Relationship Between Physical Exercise and Cognitive Impairment Among Older Adults with Type 2 Diabetes: Chain Mediating Roles of Sleep Quality and Depression

Association between sleep quality and cognitive impairment in older adults hypertensive patients in China: a case-control study

Background

Previous studies have found that poor sleep quality promotes the occurrence of cognitive impairment (CI), but this relationship has been rarely reported in older adults hypertensive patients. The purpose of this study was to investigate the relationship between sleep quality and CI in older adults hypertensive patients and the mediating effect of sleep quality between physical activity (PA) and CI.

Methods

A total of 2072 older adults hypertensive patients were included in this case-control study. Five hundred and eighteen older adults hypertensive patients with CI were matched 1:3 by age and sex to 1,554 older adults hypertensive patients with normal cognitive function. The International Physical Activity Questionnaire-Long Form, Pittsburgh Sleep Quality Index, and Mini-Mental State Examination were used to evaluate PA intensity, sleep quality, and cognitive function in older adults hypertensive patients. Multivariate logistic regression and the mediation package in R Language were used to analyze the relationship between sleep quality and CI and the mediating effect of sleep quality between PA intensity and CI in older adults hypertensive patients.

Results

After adjusting for all confounding factors, sleep quality was positively correlated with CI in older adults hypertensive patients (OR = 2.565, 95%CI: 1.958-3.360, p < 0.001), and this relationship also existed in the older adults hypertensive patients with education levels of primary school and below and junior high school and above (OR = 2.468, 95%CI: 1.754-3.473, p < 0.001; OR = 2.385, 95%CI: 1.367-4.161, p = 0.002). In addition, sleep quality mediated part of the mediating effect between PA intensity and CI in older adults hypertensive patients (Za*Zb: - 17.19339; 95%CI: -0.37312, -0.04194).

Conclusion

Poor sleep quality was associated with the occurrence of CI in older adults hypertensive patients, and this relationship also existed in older adults hypertensive patients with education levels of primary school and below and junior high school and above.

Temporal Relationship between HbA1c and Depressive Symptom Trajectories in a Longitudinal Cohort Study: The Mediating Role of Healthy Lifestyles

This study analyzed China Health and Retirement Longitudinal Study data to explore the HbA1c-depression link, including depressive trajectories, while considering the mitigating impact of healthy lifestyles. Cross-lagged panel models and group-based trajectory modeling were performed to investigate the temporal relationship between HbA1c levels and depressive symptoms, as well as the depressive trajectories. Structural equation models were used to assess the mediating effects of healthy lifestyles. The mean age of the participants was 57.66 ± 9.04 years, with 53.68% being female. Analyzing 8826 participants across three waves, we observed a significant prediction of subsequent depressive symptoms by the preceding HbA1c levels (β = 0.296; p < 0.001). Four distinct trajectories of depressive symptoms were distinguished: stable low, stable moderate, increasing, and stable high. Elevated HbA1c levels were associated with a higher risk of developing stable high (OR 1.12 and 95% CI 1.02-1.23), increasing (OR 1.21 and 95% CI 1.11-1.32), and stable moderate depressive symptoms (OR 1.07 and 95% CI 1.01-1.13). Engaging in two healthy life behaviors reduced stable high and increasing depressive pattern risks by 32% and 30%, respectively. Adherence to a healthy lifestyle lessened 7.2% of the impact of high HbA1c levels on the subsequent depressive symptoms. These findings highlight the potential benefits of incorporating adequate sleep and light physical activities, which might reduce the adverse impact of elevated HbA1c levels on depressive symptoms.

Development and Validation of a Community-Based Prediction Model for Depression in Elderly Patients with Diabetes: A Cross-Sectional Study

Background

In elderly diabetic patients, depression is often overlooked because professional evaluation requires psychiatrists, but such specialists are lacking in the community. Therefore, we aimed to create a simple depression screening model that allows earlier detection of depressive disorders in elderly diabetic patients by community health workers.

Methods

The prediction model was developed in a primary cohort that consisted of 210 patients with diabetes, and data were gathered from December 2022 to February 2023. The independent validation cohort included 99 consecutive patients from February 2023 to March 2023. Multivariable logistic regression analysis was used to develop the predictive model. We incorporated common demographic characteristics, diabetes-specific factors, family structure characteristics, the self-perceived burden scale (SPBS) score, and the family APGAR (adaptation, partnership, growth, affection, resolution) score. The performance of the nomogram was assessed with respect to its calibration (calibration curve, the Hosmer-Lemeshow test), discrimination (the area under the curve (AUC)), and clinical usefulness (Decision curve analysis (DCA)).

