Assessment of comorbid mild cognitive impairment and depression in patients with type 2 diabetes mellitus

Relationship between serum apolipoprotein B levels and depressive symptoms in elderly Chinese patients with mild cognitive impairment: A large-scale cross-sectional and five-year follow-up study

BACKGROUND

Patients with mild cognitive impairment (MCI) often have depressive symptoms. The purpose of this study was to investigate the effects of depressive symptoms on lipid metabolism and future cognitive function in patients with MCI.

METHODS

A total of 1014 patients with MCI were included. Their demographic data, clinical data, and lipid parameters were collected. Meanwhile, they also completed a series of scale assessments, including Geriatric depression scale (GDS), Ability of Daily Living (ADL), Montreal cognitive assessment (MoCA) and Block Design Test (BDT). Then these patients were also followed for five years.

RESULTS

Patients with depressive symptoms had lower serum apolipoprotein B (ApoB) levels, lower BDT scores and higher ADL scale scores. Correlation analysis showed that GDS was significantly associated with BDT and ADL. Moreover, logistic regression analysis found that ApoB was associated with depressive symptoms. Cox regression analysis showed that only baseline MoCA scores could predict the risk of future MCI transition to dementia.

CONCLUSIONS

Our results suggest low serum ApoB levels may be associated with depressive symptoms in patients with MCI. However, depressive mood or lipids alone may not predict the risk of MCI transition to dementia.

The cross talk between chronotype, depression symptomatology, and glycaemic control among sudanese patients with diabetes mellitus: A case-control study

Aim of the Study:

There is an increasing awareness about chronotype and depression among patients with diabetes mellitus as commonly ignored serious association. We aimed to investigate the same among patients with type 2 diabetes mellitus and their relation to glycaemic control.

Subjects' and Methods:

This case-control study conducted at two diabetes centers in Omdurman, Sudan during the period from April 2019 to September 2019. Ninety-two patient with type 2 diabetes and 94 controls signed a written informed consent then interviewed using a structured questionnaire based on the morningness–eveningness scale and the 12-item general health questionnaire; A blood sample was taken for the glycated haemoglobin to assess glycaemic control. The Statistical Package for Social Silences was used for Data analysis.

Results:

They were 92 patients with diabetes (58.7% women) and 94 healthy control subjects (52.1% women); matched for ages (57.03 ± 8.59 for diabetic patients and 58.46 ± 10.58 years for control subjects) and sex. Morning chronotype was reported in 95.3% vs. 47.5% and intermediate chronotype was evident in 52.4% vs. 4.3% in controls and patients respectively, P < 0.05. Depression symptomatology was found in 76.1% of patients with diabetes vs. 40.4% of control subjects, P < 0.05. No association was shown between depression symptomatology, chronotype, age, sex, and HbA1c, P > 0.05.

Conclusion:

Sudanese patients with diabetes were more likely intermediate, less morning chronotype, and more depressed compared to their counterparts. No association was found between depression symptomatology and other patient's characters. Larger studies investigating the risk behind depression, chrono-nutrition, and social jetlag among patients with diabetes are needed.

Spot Urine Albumin Creatinine Ratio can be a Predictor of Cognitive Function in Type 2 Diabetes Mellitus

Introduction

In diabetes mellitus (DM), the underlying pathophysiology of albuminuria and cognitive dysfunction is similar. So, we hypothesized that urinary albumin excretion (UAE) could be linked to cognitive dysfunction in type 2 diabetes mellitus.

Methods and Materials

It was a hospital-based observational study. Patient aged 40-60 years with type 2 DM were included in this study. Complete assessment with detailed history, physical examination, and necessary biochemical investigations including spot urine albumin creatinine ratio (uACR) was done. Cognitive status was determined in all the individuals with the application of Hindi translated version of the mini-mental status examination (MMSE) questionnaire.

