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Hua W, Du Z, Lu T, Tian L. Effect of glycemic control on cognitive function in patients with type 1 diabetes mellitus: a systematic review and meta-analysis. Syst Rev 2024; 13:10. [PMID: 38167509 PMCID: PMC10763190 DOI: 10.1186/s13643-023-02433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND It is controversial whether the level of glycemic control in patients with type 1 diabetes mellitus (T1DM) correlates with reduced cognitive function. This study explored the influence of glycemic management quality on cognitive function in T1DM patients by examining the association between glycemic control level and impaired cognitive function. METHODS The electronic databases PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal database, Wanfang database, and China Biology Medicine disc database were systematically searched to identify eligible studies published before January 2023. Search, selection, and data extraction were performed by two independent reviewers. RevMan 5.4 software was used for meta-analysis, and standardized mean difference (SMD) between groups was calculated. RESULTS Six studies involving 351 patients with T1DM were included in this study. Compared with T1DM subjects with good glycemic control, those with poor glycemic control performed worse in full-scale intellectual quotient (P = 0.01, SMD = -0.79, 95%CI = -1.42 to -0.17), but no significant differences were observed in verbal intellectual quotient (P = 0.08, SMD = -1.03, 95%CI = -2.20 to 0.13), memory (P = 0.05, SMD = -0.41, 95%CI = -0.82 to 0.00), and attention (P = 0.23, SMD = -0.26, 95%CI = -0.69 to 0.16). CONCLUSIONS T1DM patients with suboptimal glycemic control may have a worse cognitive function, mainly focusing on the full-scale intellectual quotient. The current study highlights the significance of maintaining satisfactory glycemic control in T1DM patients to improve their health status and quality of life. Standardized tests should be employed in clinical neuropsychological practice to provide early and complete cognitive assessment of individuals with poor glycemic control. SYSTEMATIC REVIEW REGISTRATION The study protocol has been registered in the PROSPERO database (CRD42023390456).
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Affiliation(s)
- Wenting Hua
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
- Clinical Research Center for Metabolic Diseases, Gansu Province, Lanzhou, 730000, China
| | - Zouxi Du
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
- Clinical Research Center for Metabolic Diseases, Gansu Province, Lanzhou, 730000, China
| | - Tingting Lu
- Institution of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Limin Tian
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China.
- Clinical Research Center for Metabolic Diseases, Gansu Province, Lanzhou, 730000, China.
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Wu J, Wang Z, Xu H, Yang L, Liu J, Zheng Y, Kang C, Wang X, Shi J, Zhao N, Zhang XY. Thyroid dysfunction in young, first-episode and drug-naïve patients with major depressive disorder: prevalence and associated clinical factors. Front Psychiatry 2023; 14:1156481. [PMID: 37457778 PMCID: PMC10348838 DOI: 10.3389/fpsyt.2023.1156481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Objective The incidence of thyroid dysfunction (TD) and major depressive disorder (MDD) is increasing year by year in the general population. However, the prevalence and correlates of TD in first-episode drug-naive (FEDN) MDD patients have not been explored. This study sought to fill this gap and examine the association between TD and MDD. Methods We recruited 1,289 FEDN MDD patients aged 18 ~ 45 years. A total of 1,289 FEDN MDD outpatients were recruited. Demographical and suicide data were collected for each patient, and lipid profiles, thyroid function, and fasting blood glucose (FBG) levels were measured. The Hamilton Depression Scale 17 (HAMD-17) was assessed for depression. Results The prevalence of TD in young FEDN MDD patients was 64.86%. Compared with those without TD, patients with TD had longer duration of illness, greater HAMD score, higher BMI, TG, TC, and LDL-C levels, and higher suicide attempt rates, but lower HDL-C and FBG levels. Further logistic regression indicated that duration of illness, HAMD score, TC, HDL-C, BMI, and FBG levels were significantly associated with TD. Limitations No causal relationship can be drawn due to the cross-sectional design. Conclusion TD is common in young FEDN MDD patients. So clinicians should monitor thyroid function in patients with MDD.
