Examination (m-MMSE), were administered at baseline and 3 to 6 years later. Change in cognitive function was defined by the change in the score for each test. Major cognitive decline was defined as the worst 10th percentile change in the score for each test. RESULTS: Women with diabetes (n = 682 [7.0%]) had lower baseline scores than those without diabetes on all 3 tests of cognitive function (Digit Symbol and Trials B tests, P<.01; m-MMSE, P = .03) and experienced an accelerated cognitive decline as measured by the Digit Symbol test (P<.01) and m-MMSE (P = .03). Diabetes was also associated with increased odds of major cognitive decline as determined by scores on the Digit Symbol (odds ratio = 1.63; 95% confidence interval, 1.20-2.23) and Trails B (odds ratio, 1.74; 95% confidence interval, 1.27-2.39) tests when controlled for age, education, depression, stroke, visual impairment, heart disease, hypertension, physical activity, estrogen use, and smoking. Women who had diabetes for more than 15 years had a 57% to 114% greater risk of major cognitive decline than women without diabetes. CONCLUSION: Diabetes is associated with lower levels of cognitive function and greater cognitive decline among older women.