The brain of the elderly diabetic patient (original) (raw)
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Diabetes and the elderly brain: sweet memories?
Therapeutic advances in endocrinology and metabolism, 2012
Type 2 diabetes is common in older people and is associated with higher risk of both vascular dementia and Alzheimer's disease. This review examines the evidence for increased risk of dementia and mild cognitive impairment in patients with diabetes and the role of potential confounders. The relationship of diabetes and impaired fasting glucose with brain structure is also reviewed, focusing on longitudinal studies in older people. The pathophysiology underlying cognitive change in type 2 diabetes is examined with reference to vascular disease, hypoglycaemia, inflammation and insulin levels. Implications for clinical care in older people with diabetes are discussed, with a recommendation for cognitive evaluation as a routine part of end-organ, diabetes complication review.
Diabetes as a Risk Factor for Cognitive Decline in Older Patients
Dementia and Geriatric Cognitive Disorders, 2008
To assess the role of type 2 diabetes as a risk factor for cognitive decline among elderly people. Methods: Analyses were carried out on data from the Italian Longitudinal Study on Aging, a study on 5,632 subjects aged 65-84 years, with baseline in 1992 and follow-ups in 1996 and 2000. Results: At baseline, diabetic women had significantly worse scores on all cognitive tests compared to nondiabetic women, but did not show worsening over time, whereas men with diabetes did not show worse scores on cognitive tests at baseline compared to nondiabetic males; however, diabetes in men was associated with a risk of cognitive decline over time, particularly in attention. Higher levels of HbA 1c were associated with poorer performance on memory tests at follow-up in both sexes. Conclusion: The impact of diabetes on cognitive status might differ in older men and women, probably because of a survival effect, with a higher mortality at a younger age among diabetic men. The metabolic and cardiovascular abnormalities associated with diabetes might be responsible for the cognitive decline, at different rates and ages, in men and women. The routine assessment of diabetes complications in the elderly should include cognitive evaluation in both sexes.
Alzheimer's Research & Therapy, 2015
Older people with type 2 diabetes are at increased risk of developing cognitive impairment, for which several potential risk factors have been proposed. The present article reviews evidence in people with type 2 diabetes for associations of cognitive impairment with a range of vascular, metabolic, and psychosocial risk factors, many of which have a higher prevalence in people with type 2 diabetes than in non-diabetic adults of a similar age. Definitive research studies in this field are few in number. The risk factors may be involved in causal pathways or may act as useful markers of cerebrovascular damage (or both), and for which relatively consistent evidence is available, include poor glycemic control, hypoglycemia, microvascular disease, inflammation, and depression. For macrovascular disease, the strength of the association with cognitive impairment appears to depend on which vascular system has been examined. A role for pre-morbid ability in young adulthood as influencing the risk of both diabetes and cognitive impairment has also been suggested. The importance of considering inter-relationships between risk factors when investigating their potential contribution to cognitive impairment in future investigations is discussed.
COGNITIVE FUNCTION-A COMPARISON BETWEEN ELDERLY NON DIABETIC AND DIABETIC SUBJECTS
Introduction:- Increase in life expectancy and fall in death rate has led to rise in the proportion of the elderly in the community all over the world. The ageing population is facing a double epidemic of dementia including Alzheimer’s disease and diabetes mellitus. The increase in diabetes among elderly is concerning because, in addition to the traditional diabetes complications like acute hyperglycemic and hypoglycemic events and vascular complications, diabetes also affects the central nervous system, a complication referred to as ‘diabetic encephalopathy’, which presents as impaired cognitive functioning and is also associated with an increased risk of dementia. Hence this study was under taken to draw attention to the occurrence of cognitive impairment in type 2 diabetes mellitus, in our community, and thereby pave the way for future initiatives to reduce its incidence. Aim and objectives:- To compare the cognitive functions of elderly non-diabetic subjects with that of elderly type 2 diabetes mellitus subjects using standard neuropsychological tests and to correlate with their blood sugar and lipid levels. Materials and methods:- The study was conducted in 60 participants in the age group of 58-65 years. Of these the case group comprised of 30 individuals with type 2 diabetes mellitus and the control group was formed by age, gender and education matched non-diabetic individuals. Blood samples were collected from all participants. After a brief screening test the participants were asked to take the neuropsychological test battery for evaluating their cognitive status. Comparison of the raw test scores of the cases and controls was done using the student‘t’ test. Results and conclusion:- The diabetes group showed poorer performance in all the cognitive function tests than the non-diabetes group with no correlation between blood glucose and cholesterol levels and the neuropsychological test scores of the patients. Hence, it can be concluded that periodical assessment of cognitive functions in diabetes clinics would be helpful in early identification and management of cases with cognitive impairment, which in turn can reverse the cognitive decline and prevent the development of dementias in these patients.