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Affiliation(s)
- Jinbo Wu
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | | | - Hongjiao Xu
- Qingdao Mental Health Center, Qingdao, China
| | - Liying Yang
- Dalian No.7 People's Hospital, Dalian, Liaoning Province, China
| | - Jiacheng Liu
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yue Zheng
- Peking University Sixth Hospital, Beijing, China
| | - Chuanyi Kang
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiaohong Wang
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jingjing Shi
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Na Zhao
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Zhao S, Du Y, Zhang Y, Wang X, Xia Y, Sun H, Huang Y, Zou H, Wang X, Chen Z, Zhou H, Yan R, Tang H, Lu Q, Yao Z. Gray matter reduction is associated with cognitive dysfunction in depressed patients comorbid with subclinical hypothyroidism. Front Aging Neurosci 2023; 15:1106792. [PMID: 36845662 PMCID: PMC9945283 DOI: 10.3389/fnagi.2023.1106792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction To explore the association between regional gray matter volume (GMV) and cognitive impairments and ascertain whether the regional brain alterations related to cognitive impairments occur in major depressive disorder (MDD) patients with comorbid subclinical hypothyroidism (SHypo). Methods We enrolled 32 MDD patients, 32 MDD patients with comorbid SHypo, and 32 normal controls and subjected them to thyroid function tests, neurocognitive tests, and magnetic resonance imaging (MRI). Using voxel-based morphometry (VBM) analysis, we examined the pattern of gray matter (GM) in these participants. We also used ANOVA to detect group differences and partial correlation to explore the potential association between GMV alterations and cognitive tests in comorbid patients. Results The comorbid patients exhibited significantly smaller GMV in the right middle frontal gyrus (MFG) than the non-comorbid group. Furthermore, the partial correlation analysis showed that GMV of the right MFG was associated with poor executive function (EF) performance in comorbid patients. Conclusion These findings provide valuable insight into the relationship between the alteration of GMV and cognitive dysfunction of MDD patients with comorbid SHypo.
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Affiliation(s)
- Shuai Zhao
- Department of Psychiatry, The Affiliated Psychological Hospital of Anhui Medical University, Hefei, China,Hefei Fourth People’s Hospital, Hefei, China,Anhui Mental Health Center, Hefei, China,Anhui Clinical Research Center for Mental Disorders, Hefei, China,Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yishan Du
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoqin Wang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Xia
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Sun
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yinghong Huang
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Haowen Zou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xumiao Wang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zhilu Chen
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hongliang Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Rui Yan
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Tang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China,*Correspondence: Qing Lu, ; Zhijian Yao,
| | - Zhijian Yao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China,Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China,*Correspondence: Qing Lu, ; Zhijian Yao,
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Abstract
Background: Some levothyroxine (LT4)-treated hypothyroid patients report a constellation of persistent and distressing cognitive symptoms that has been termed brain fog. This narrative review focuses on attempts to define and measure hypothyroid-associated brain fog, summarize possible etiologies and contributing factors, present treatment options, and propose avenues for future research. Methods: Published literature was reviewed to summarize available information on patient-reported symptoms associated with brain fog in hypothyroidism, as well as objective evidence of impairment based on neurocognitive testing and functional imaging studies. Given the limited information specific for hypothyroid-associated brain fog, relevant data from other medical conditions associated with brain fog were also reviewed and incorporated into recommendations for clinical care and future research areas. Results: Hypothyroid-associated brain fog has not been well defined or quantitated, and the underlying pathophysiology is unclear. Symptoms vary among patients but commonly include fatigue, depressed mood, and cognitive difficulties in the areas of memory and executive function. Symptoms often predate the diagnosis of hypothyroidism, and the magnitude of cognitive impairment can range from mild to severe. Regardless of severity, these symptoms are associated with impaired quality of life and cause dissatisfaction with treatment, so often lead to requests for alternate therapies. Disease-specific and psychological factors impact the experience of brain fog in complex ways, including potential limitations in LT4 monotherapy, self-knowledge of a disease state, and expectations for therapeutic effects. Conclusions: Brain fog is a variable symptom complex in people with hypothyroidism, causing significant distress and diminished quality of life. In the absence of proven therapies, individualized treatment plans are recommended, which incorporate thyroid-specific, general medical, and psychosocial approaches. In particular, cognitive rehabilitation is an underutilized technique that is beneficial in other medical conditions associated with brain fog and could improve symptoms in hypothyroid people. The limitations in our current knowledge and questions presented throughout this review highlight a major need for clinical research in this understudied area. Future research should include attention to standardization of survey instruments to quantitate brain fog in hypothyroid people, as well as rigorously designed intervention studies.