Results

The prediction nomogram incorporated 5 crucial factors such as glucose monitoring status, exercise status, monthly income, sleep disorder status, and the SPBS score. The model demonstrated strong discrimination in the primary cohort, with an AUC of 0.839 (95% CI, 0.781-0.897). This discriminative ability was further validated in the validation cohort, with an AUC of 0.857 (95% CI, 0.779-0.935). Moreover, the nomogram exhibited satisfactory calibration. DCA suggested that the prediction of depression in elderly patients with diabetes mellitus was of great clinical value.

Conclusion

The prediction model provides precise and user-friendly guidance for community health workers in preliminary screenings for depression among elderly patients with diabetes.

Leisure-Time Physical Activity May Attenuate the Impact of Diabetes on Cognitive Decline in Middle-Aged and Older Adults: Findings From the ELSA-Brasil Study

OBJECTIVE

To assess leisure-time physical activity (LTPA) as a modifier of the diabetes/cognitive decline association in middle-aged and older participants in the Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) study.

RESEARCH DESIGN AND METHODS

ELSA-Brasil is a cohort of 15,105 participants (age 35-74 years) enrolled between 2008 and 2010. We evaluated global cognitive function, summing the scores of six standardized tests evaluating memory and verbal fluency, including the Trail-Making Test, at baseline and follow-up. Incident cognitive impairment was defined as a global cognitive function score at follow-up lower than -1 SD from baseline mean. Participants reporting ≥150 min/week of moderate to vigorous LTPA at baseline were classified as physically active. We assessed the association of LTPA with global cognition change in those with diabetes in the context of our overall sample through multivariable regression models.

RESULTS

Participants' (N = 12,214) mean age at baseline was 51.4 (SD 8.8) years, and 55.5% were women. During a mean follow-up of 8.1 (SD 0.6) years, 9,345 (76.5%) inactive participants and 1,731 (14.1%) participants with diabetes at baseline experienced faster declines in global cognition than those who were active (β = -0.003, -0.004, and -0.002) and those without diabetes (β = -0.004, -0.005, and -0.003), respectively. Diabetes increased the risk of cognitive impairment (hazard ratio [HR] 1.71; 95% Cl 1.22, 2.39) in inactive but not in active adults (HR 1.18; 95% CI 0.73, 1.90). Among participants with diabetes, those who were active showed a delay of 2.73 (95% CI 0.94, 4.51) years in the onset of cognitive impairment.

CONCLUSIONS

In adults living with diabetes, LTPA attenuated the deleterious association between diabetes and cognitive function.

Association between depression and quality of life in older adults with type 2 diabetes: A moderated mediation of cognitive impairment and sleep quality

BACKGROUND

The acceleration of aging and the increase in life expectancy have resulted in an increasing number of older adults developing physical and mental comorbidities. We examined the association between depression and quality of life (QoL) using cognitive impairment (COI) as a mediator and sleep quality (SQ) as a moderator among older adults with type 2 diabetes.

METHODS

A total of 2646 participants from Weifang, Shandong, China completed the survey. Their depression, cognitive function, SQ, and QoL were assessed. PROCESS was used to investigate mediating and moderating effects.

RESULTS

COI mediated the association between depression and QoL (indirect effect = -0.1058, bootstrapped 95 % CI [-0.1417, -0.0725]). Moderated mediation analyses indicated that SQ moderated the first half of the pathway of depression's impact on QoL through COI (moderating effect = -0.1128, bootstrapped 95 % CI [-0.1981, -0.0348]). Depression negatively impacted cognitive function in participants with poor (vs. better) SQ.

LIMITATIONS

First, multiple assessment tools should be considered to increase objective assessment. Second, the cross-sectional design limited our ability to make causal inferences. Third, additional diabetes-related variables should be included to explore this relationship. Finally, the pathways of influence and mechanisms of action of COI in older adults should be explored further.

CONCLUSION

Depression could impair the QoL of older adults by aggravating their COI. Fortunately, improving patients' SQ may undermine this negative effect. These findings may play an integral role in promoting the psychiatric health of older adults with type 2 diabetes.