Results

In 80 patients, the mean MMSE score was 25.37 ± 3.34. Cognitive dysfunction (score <26) was present in 45% of individuals. Spot uACR, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), presence of retinopathy and dyslipidemia were significantly different between the normal and subnormal scoring groups. On multivariate analysis spot uACR was found to be independently predicting odds of developing cognitive dysfunction (OR 1.01, CI 1.004-1.022; P = 0.001). The mean MMSE scores in normo-albuminuric (n = 15), moderately increased albuminuric (n = 48) and severely albuminuric (n = 17) patients were 28.00 ± 1.60, 25.54 ± 3.33 and 22.58 ± 2.31, respectively, which were significantly different among the three groups (P < 0.001).

Conclusions

Spot uACR could be helpful in predicting cognitive decline in people with type 2 DM.

Elevated Plasma Free Fatty Acid Susceptible to Early Cognitive Impairment in Type 2 Diabetes Mellitus

BACKGROUND

Elevated free fatty acid (FFA) induces lipotoxicity, attributed to diabetes and cognitive decline. Sterol regulatory element-binding protein-1c (SREBP-1c) regulates lipid metabolism.

OBJECTIVE

We investigated the roles of FFA in mild cognitive impairment (MCI) of type 2 diabetes mellitus (T2DM) patients and determine its association with rs11868035 polymorphism.

METHODS

We recruited 191 Chinese T2DM patients into two groups through Montreal Cognitive Assessment. Demographic and clinical data were collected, multiple domain cognitive functions were tested, plasma FFA levels were measured through ELISA, and SREBP-1c rs11868035 genotype was detected using the Seqnome method.

RESULTS

In comparison with the healthy-cognition group (n = 128), the MCI group (n = 63) displayed lower glucose control (p = 0.012) and higher plasma FFA level (p = 0.021), which were independent risk factors of MCI in T2DM patients in multivariate regression analysis (OR = 1.270, p = 0.003; OR = 1.005, p = 0.036). Additionally, the plasma FFA levels of MCI patients were positively correlated with Stroop color word test-C time scores (r = 0.303, p = 0.021) and negatively related to apolipoprotein A1 levels (r = -0.311, p = 0.017), which are associated positively with verbal fluency test scores (r = 0.281, p = 0.033). Both scores reflected attention ability and executive function. Moreover, the G allele carriers of rs11868035 showed higher digit span test scores than non-carriers in T2DM patients (p = 0.019) but without correlation with plasma FFA levels.

CONCLUSION

In T2DM, elevated plasma level of FFA, when combined with lower apolipoprotein A1 level portends abnormal cholesterol transport, were susceptible to early cognitive impairment, especially for attention and execution deficits. The G allele of SREBP-1c rs11868035 may be a protective factor for memory.

Meta-analysis of studies on depression prevalence among diabetes mellitus patients in Africa

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. It can be caused by the consumption of carbohydrate meals or medication side effects. Depression as a comorbid condition in an individual with diabetes is accountable for increased disability, mortality, and significant health problem in patients. As a continent, Africa does not have an overall estimation of depression prevalence among diabetes mellitus patients at a regional level. Consequently, this study's purpose was to use the meta-analysis method to summarize estimates of extant studies that have reported depression prevalence among patients with diabetes mellitus in Africa. The literature search method was executed to classify studies with reported depression prevalence with evidently designed inclusion and exclusion criteria. In total, 20 studies from sundry screened articles were appropriate for ultimate inclusion in the meta-analysis. Since substantial heterogeneity was expected, a random-effects meta-analysis was carried out using the number of cases with a total sample size to estimate the prevalence of diabetes mellitus at a regional level. The residual amount of heterogeneity was found to be high according to the statistics of τ² = 0.06; I² = 99.10%, chi-square = 2184.85, degree of freedom = 19 and P =< 0.001. The pooled depression prevalence was 40% within a 95% confidence interval of 29%–51%. The meta-regression analysis result showed that none of the included moderators contributed to the heterogeneity of studies. The result of effect size estimates against its standard error showed publication bias with a P-value of 0.001. The meta-analysis findings of this study have indicated that depression prevalence in Africa is still high. Reporting on numerous risk factors like socio-demographic characteristics were not possible in this study because of a lack of completeness in the included articles. Consequently, screening diabetes patients for comorbid depression with its associated risk factors is highly recommended.

