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Alqahtani BA, Alenazi AM. Cognitive Frailty among Older Adults in Rural Areas: Prevalence and Risk Factors. J Clin Med 2023; 12:7019. [PMID: 38002633 PMCID: PMC10672463 DOI: 10.3390/jcm12227019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Cognitive frailty (CF), which is a combination of physical frailty and cognitive impairment, has been associated with functional deterioration in the elderly. However, information about the prevalence of CF and associated factors among Saudi older adults is lacking. OBJECTIVES To assess the prevalence of CF and its associated factors in Saudi community-dwelling older adults. DESIGN Cross-sectional. SETTING Community-based. SUBJECTS AND METHODS Thise study included community-dwelling elderly adults aged 60 years and over living in the Riyadh region. This study took place from August 2019 to June 2020. CF was defined as the co-existence of physical frailty and mild cognitive impairment (MCI) without dementia. The association between sociodemographic and clinical factors and CF was estimated using the relative risk ratio and confidence intervals (RRR; CIs 95%) using a multivariable binary logistic regression. MAIN OUTCOME MEASURES Fried's frailty phenotype index; and the Mini-Mental State Examination. SAMPLE SIZE A total of 421 community-dwelling older adults (63% male; mean [SD] age 70 [7.1] years). RESULTS The overall prevalence of CF was 6.1%. The following factors were associated with CF: age (RRR 16.3; 95% CI 4.91-54.4), being single (RRR = 3.76 95% CI 1.70-8.31), and number of chronic conditions (RRR 3.1; 95% CI 1.74-5.49). CONCLUSIONS This study indicated the high prevalence of CF among Saudi community-dwelling older individuals compared to other populations. Screening for early diagnosis should be incorporated during examination for older adults. LIMITATIONS The cross-sectional design limits the causality inference with associated risk factors.
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Affiliation(s)
- Bader A. Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
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Miyazaki S, Kitamura M, Hayashida M, Tamaki A, Tomura H, Yamaguchi K, Nishino T, Funakoshi S. Survival and cognitive deterioration in elderly patients undergoing hemodialysis. Geriatr Gerontol Int 2023; 23:111-116. [PMID: 36608644 DOI: 10.1111/ggi.14531] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Abstract
AIM This study aimed to elucidate the 5-year changes in the cognitive function of elderly patients undergoing hemodialysis and its association with survival and related factors. METHODS Cognitive function in patients aged ≥65 years undergoing hemodialysis at the Nagasaki Renal Center was assessed using the Mini-Mental State Examination (MMSE) in 2016. Patients were subsequently classified into normal, mild cognitive impairment (MCI) and suspected dementia groups according to their scores; MMSE was conducted at 30 and 60 months thereafter. The patients were followed until 2021. The association between survival and patient backgrounds was analyzed. RESULTS Of the 181 patients, 168 completed follow-up and were classified into normal (n = 71, 42.3%), MCI (n = 44, 26.1%), and suspected dementia (n = 53, 31.5%) groups. Multivariable logistic regression analysis showed that age, female sex, and geriatric nutritional risk index were associated with MMSE scores <24. The 5-year survival rates were 60.6%, 40.9%, and 22.6% in the normal, MCI and suspected dementia groups, respectively. With some exceptions, MMSE results tended to decline during the observation period. A multivariate Cox proportional hazards model showed that age (hazard ratio [HR], 1.04; P = 0.007), dialysis vintage (HR, 0.96; P = 0.04), male sex (HR, 1.77; P = 0.02), geriatric nutritional risk index (HR, 0.94; P < 0.001) and MMSE score (HR, 0.96; P = 0.01) were independent risk factors for patient survival. CONCLUSIONS Cognitive impairment in patients undergoing hemodialysis was associated with age and nutritional status. Patients with cognitive impairment had a poor prognosis. Geriatr Gerontol Int 2023; 23: 111-116.
