Impact of Intensive Lifestyle Intervention for Weight Management on Self-Reported Cognitive Function—The Action for Health in Diabetes (Look AHEAD) Randomized Controlled Trial

• Published in: Diabetes (New York, N.Y.) Vol. 67; no. Supplement_1
• Main Authors: DUTTON, GARETH R., ESPELAND, MARK, NEIBERG, REBECCA H., CARMICHAEL, OWEN, HAYDEN, KATHLEEN M., JOHNSON, KAREN C., JEFFERY, ROBERT W., BAKER, LAURA D., COOK, DELILAH, KITZMAN, DALANE, RAPP, STEVE R.
• Format: Journal Article
• Language: English
• Published: 01-07-2018
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db18-817-P

Background: Intensive lifestyle interventions (ILI) to reduce weight and increase physical activity may preserve higher-order cognition in overweight and obese adults with type 2 diabetes (T2D).
Methods: Adults with T2D who enrolled in a randomized clinical trial of a 10-year ILI compared with diabetes support and education (DSE; N=5,084; mean age=58.7 years; mean BMI=35.9 kg/m2; 36.8% racial/ethnic minority) provided self-assessments of difficulty with memory, problem-solving, and decision-making abilities at baseline and over ≥10 years of follow-up. The Health Utilities Index assessed memory and problem-solving; the Beck Depression Inventory-II assessed decision-making. Analyses included the full sample and sub-groups based on baseline weight status and history of cardiovascular disease (CVD).
Results: At baseline, 12%, 16%, and 23% of all participants reported some difficulty with problem-solving, decision-making, and memory, respectively. For those without baseline self-identified cognitive difficulties in a specific domain, ILI was associated with lower odds of decision-making difficulties at follow-up compared to DSE (odds ratio [OR]=0.85, [95% CI 0.75,0.97]). Among those who were not obese, ILI was associated with lower odds of problem-solving difficulties at follow-up (OR=0.69 [0.51,0.95]). For participants with self-identified cognitive difficulties at baseline who had a history of CVD, ILI may have worsened difficulties in problem-solving at follow-up visits (OR=2.95 [1.38,6.31]).
Conclusions: A long-term ILI targeting weight loss and physical activity may protect self-reported higher-order cognitive abilities in adults with T2D without preexisting memory, problem-solving, or decision-making problems. However, among those with preexisting problems, ILI was not protective.