Diabetes Mellitus And The Brain: Special Emphasis To Cognitive Function
Diabetes mellitus (DM) is a major public health problem. Cognitive deficits are common with DM which range from subclinical or subtle to severe deficits as dementia. Both hypoglycemia and hyperglycemia are causes of cognitive impairment with DM. In patients with DM, not only severe hypoglycemia but also recurrent mild or moderate hypoglycemia have deleterious effect on the brain. Recurrent mild/moderate hypoglycemia is associated with intellectual decline, reduced attention, impaired mental abilities and memory deficits. Hypoglycemia may result in abnormalities of neuronal plasticity, synaptic weakening and scattered neuronal death in the cerebral cortex and the hippocampus. Chronic hyperglycemia in type 1 and type 2 DM is associated with low IQ (verbal, performance and total) and abnormalities in testing for different domains of cognitive function as verbal relations, comprehension, visual reasoning, pattern analysis, quantitation, memory, learning, mental control, psychomotor efficiency, mental and motor processing speed and executive function. The suggested mechanisms incriminated in the pathogenesis of hyperglycemia related cognitive dysfunction include, macro- and micro-vascular disease or vasculopathy, hyperlipidemia, hypertension, insulin resistance and hyperinsulinemia, stress response, direct toxic effect of chronic hyperglycemia on the brain, advanced glycation end products, inflammatory cytokines and oxidative stress. Hyperglycemia causes oxidative stress, amyloidosis, angiopathy, abnormal lipid peroxidation, accumulation of β-amyloid and tau phosphorylation, neuroinflammation, mitochondrial pathology, apoptosis and neuronal degeneration in the cortex and hippocampus. Depression has been identified as a risk for accelerated cognitive decline with DM. The knowledge that diagnosis at early age, frequency of hypoglycemia, poor glycemic control and presence of risk factors which negatively affect cognitive functions in DM, will have important implications for treatment and for research purposes. Key Words: Diabetes Mellitus; Hypoglycemia; Insulin Resistance; Cognition; Vascular Disease
Diabetes mellitus and cognitive impairments
World Journal of Diabetes, 2016
There is strong evidence that diabetes mellitus increases the risk of cognitive impairment and dementia. Insulin signaling dysregulation and small vessel disease in the base of diabetes may be important contributing factors in Alzheimer's disease and vascular dementia pathogenesis, respectively. Optimal glycemic control in type 1 diabetes and identification of diabetic risk factors and prophylactic approach in type 2 diabetes are very important in the prevention of cognitive complications. In addition, hypoglycemic attacks in children and elderly should be avoided. Anti-diabetic medications especially Insulin may have a role in the management of cognitive dysfunction and dementia but further investigation is needed to validate these findings.
The diabetic brain and cognition
Journal of neural transmission (Vienna, Austria : 1996), 2017
The prevalence of both Alzheimer's disease (AD) and vascular dementia (VaD) is increasing with the aging of the population. Studies from the last several years have shown that people with diabetes have an increased risk for dementia and cognitive impairment. Therefore, the authors of this consensus review tried to elaborate on the role of diabetes, especially diabetes type 2 (T2DM) in both AD and VaD. Based on the clinical and experimental work of scientists from 18 countries participating in the International Congress on Vascular Disorders and on literature search using PUBMED, it can be concluded that T2DM is a risk factor for both, AD and VaD, based on a pathology of glucose utilization. This pathology is the consequence of a disturbance of insulin-related mechanisms leading to brain insulin resistance. Although the underlying pathological mechanisms for AD and VaD are different in many aspects, the contribution of T2DM and insulin resistant brain state (IRBS) to cerebrovascu...
Diabetes and cognitive function in a population-based study of elderly women and men
Journal of Diabetes and its Complications, 2006
The aim of this study was to examine the association between diabetes and cognitive function in the elderly. From January to December 2003, all 740 participants, aged 70 years or more, of an ongoing population-based cohort study were eligible for a telephone interview on cognitive function. Cognitive function was assessed using validated instruments, including the Telephone Interview of Cognitive Status (TICS) and the East Boston Memory Test (EBMT). Information on diabetes was available from prior questionnaires and was validated in 2002. We used multivariable logistic regression to estimate odds ratios (OR) of an impaired cognitive function (below 25th percentile) and their 95% confidence intervals (CI) adjusting for age, gender, smoking, alcohol consumption, body mass index (BMI), physical exercise, educational level, and depressive symptoms. Out of 473 participants interviewed (64.9%), 66 had diabetes (14.1%). The adjusted OR for diabetes and impaired cognitive function assessed by TICS was 2.3 (95% CI: 1.2-4.3). Diabetes was also associated with performance on delayed recall EBMT (adjusted OR=2.0; 95% CI: 1.0-4.1), but not immediate EBMT recall (adjusted OR=1.0; 95% CI: 0.5-2.1). The association between diabetes and cognitive function was a bit more pronounced in participants in whom diabetes was diagnosed 12 (median) or more years prior (adjusted OR with TICS=2.4; 95% CI: 1.0-5.8) and in those without antidiabetic treatment (age- and sex-adjusted OR=3.4; 95% CI: 1.7-6.5). Diabetes should be considered to be a risk factor for cognitive impairment in the elderly, which might be attenuated by antidiabetic treatment.