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Affiliation(s)
| | - Mineaki Kitamura
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Akira Tamaki
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideyuki Tomura
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosei Yamaguchi
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Yamamoto K, Akasaka H, Yasunobe Y, Shimizu A, Nomoto K, Nagai K, Umegaki H, Akasaki Y, Kojima T, Kozaki K, Kuzuya M, Ohishi M, Akishita M, Takami Y, Rakugi H. Clinical characteristics of older adults with hypertension and unrecognized cognitive impairment. Hypertens Res 2022; 45:612-619. [PMID: 35210565 DOI: 10.1038/s41440-022-00861-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/09/2022]
Abstract
To treat older patients with hypertension, it is important to detect cognitive impairment at an early stage because of its potential influence on treatment efficacy and functional prognosis. In this study, we aimed to identify the incidence and determinants of cognitive impairment in hypertensive patients aged 65 years and above who visited our outpatient clinic and were not previously diagnosed with cognitive impairment. Among 312 patients with hypertension, we found that 35% (n = 109) and 7.7% (n = 24) had cognitive impairment and dementia, respectively, as defined by the Mini-Mental State Examination (≤27 or ≤23, respectively). Patients with cognitive impairment were older, had lower levels of education, and had lower instrumental activities of daily living (IADL) scores than those without cognitive impairment. Multiple regression analysis revealed that age and IADL were associated with cognitive impairment in patients with hypertension. Regarding the treatment of hypertension, the office and home blood pressure levels, number of antihypertensive medications prescribed, and proportion of the use of each antihypertensive drug was equivalent between patients with and without cognitive impairment. Finally, patients with unrecognized cognitive impairment showed distinct clinical characteristics, including high antihypertensive medication burden and preserved IADL, when compared to hypertensive patients in the different cohorts of definitive mild cognitive impairment of a similar age. These findings suggest that older hypertensive patients are at a high risk of masked cognitive decline, even if they are functionally independent.
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Affiliation(s)
- Koichi Yamamoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiroshi Akasaka
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukiko Yasunobe
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsuya Shimizu
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Kumiko Nagai
- Department of Geriatric Medicine, Graduate School of Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yuichi Akasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Graduate School of Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoichi Takami
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
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Hippocampal SIRT1 improves cognitive impairment by deacetylating tau protein in diabetic models. Eur J Pharmacol 2022; 914:174666. [PMID: 34861210 DOI: 10.1016/j.ejphar.2021.174666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
Diabetes mellitus (DM) is associated with accelerated cognitive decline. However, the mechanism of diabetic cognitive impairment remains poorly understood. In this study, we found that the expression of Sirtuin 1 (SIRT1), a nicotinamide adenine dinucleotide (NAD+)-dependent histone deacetylase, was downregulated significantly in the hippocampus of streptozotocin (STZ)-induced diabetic cognitive impairment rats. Viral overexpression of hippocampal SIRT1 ameliorated cognitive impairment in diabetic rats, but viral knockdown of hippocampal SIRT1 mimicked the diabetic effect, eliciting the cognitive decline in normal animals. Further study showed that the decreased level of SIRT1 may result in the increase of acetylated tau protein in the hippocampus, which may mediate the development of diabetic cognitive impairment. These results suggest that SIRT1 may be a key epigenetic regulator that guards against the development of diabetic cognitive impairment by deacetylating the tau protein. SIRT1 activator may serve as a new therapeutic approach for the treatment of diabetic cognitive impairment.
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Osama A, Khalil TH, Negm M, AbdEl-Razek R, AbouElhamd H. Association between microstructural white matter abnormalities and cognitive functioning in patients with type 2 diabetes mellitus: a diffusion tensor imaging study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00232-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diffusion tensor imaging (DTI) technique is important for exploring more sensitive imaging-based biomarkers in prevention and early treatment of cognitive dysfunction induced by type 2 diabetes mellitus (DM).
Objectives
To predict early cognitive dysfunction and detection of microstructural white matter changes in patients with type 2 DM by diffusion tensor imaging.
Patients and methods
A case-control study included thirty patients aged ≥ 18 years old of both sexes with type 2 DM and 30 controls. All subjects underwent to Montreal Cognitive Assessment (MoCA) “Arabic version”: to detect mild cognitive impairment (MCI) and diffusion tensor imaging study (DTI).