Evaluation of the cognitive impairments and depressive symptoms in patients with Parkinson's disease: A case-control study from Iran

BACKGROUND

Parkinson's disease is a progressive neurodegenerative disease and the second most common neurological disease in the world, which usually affects people mainly in later years of life. Cognitive impairments and depressive symptoms are important symptoms in these patients that are associated with a poor prognosis. The study will focus on the original data regarding the cognitive impairments and depressive symptoms in patients with Parkinson's disease and control group.

METHODS

In a case-control study, a total of 100 Parkinson's patients who were hospitalized in Rouhani Hospital and 200 non-Parkinson's people (control group) from Amirkola Health and aging project (AHAP) Marras et al., Babol, Iran were enrolled between September 2019 to February 2020. Data were collected by simple random sampling. Data were collected using a four-part questionnaire, including demographic characteristics, Unified Parkinson Disease Rating Scale (UPDRS), Modified Hoehn and Yahr staging Scale (MHYSS), Mini-M ental State Examination (MMSE) and Geriatric Depression Scale (GDS). P-value less than 0.05 was considered as significant RESULTS: A total of 300 persons were enrolled in the study. The mean age of Parkinson's patients and non-Parkinson's people was 70.34 ± 7.76 and 70.87 ± 7.59 years, respectively. The mean MMSE score in Parkinson's and non-Parkinson's people was 24.80 ± 4.53 and 25.40 ± 3.1, respectively (p = 0.182). The mean GDS score in Parkinson's and non-Parkinson's people was 7.06 ± 4.06 and 4.31 ± 3.47, respectively (p = 0.001). There was a statistically significant relationship between depressive symptoms and cognitive impairments with disease severity (p = 0.022 and p = 0.012, respectively). In addition, variables, such as age and the education level were associated with cognitive impairments (p = 0.001 and p = 0.021, respectively), but these variables were not significantly associated with depressive symptoms (p = 0.843 and p = 0.411, respectively). There was a significant relationship between depressive symptoms and cognitive impairment in Parkinson's patients and the control group (p = 0.001 and p = 0.003, respectively).

CONCLUSIONS

Cognitive impairments and depressive symptoms were significantly associated with an increase in the severity of Parkinson's disease, and also, depressive symptoms in Parkinson's patients was associated with an increase in cognitive impairments.

Statins-related peripheral neuropathy among diabetic patients

BACKGROUND

Peripheral neuropathy (PN) is a complaint with often unidentified reasons. Some medicines, including statins therapy, are anticipated to be amongst the reasons for PN.

AIMS

This study intended to assess the association of peripheral neuropathy with statins therapy amongst Type 2 diabetic patients.

METHODS

At Penang General Hospital, 757 cases were categorized into two groups (564 with statins therapy and 193 without statins therapy). The diagnosis of PN was investigated retrospectively for a period of 10 years (2006-2016). Confounding risk factors as age, diabetes period, hypertension, glycemic control, other co-morbidity, and prescriptions were matched.

RESULTS

About 129 (22.9%) cases from 564 statins users had PN. Only 30 (15.5%) subjects had PN from 193 statins non-users. Chi-square test showed a significant variance among statins treatment cohort and statin-free cohort in the occurrence of PN (P-value: 0.001). Spearman's investigation presented a positive correlation (r: 0.078, p-value: 0.031) among statins use and PN prevalence. Binary logistic regression was statistically significant for statins therapy as a predictor of peripheral neuropathy incidence (r²: 0.006, p-value: 0.027) amid diabetic patients. The relative risk of peripheral neuropathy connected with statins therapy is (RR: 1.47, 95% CI: 1.02-2.11). The excess relative risk is 47.1%. While the absolute risk (AR) is 7.3% and the number needed to harm (NNH) is 14.

CONCLUSIONS

The study indicated a positive association between peripheral neuropathy and statins utilization. Peripheral neuropathy was higher amongst statins users than the statins-free group.