The Relationship between Glucose Control and Cognitive Function in People with Diabetes after a Lacunar Stroke

Tali Cukierman-Yaffe*, Leslie A. McClure, Thomas Risoli, Jackie Bosch, Mike Sharma, Hertzel C. Gerstein, Oscar Benavente

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Context: Lacunar strokes and diabetes are risk factors for cognitive dysfunction. Elucidating modifiable risk factors for cognitive dysfunction has great public health implications. One factor may be glycemic status, as measured by glycated hemoglobin (A1c). Objective: The aim of this study was to assess the relationship between A1c and cognitive function in lacunar stroke patients with diabetes. Methods: The effect of baseline and follow-up A1c on the baseline and the change in Cognitive Assessment Screening Instrument (CASI) score over time among participants with a median of 2 cognitive assessments (range, 1-5) was examined in 942 individuals with diabetes and a lacunar stroke who participated in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial ( No. NCT00059306). Results: Every 1% higher baseline A1c was associated with a 0.06 lower standardized CASI z score (95% CI, -0.101 to -0.018). Higher baseline A1c values were associated with lower CASI z scores over time (P for interaction = .037). A 1% increase in A1c over time corresponded with a CASI score decrease of 0.021 (95% CI, -0.0043 to -0.038) during follow-up. All these remained statistically significant after adjustment for age, sex, education, race, depression, hypertension, hyperlipidemia, body mass index, cardiovascular disease, obstructive sleep apnea, diabetic retinopathy, nephropathy insulin use, and white-matter abnormalities. Conclusion: This analysis of lacunar stroke patients with diabetes demonstrates a relationship between A1c and change in cognitive scores over time. Intervention studies are needed to delineate whether better glucose control could slow the rate of cognitive decline in this high-risk population.

Original languageEnglish
Pages (from-to)E1521-E1528
JournalJournal of Clinical Endocrinology and Metabolism
Issue number4
StatePublished - 1 Apr 2021


  • A
  • cognition
  • cognitive dysfunction
  • diabetes
  • glycemia
  • lacunar infarct


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