Results
Mild cognitive impairment is related to type 2 DM (56.7% of diabetic group), reduced fractional anisotropy (FA) values, and elevated mean diffusivity (MD) values were related to cognitive impairment evaluated through Montreal Cognitive Assessment (MoCA) in patients with type 2 DM.
Conclusion
The integrity of the white matter measured using DTI vary in MCI diabetics compared with non-MCI diabetics. Such changes have major implications on the cognitive function.
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Association Between Sarcopenia and Mild Cognitive Impairment Using the Japanese Version of the SARC-F in Elderly Patients With Diabetes. J Am Med Dir Assoc 2017; 18:809.e9-809.e13. [DOI: 10.1016/j.jamda.2017.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 02/08/2023]
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Omori K, Kawamura T, Urata M, Matsuura M, Kusama M, Imamine R, Watarai A, Nakashima E, Umemura T, Hotta N. Effect of re-coaching on self-injection of insulin in older diabetic patients - Impact of cognitive impairment. Diabetes Res Clin Pract 2017; 130:34-42. [PMID: 28554141 DOI: 10.1016/j.diabres.2017.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 12/30/2022]
Abstract
AIMS We investigated the effect of re-coaching on self-injection of insulin and impact of cognitive function in 100 older diabetic patients. METHODS We examined patients on a variety of skills and knowledge regarding self-injection of insulin and evaluated the effect of re-coaching the patients after 3months and 4years. We also investigated the influence of cognitive impairment (CI) on coaching. RESULTS Skills scores for self-injection of insulin and HbA1c improved significantly 3months after re-coaching. In 51 patients followed-up for 4years, skills scores were maintained during the 4years, while knowledge scores improved after 3months but then returned to the baseline level. In the group of patients with CI as determined by the Mini-Mental Status Examination, skills scores were similar to those in the group without CI, while knowledge scores were significantly lower as compared with those in the group without CI at any time point. Skills scores were maintained during the 4years regardless of CI. CONCLUSION The present study showed that re-coaching in skills for self-injection of insulin was effective in improving and maintaining insulin treatment in older diabetic patients, even if patients had CI.
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Affiliation(s)
- Keiko Omori
- Diabetic Center, Chubu Rosai Hospital, Nagoya, Japan
| | - Takahiko Kawamura
- Center for Preventive Medicine, Chubu Rosai Hospital, Nagoya, Japan; Department of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.
| | - Misako Urata
- Diabetic Center, Chubu Rosai Hospital, Nagoya, Japan
| | | | - Minoru Kusama
- Department of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan
| | - Rui Imamine
- Department of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan
| | - Atsuko Watarai
- Center for Preventive Medicine, Chubu Rosai Hospital, Nagoya, Japan
| | - Eitaro Nakashima
- Department of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan
| | | | - Nigishi Hotta
- Department of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan
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Cognitive impairment in elderly patients with type 2 diabetes mellitus: prevalence and related clinical factors. Diabetol Int 2016; 8:193-198. [PMID: 30603321 DOI: 10.1007/s13340-016-0292-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/16/2016] [Indexed: 12/20/2022]
Abstract
Aim Diabetes mellitus is reported to be a risk factor for dementia. We evaluated the cognitive function in elderly diabetic patients and estimated the prevalence of patients with cognitive impairment and looked for any related clinical factors. Subjects and methods Using 281 elderly (65 years of age or older) Japanese patients with type 2 diabetes mellitus who were free of clinically evident cognitive impairment, we evaluated their cognitive function with the Mini Mental State Examination (MMSE). Results The MMSE score of all the participants was 27.3 ± 2.4 with 31.3% of them being in the abnormal range (tentatively defined normal range as having an MMSE score of 27-30). Multiple regression analysis disclosed that fasting serum non-esterified fatty acid (NEFA), estimated glomerular filtration ratio (eGFR) and insulin treatment were significantly related factors for the MMSE score, in addition to age and schooling history, which are extremely strong factors. Conclusions We revealed that approximately one-third of elderly type 2 diabetic patients who were free of clinically evident cognitive impairment had impaired cognitive function, demonstrating that the MMSE score was significantly correlated with fasting NEFA level, renal function, insulin treatment, age and schooling history.
