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Project 4:

The Northern Manhattan Study of Metabolism and Mind

 

 

The Northern Manhattan Study of Metabolism and Mind (NOMEM) is one of the projects of the Northern Manhattan Center of Excellence in Minority Health and Health Disparities (NOCEMHD: P60 MD 000206). The explicit goal of NOMEM is to study the relation of diabetes and pre-diabetes with mental health outcomes, including cognition, in middle-aged Hispanics, and to study predictors of metabolic and mental health outcomes in general. We decided to focus on Hispanics aged 55 to 64 years recruited from Northern Manhattan because late middle age is a critical stage for the onset of both diabetes and cognitive impairment, and because this is a disparity population in Northern Manhattan for both diabetes and cognitive impairment (1). We chose an initial sample size of 600 because our preliminary sample size calculations showed that 250 persons with diabetes or pre-diabetes were needed to have 90% power to find a 0.5 SD difference in total recall of the selective reminding test, the main cognitive outcome in NOMEM. We proposed a time interval of 24 months because that is a reasonable length of time to observe changes in cognition. The first 600 participants of the cohort were recruited between 01/01/12 and 12/31/13. These participants are now undergoing the second wave of assessments. NOMEM is currently approved by the Institutional Review Board at Columbia University Medical Center (IRB AAAI5156).

We examined the association of glycemia and diabetes status with cognition among the 600 participants using the data from the baseline wave.  Diabetes was ascertained by history or Hemoglobin A1c (HbA1c). Normal glucose tolerance (NGT) and pre-diabetes were ascertained with HbA1c. Memory was assessed with the Selective Reminding Test (SRT). Executive abilities were assessed using the Color trails 1 and 2, and verbal fluency test. The cross-sectional association of glycemia and diabetes status with cognitive performance was examined using linear regression.  Participants were 59.2 ± 2.9 years old, were 76.7% female, and over 65% had pre-diabetes or diabetes. HbA1C (β = - 0.97; p <0.001) and diabetes (β = - 2.06; p = 0.001) were related with lower SRT total recall after adjustment for demographics, education, and vascular risk factors. Glycemia (β = - 0.85; p = 0.01) and diabetes (β = - 2.58 p = 0.01) were also related to lower verbal fluency scores after adjustment for age and sex, but these associations became non-significant after adjustment for education and Hispanic subgroup.  Only pre-diabetes was associated with worse performance in color trails 1 (β = - 4.58 p = 0.04) and 2 (β = - 6.20 p = 0.01), but only the latter association persisted after full adjustment.  From these analyses we can conclude that higher glycemia and diabetes are related to worse memory and executive abilities in late middle age, while pre-diabetes is related only to worse executive abilities. Longitudinal follow-up is needed to understand the order and progression of these deficits.

Our goal is to continue follow-up of NOMEM in order to study factors associated with mental health and diabetes, prediabetes, glycemia, and other metabolic factors, in a critical period of the lifespan. Exposures of interest include social determinants of health (e.g. social support, safety, discrimination, built environment), and environmental agents (lead, manganese, polycyclic aromatic hydrocarbons).

Publication

Noble JM, Manly JJ, Schupf N, Tang MX, Luchsinger JA. Type 2 diabetes and ethnic disparities in cognitive impairment. Ethn Dis. 2012 Winter;22(1):38-44. PubMed PMID: 22774307; PubMed Central PMCID: PMC3398739.

 
 
NOCHOP, COACH and address
link to NOCHOP link to COACH email link rc2415@cumc.columbia.edu