A Comparative Exploratory Study of Cognitive and Functional Outcomes by Sex and Age in Patients With Type 2 Diabetes Mellitus and Atrial Fibrillation

BACKGROUND/AIM: Atrial fibrillation (AF) and type 2 diabetes mellitus (T2DM) are associated with cognitive decline, but possible sex-related differences in cognitive and functional outcomes remain uncertain. This exploratory study evaluated sex-stratified associations of clinical factors, depressive symptoms, and functional independence with severe cognitive impairment in patients with T2DM, AF, and newly identified cognitive decline. PATIENTS AND METHODS: The study included 140 patients with T2DM, AF, and a Mini-Mental State Examination (MMSE) score <27, comprising 68 men and 72 women. Cognitive performance, depressive symptoms, and functional status were assessed using the MMSE, Montreal Cognitive Assessment, 15-item Geriatric Depression Scale (GDS-15), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living scales. Logistic regression was used to evaluate factors associated with severe cognitive impairment, defined as MMSE <24, in the overall cohort and separately in male and female patients. RESULTS: Severe cognitive impairment was present in 32/68 men (47.06%) and 36/72 women (50.00%), with no significant difference between sexes. Increasing age and higher diastolic blood pressure were associated with higher odds of MMSE <24 in the overall cohort and in sex-stratified analyses. Higher GDS-15 scores were associated with increased odds of severe cognitive impairment in both sexes, whereas greater functional independence, reflected by higher ADL scores, was associated with lower odds of MMSE <24. CONCLUSION: Age, higher diastolic blood pressure, and greater depressive symptom burden in patients with type 2 diabetes mellitus were associated with increased odds of severe cognitive impairment, whereas greater functional independence was associated with lower odds in both sexes. These exploratory findings support cognitive, cardiovascular, psychological, and functional assessment in patients with T2DM and AF.