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Dong Y, Kua ZJ, Khoo EYH, Koo EH, Merchant RA. The Utility of Brief Cognitive Tests for Patients With Type 2 Diabetes Mellitus: A Systematic Review. J Am Med Dir Assoc 2016; 17:889-95. [PMID: 27461866 DOI: 10.1016/j.jamda.2016.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/05/2016] [Accepted: 06/08/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with an increased risk for mild cognitive impairment and dementia in both middle-aged and older individuals. Brief cognitive tests can potentially serve as a reliable and cost effective approach to detect for cognitive decrements in clinical practice. OBJECTIVE This systematic review examined the utility of brief cognitive tests in studies with patients with T2DM. METHOD This systematic review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. "PubMed," "PsychINFO," "ScienceDirect," and "ProQuest" electronic databases were searched to identify articles published from January 1, 2005 to December 31, 2015. RESULTS The search yielded 22 studies, with only 8 using brief tests as a cognitive screening tool, whereas the majority using these tests as a measure of global cognitive functions. In regard to cognitive screening studies, most had failed to fulfil the standard reporting of diagnostic test accuracy criteria such as Standards for Reporting of Diagnostic Accuracy for dementia and cognitive impairment. Moreover, few studies reported discriminant indices such as sensitivity, specificity, and positive and negative predictive values of brief cognitive tests in detecting cognitive impairment in patients with T2DM. Among studies which used brief cognitive tests as a measure of global cognitive function, patients with diabetes tended to perform worse than patients without diabetes. Processing speed appeared to be particularly impaired among patients with diabetes, therefore, measures of processing speed such as the Digit Symbol Substitution Test may add value to brief cognitive tests such as the Montreal Cognitive Assessment. CONCLUSIONS The Montreal Cognitive Assessment supplemented by the Digit Symbol Substitution Test indicate initial promise in screening for cognitive impairment in T2DM.
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Affiliation(s)
- YanHong Dong
- Department of Pharmacology, National University of Singapore, Singapore; Center for Healthy Brain Ageing (CHeBA) and Dementia Collaborative Research Center-Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.
| | - Zhong Jie Kua
- Department of Medicine, National University Hospital, Singapore; School of Psychology, University of Queensland, Brisbane, Australia
| | - Eric Yin Hao Khoo
- Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Edward H Koo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Reshma A Merchant
- Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Mori Y, Futamura A, Murakami H, Kohashi K, Hirano T, Kawamura M. Increased detection of mild cognitive impairment with type 2 diabetes mellitus using the Japanese version of the Montreal Cognitive Assessment: A pilot study. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ncn3.153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Yukiko Mori
- Department of Neurology School of Medicine Showa University Tokyo Japan
| | - Akinori Futamura
- Department of Neurology School of Medicine Showa University Tokyo Japan
| | - Hidetomo Murakami
- Department of Neurology School of Medicine Showa University Tokyo Japan
| | - Kyoko Kohashi
- Department of Diabetes and Endocrinology School of Medicine Showa University Tokyo Japan
| | - Tsutomu Hirano
- Department of Diabetes and Endocrinology School of Medicine Showa University Tokyo Japan
| | - Mitsuru Kawamura
- Department of Neurology School of Medicine Showa University Tokyo Japan
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Sanke H, Mita T, Yoshii H, Yokota A, Yamashiro K, Ingaki N, Onuma T, Someya Y, Komiya K, Tamura Y, Shimizu T, Ohmura C, Kanazawa A, Fujitani Y, Watada H. Relationship between olfactory dysfunction and cognitive impairment in elderly patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2014; 106:465-73. [PMID: 25451914 DOI: 10.1016/j.diabres.2014.09.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/18/2014] [Accepted: 09/15/2014] [Indexed: 01/06/2023]
Abstract
