The Power of Birth Cohorts to Study Risk Factors for Cognitive Impairment

Association between cognitive dysfunction and diabetes in patients over 65 years old: a cross-sectional study using propensity score matching

OBJECTIVES

To investigate the association between diabetes and cognitive dysfunction in the elderly population, and examine the impact of cognitive dysfunction on level of activities of daily living (ADL) in patients with diabetes.

METHODS

Data analysis was conducted on 2,951 individuals aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey cohort. Propensity score matching was utilized to mitigate selection bias. Multivariate binary logistic regression was performed to analyse the association between diabetes and cognitive dysfunction in the study subjects. In addition, the relationship between ADL and cognitive function in patients with diabetes was analysed using the Wilcoxon rank-sum test.

RESULTS

A significant association (p = 0.017) was found between diabetes and the occurrence of cognitive dysfunction in older adults. Subgroup analyses revealed that diabetes patients with cognitive dysfunction exhibited a worse ADL dependence compared with those without cognitive dysfunction (p < 0.001).

CONCLUSION

These findings indicate that diabetes is associated with cognitive dysfunction in older adults. Meanwhile, there is an association between cognitive impairment and ADL level in subjects with diabetes. As such, healthcare professionals should pay close attention to the occurrence of cognitive dysfunction and ADL decline during diagnosis and treatment, and proactive prevention and intervention strategies should be implemented.

Drugs with a negative impact on cognitive function (Part 1): chronic kidney disease as a risk factor

People living with chronic kidney disease (CKD) frequently suffer from mild cognitive impairment and/or other neurocognitive disorders. This review in two parts will focus on adverse drug reactions resulting in cognitive impairment as a potentially modifiable risk factor in CKD patients. Many patients with CKD have a substantial burden of comorbidities leading to polypharmacy. A recent study found that patients seen by nephrologists were the most complex to treat because of their high number of comorbidities and medications. Due to polypharmacy, these patients may experience a wide range of adverse drug reactions. Along with CKD progression, the accumulation of uremic toxins may lead to blood-brain barrier (BBB) disruption and pharmacokinetic alterations, increasing the risk of adverse reactions affecting the central nervous system (CNS). In patients on dialysis, the excretion of drugs that depend on kidney function is severely reduced such that adverse and toxic levels of a drug or its metabolites may be reached at relatively low doses, unless dosing is adjusted. This first review will discuss how CKD represents a risk factor for adverse drug reactions affecting the CNS via (i) BBB disruption associated with CKD and (ii) the impact of reduced kidney function and dialysis itself on drug pharmacokinetics.

Effects of weight loss on cognitive function in patients with diabetes: a systematic review and meta-analysis

AIMS

Normalization of body weight is a treatment objective for diabetes. Therefore, anti-diabetic drugs that cause weight loss are widely used in clinics, with the aim of reducing the risk of chronic complications. However, the effect of weight loss on cognition in patients with diabetes is unclear.

METHODS

Embase, the Cochrane Library, PubMed, and the Web of Science were searched systematically, without study type restrictions, from inception to December 18, 2022. Weight loss was defined as a statistically significant decrease in body mass index (BMI) following an observation or intervention. We conducted an analysis of pooled data using a random-effects model.

RESULTS

A total of 619 participants in five studies were included. Weight loss was not associated with cognitive changes in patients with diabetes (standardized mean difference 0.50, 95% confidence interval -0.09 to 1.08). Subgroup analyses showed that this was not significantly affected by the duration of intervention or observation, or the size of the reduction in BMI. However, it was challenging to draw definitive conclusions regarding the effects of interventions and baseline BMI, because only one study was included.

CONCLUSIONS

Weight loss may be neutral to cognitive function in diabetes, but further studies are required to draw more definitive conclusions.