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Affiliation(s)
- Mary H. Samuels
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
- Address correspondence to: Mary H. Samuels, MD, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, 3181 Sam Jackson Park Road, CR107, Portland, OR 97221, USA
| | - Lori J. Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Cancer-Related Cognitive Impairment or “Chemobrain:” Emerging Assessments, Treatments, and Targets for Intervention. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00319-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ekinci İ, Ekinci E, Buyukkaba M, Cinar A, Kirac Utku İ, Ozkan H, Tunc M, Kumbasar A, Tabak O. Selective Attention and Information Processing Speed in Graves' Disease: Stroop Interference Effect. Cureus 2021; 13:e14072. [PMID: 33903835 PMCID: PMC8062313 DOI: 10.7759/cureus.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Cognitive functions are affected by thyroid hormones. In this study, we aimed to investigate the selective attention and information processing speed in thyrotoxic Graves’ disease. Methodology This study was conducted among 40 patients with thyrotoxic Graves’ disease and age and gender-matched 40 healthy controls. Stroop Color and Word test were applied to healthy controls once and to patients with Graves’ disease during thyrotoxic and euthyroid periods. Stroop interference effect was calculated. Results The mean age was 34.67 ± 11 in the Graves’ group and 34.72 ± 9.16 in the control group (p > 0.05). The number of errors and self-corrections in Stroop Color and Word test was higher in patients with thyrotoxic Graves’ disease than both patients with euthyroid Graves’ disease and healthy controls (p < 0.05). Stroop interference effect was significantly longer in patients with thyrotoxic Graves’ disease than both patients with euthyroid Graves’ disease and healthy controls (p < 0.05). All parameters obtained from the Stroop Color and Word test including errors, self-corrections, and Stroop interference effect were similar in patients with euthyroid Graves’ disease and healthy controls. Conclusions Selective attention was impaired and information processing speed was slow in patients with thyrotoxic Graves’ disease, and these findings were associated with age and educational level. After becoming euthyroid through antithyroid medication, these pathological findings returned to normal levels. Additionally, Stroop interference effect was significantly decreased when patients with Graves’ disease became euthyroid.
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Affiliation(s)
- İskender Ekinci
- Internal Medicine, Health Sciences University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Esra Ekinci
- Social Services Department, Directorate of Woman and Family Services, Istanbul Metropolitan Municipality, Istanbul, TUR
| | - Mitat Buyukkaba
- Internal Medicine, Health Sciences University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Ahmet Cinar
- Internal Medicine, Arnavutkoy State Hospital, Istanbul, TUR
| | - İrem Kirac Utku
- Internal Medicine, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Hanise Ozkan
- Internal Medicine, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Muhammed Tunc
- Internal Medicine, Bezmialem Vakif University, Istanbul, TUR
| | - Abdulbaki Kumbasar
- Internal Medicine, Health Sciences University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Omur Tabak
- Internal Medicine, Health Sciences University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
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Yin J, Xie L, Luo D, Huang J, Guo R, Zheng Y, Xu W, Duan S, Lin Z, Ma S. Changes of Structural and Functional Attention Control Networks in Subclinical Hypothyroidism. Front Behav Neurosci 2021; 15:725908. [PMID: 34776889 PMCID: PMC8585844 DOI: 10.3389/fnbeh.2021.725908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/24/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: This study aimed to explore the structural changes in patients with subclinical hypothyroidism (SCH) using voxel-based morphometry (VBM) and to investigate the altered attentional control networks using functional MRI (fMRI) during the performance of a modified Stroop task with Chinese characters. Methods: High-resolution three-dimensional (3D) T1-weighted images and an fMRI scan were taken from 18 patients with SCH and 18 matched control subjects. The Montreal Cognitive Assessment Chinese-revised (MoCA-CR) and the Stroop task were used to evaluate the cognitive and attention control of the participants. Results: Compared to controls, the VBM results showed decreased gray matter volumes (GMVs) in bilateral prefrontal cortices (PFCs, including middle, medial, and inferior frontal gyri), cingulate gyrus, precuneus, left middle temporal gyrus, and insula in patients with SCH. The fMRI results showed a distributed network of brain regions in both groups, consisting of PFCs (including superior and middle and inferior frontal cortices), anterior cingulate cortex (ACC), posterior cingulate cortex, and precuneus, as well as the insula and caudate nucleus. Compared to controls, the SCH group had lower activation of the above brain areas, especially during the color-naming task. In addition, the normalized GMV (nGMV) was negatively correlated with thyroid-stimulating hormone (TSH) level (r = -0.722, p < 0.001). Conclusion: Results indicate that patients with SCH exhibit reduced GMVs, altered BOLD signals, and activation in regions associated with attention control, which further suggest that patients with SCH may have attentional control deficiency, and the weakened PFC-ACC-precuneus brain network might be one of the neural mechanisms. Negative correlations between nGMV and TSH suggest that TSH elevation may induce abnormalities in the cortex.
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Affiliation(s)
- Jingjing Yin
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Medical Imaging and Nuclear Medicine, Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lei Xie
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Medical Imaging and Nuclear Medicine, Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - DongXue Luo
- Department of Nuclear Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jinzhuang Huang
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Medical Imaging and Nuclear Medicine, Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ruiwei Guo
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Medical Imaging and Nuclear Medicine, Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yanmin Zheng
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Medical Imaging and Nuclear Medicine, Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Wencan Xu
- Department of Endocrinology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shouxing Duan
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhirong Lin
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuhua Ma
- Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Medical Imaging and Nuclear Medicine, Shantou University Medical College, Shantou, China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- *Correspondence: Shuhua Ma
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