AIMS Recent clinical studies identified the relation between olfactory dysfunction and cognitive impairment in the elderly without type 2 diabetes mellitus. The aim of the present study was to define the relation between olfactory function and cognition in elderly patients with type 2 diabetes mellitus. METHODS The study participants comprised 250 elderly (age, 68-77, median 72) Japanese outpatient with type 2 diabetes mellitus free of clinically-evident cognitive impairment. Olfactory and cognitive functions were evaluated by the Open Essence (OE) test and Mini-mental State Examination (MMSE), respectively. RESULTS Based on the MMSE score, 62.0%, 24.4%, and 13.6% of the participants were considered to have no impairment, possible cognitive impairment and probable dementia, respectively. The OE test score of the probable dementia group was significantly lower than other groups. Furthermore, age and serum uric acid were significantly higher in the probable dementia group than other groups. Simple correlation analysis showed positive correlation between the MMSE score and diastolic blood pressure, education, OE test score, total cholesterol, LDL cholesterol, folic acid, and negative correlation with age, HbA1c, aspartate aminotransferase, serum adiponectin and urinary albumin excretion. Multivariate regression analysis showed that OE test score correlated significantly and independently with MMSE score (standardized coefficients β=0.542, R(2)=0.478, P<0.01), in addition to education level, HbA1c and serum adiponectin. CONCLUSIONS The results suggested the association of olfactory dysfunction with cognitive impairment in elderly patients with type 2 diabetes mellitus.
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Affiliation(s)
- Haruna Sanke
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Tomoya Mita
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan.
| | - Hidenori Yoshii
- Department of Medicine, Diabetology & Endocrinology Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo 136-0075, Japan
| | - Ayako Yokota
- Department of Medicine, Diabetology & Endocrinology Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo 136-0075, Japan
| | - Keiko Yamashiro
- Department of Medicine, Diabetology & Endocrinology Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo 136-0075, Japan
| | - Noriko Ingaki
- Department of Medicine, Diabetology & Endocrinology Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo 136-0075, Japan
| | - Tomio Onuma
- Department of Medicine, Diabetology & Endocrinology Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna 3-3-20, Koto-ku, Tokyo 136-0075, Japan
| | - Yuki Someya
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Koji Komiya
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Yoshifumi Tamura
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Sportology Center, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Tomoaki Shimizu
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Chie Ohmura
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Akio Kanazawa
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Yoshio Fujitani
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
| | - Hirotaka Watada
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan; Sportology Center, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, Tokyo 113-8421, Japan
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Khosravizade Tabasi H, Madarshahian F, Khoshniat Nikoo M, Hassanabadi M, Mahmoudirad G. Impact of family support improvement behaviors on anti diabetic medication adherence and cognition in type 2 diabetic patients. J Diabetes Metab Disord 2014; 13:113. [PMID: 25436202 PMCID: PMC4247652 DOI: 10.1186/s40200-014-0113-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 11/11/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Glycaemic control is the main goal of treatment for type 2 diabetic patients. Hyperglycaemia may result in cognitive decline. More family support may increase medication adherence and decrease glycaemic level. The purpose of this study was to determine the impact of family support improvement behavior on anti diabetic medication adherence and cognition in type 2 diabetic patients. METHOD The randomized control trial study was conducted on 91 patients from an outpatient diabetes clinic. They were randomly divided to intervention (n = 45) and control (n = 46) group. Data on the patients' demographic information and their family gathered using a questionnaire, For two groups Morisky Medication Adherence Scale (MMAS), drug administration part of Diabetes Social Support Questionnaire - family version (DSSQ), Number Connection Test (NCT) were applied and hemoglobin A1C was measured two times in the onset of study and three months later for control group and before and after intervention for intervention group. The key family members of the intervention group were taught according to their educational needs in small groups. RESULT In intervention group mean of NCT score was significantly decreased after intervention (P = 0.006) however in the control group there was no significant difference after three months. In intervention group a significant correlation was noted between DSSQ scores and MMAS scores after intervention(r =0.67, P < 0.001) but, there was no significant correlation in the control group. CONCLUSION Family support instruction based on the educational needs of family members, may improve medication adherence through direct effect and cognitive status with indirect effect.
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Affiliation(s)
| | - Farah Madarshahian
- />Birjand University of Medical Sciences, Ghafary Ave., Birjand, 9717853577 Iran
| | - Mohsen Khoshniat Nikoo
- />Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, North Kargar Street, Tehran, 1411413137 Iran
| | - Mohsen Hassanabadi
- />Birjand University of Medical Sciences, Ghafary Ave., Birjand, 9717853577 Iran
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Yajima K, Matsushita T, Sumitomo H, Sakurai H, Katayama T, Kanno K, Sakai M, Shigeta M, Shirabe S, Nakano T, Nishimura K, Ueki A, Kitaoka M. One-minute mental status examination for category fluency is more useful than mini-mental state examination to evaluate the reliability of insulin self-injection in elderly diabetic patients. J Diabetes Investig 2014; 5:340-4. [PMID: 24843784 PMCID: PMC4020340 DOI: 10.1111/jdi.12159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/29/2013] [Accepted: 08/18/2013] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION We investigated the factors associated with the reliability of insulin self-injection in elderly diabetic patients receiving insulin therapy. MATERIALS AND METHODS We enrolled diabetic patients aged ≥65 years and receiving insulin therapy, and assessed their cognitive function by the mini-mental state examination and 1-min mental status examination for category fluency. We also observed their technique of insulin self-injection, and evaluated whether or not patients were able to inject insulin by themselves according to nine defined details in terms of insulin self-injection. The predictive factors for the reliability of insulin self-injection were determined by univariate and multivariate logistic regression analysis. There were 278 participants (135 males, 143 females) enrolled in the present study. RESULTS According to multivariate logistic regression analysis, only the 1-min mental status examination score was found to be a significant independent predictor of the reliability of insulin self-injection (odds ratio 0.75; 95% confidence interval 0.62-0.90; P = 0.002). CONCLUSIONS The 1-min mental status examination for category fluency can be considered more useful than mini-mental state examination to evaluate the reliability of insulin self-injection in elderly diabetic patients receiving insulin therapy.
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Affiliation(s)
- Ken Yajima
- Department of Internal MedicineFederation of National Public Service Personnel Mutual Aid AssociationsTachikawa HospitalKanagawaJapan
| | - Takaya Matsushita
- Department of Diabetology, Endocrinology and MetabolismTokyo Medical University Hachioji Medical CenterKanagawaJapan
| | - Hidetaka Sumitomo
- Division of Endocrinology and MetabolismTachikawa Sogo HospitalKanagawaJapan
| | - Hirofumi Sakurai
- Department of Geriatric MedicineTokyo Medical University HospitalKanagawaJapan
| | | | | | - Masashi Sakai
- Department of MedicineRyokufuso HospitalKanagawaJapan
| | - Masayuki Shigeta
- Division of Endocrinology and MetabolismShowa General HospitalKanagawaJapan
| | | | - Tadasumi Nakano
- Department of DiabetologyMitsubishi Kyoto HospitalKyotoJapan
| | | | - Akio Ueki
- Department of Diabetology, Endocrinology and MetabolismTokyo Medical University Hachioji Medical CenterKanagawaJapan
| | - Masafumi Kitaoka
- Division of Endocrinology and MetabolismShowa General HospitalKanagawaJapan
- Nonprofit Organization West Tokyo Diabetic AssociationTokyoJapan
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Lee YJ, Kang HM, Kim NK, Yang JY, Noh JH, Ko KS, Rhee BD, Kim DJ. Factors associated for mild cognitive impairment in older korean adults with type 2 diabetes mellitus. Diabetes Metab J 2014; 38:150-7. [PMID: 24851209 PMCID: PMC4021302 DOI: 10.4093/dmj.2014.38.2.150] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to identify factors associated with mild cognitive impairment (MCI) in older Korean adults with type 2 diabetes mellitus. METHODS A total of 226 older (age ≥65 years) adults without a history of cerebrovascular disease or dementia participated in this study. Cognitive function was assessed with the Montreal Cognitive Assessment-Korean version (MoCA-K). A MoCA-K score <23 was defined as MCI. RESULTS The prevalence of MCI was 32.7%. In a logistic regression analysis, age (≥74 years old vs. 65-68 years old; odds ratio [OR], 3.69; 95% confidence interval [CI], 1.55 to 8.82; P=0.003), educational background (college graduation vs. no school or elementary school graduation; OR, 0.16; 95% CI, 0.05 to 0.46; P=0.001), and systolic blood pressure (≥135 mm Hg vs. ≤120 mm Hg; OR, 3.25; 95% CI, 1.29 to 8.17; P=0.012) were associated with MCI. CONCLUSION More concentrated efforts focused on early detection and appropriate management of MCI may be required in older Korean adults with type 2 diabetes mellitus.
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Affiliation(s)
- Yun Jeong Lee
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Hye Mi Kang
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Na Kyung Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Ju Yeon Yang
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Kyung Soo Ko
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Byoung Doo Rhee
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
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15
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Madarshahian F, Hassanabadi M, Koshniat Nikoo M. Cognitive status and foot self care practice in overweight diabetics, engaged in different levels of physical activity. J Diabetes Metab Disord 2014; 13:31. [PMID: 24495364 PMCID: PMC3922616 DOI: 10.1186/2251-6581-13-31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 01/19/2014] [Indexed: 01/15/2023]
Abstract
Background Type 2 diabetes along with chronic hyperglycemia may result in cognitive impairment. This can negatively affect the patient’s adherence to diabetes treatment. The purpose of this study was to compare the cognitive status and foot self care practice in overweight type 2 diabetic patients who exercised regularly and those who did not. Methods The comparative study was conducted on 160 consecutive patients from an outpatient diabetes clinic. They were divided into two groups: The active group comprised of 80 patients engaged in regular exercise for at least 15–30 minutes, three times per week during the past 6 months. The control group included 80 patients who had not exercised regularly for the past 12 months, matched for sex, age, education, diabetes duration, hemoglobin A1C and body mass index (BMI: 25–29.9Kg/m2). Data on the patients’ demographic information, foot care practice and physical activity habits were gathered using a questionnaire. The Mini Mental Status examination (MMSE) was applied to assess cognitive status. Results MMSE score was significantly higher in the active group. A significant negative correlation was noted between MMSE scores and BMI in the control group (r = −0.2, P = 0.03). A significant difference was noted in the four domains of foot self care practice between the active (4.77 ± 0.77) and control (4.45 ± 0.83) groups (P < 0.01). Conclusions Regular physical activity can help promote cognitive status and foot self care practice in overweight patients with type 2 diabetes.
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Affiliation(s)
| | - Mohsen Hassanabadi
- Community and Public Health Department, Birjand University of Medical Sciences, Ghafary Avenue, Birjand 9717853577, Iran.
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16
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Yun HS, Kim E, Suh SR, Kim MH, Kim H. Diabetes reduces the cognitive function with the decrease of the visual perception and visual motor integration in male older adults. J Exerc Rehabil 2013; 9:470-6. [PMID: 24282807 PMCID: PMC3836550 DOI: 10.12965/jer.130059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 09/06/2013] [Accepted: 10/04/2013] [Indexed: 01/21/2023] Open
Abstract
This study investigated the influence of diabetes on cognitive decline between the diabetes and non- diabetes patients and identified the associations between diabetes and cognitive function, visual perception (VP), and visual motor integration (VMI). Sixty elderly men (67.10± 1.65 yr) with and without diabetes (n= 30 in each group) who were surveyed by interview and questionnaire in South Korea were enrolled in this study. The score of Mini-Mental State Examination of Korean version (MMSE-KC), Motor-free Visual Perception Test-Vertical Format (MVPT-V), and Visual-Motor Integration 3rd Revision (VMI-3R) were assessed in all of the participants to evaluate cognitive function, VP, and VMI in each. The score of MMSE-KC in the diabetic group was significantly lower than that of the non-diabetes group (P< 0.01). Participants in the diabetes group also had lower MVPT-V and VMI-3R scores than those in the non-diabetes group (P< 0.01, respectively). Especially, the scores of figure-ground and visual memory among the subcategories of MVPT-V were significantly lower in the diabetes group than in the non-diabetes group (P< 0.01). These findings indicate that the decline in cognitive function in individuals with diabetes may be greater than that in non-diabetics. In addition, the cognitive decline in older adults with diabetes might be associated with the decrease of VP and VMI. In conclusion, we propose that VP and VMI will be helpful to monitor the change of cognitive function in older adults with diabetes as part of the routine management of diabetes-induced cognitive declines.
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Montreal Cognitive Assessment is superior to Standardized Mini-Mental Status Exam in detecting mild cognitive impairment in the middle-aged and elderly patients with type 2 diabetes mellitus. BIOMED RESEARCH INTERNATIONAL 2013; 2013:186106. [PMID: 23936778 PMCID: PMC3726014 DOI: 10.1155/2013/186106] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/19/2013] [Accepted: 06/19/2013] [Indexed: 11/17/2022]
Abstract
Aim. This study compares the usefulness of Montreal Cognitive Assessment (MoCA) to Standardized Mini-Mental Status Exam (SMMSE) for diagnosing mild cognitive impairment (MCI) in Type 2 diabetes mellitus (DM) population. Methods. This prospective pilot study enrolled 30 community dwelling adults with Type 2 DM aged 50 years and above. Subjects were assessed using both the SMMSE and MoCA for MCI. In all subjects, depression and dementia were ruled out using the DSM IV criteria, and a functional assessment was done. MCI was diagnosed using the standard test, the European consortium criteria. Sensitivity and specificity analysis, positive and negative predictive values, likelihood ratios and Kappa statistic were calculated. Results. In comparison to consortium criteria, the sensitivity and specificity of MoCA were 67% and 93% in identifying individuals with MCI, and SMMSE were 13% and 93%, respectively. The positive and negative predictive values for MoCA were 84% and 56%, and for SMMSE were 66% and 51%, respectively. Kappa statistics showed moderate agreement between MoCA and consortium criteria (kappa = 0.4) and a low agreement between SMMSE and consortium criteria (kappa = 0.07). Conclusion. In this pilot study, MoCA appears to be a better screening tool than SMMSE for MCI in the diabetic population.
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Abstract
The occurrence of altered brain glucose metabolism has long been suggested in both diabetes and Alzheimer’s diseases. However, the preceding mechanism to altered glucose metabolism has not been well understood. Glucose enters the brain via glucose transporters primarily present at the blood-brain barrier. Any changes in glucose transporter function and expression dramatically affects brain glucose homeostasis and function. In the brains of both diabetic and Alzheimer’s disease patients, changes in glucose transporter function and expression have been observed, but a possible link between the altered glucose transporter function and disease progress is missing. Future recognition of the role of new glucose transporter isoforms in the brain may provide a better understanding of brain glucose metabolism in normal and disease states. Elucidation of clinical pathological mechanisms related to glucose transport and metabolism may provide common links to the etiology of these two diseases. Considering these facts, in this review we provide a current understanding of the vital roles of a variety of glucose transporters in the normal, diabetic and Alzheimer’s disease brain.
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Affiliation(s)
- Kaushik Shah
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, 1300 S. Coulter Street, Amarillo, TX 79106, USA.
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N S, Karan. Assessment of the cognitive status in diabetes mellitus. J Clin Diagn Res 2012; 6:1658-62. [PMID: 23373022 DOI: 10.7860/jcdr/2012/4837.2649] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 08/19/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Diabetes is considered as an independent risk factor for cognitive impairment and dementia. In this study, we assessed the cognitive status of diabetics and non diabetics by the Mini Mental Status Examination (MMSE) and the Modified Mini Mental Status Examination (3MS) and also found a correlation of age, sex, the duration of diabetes and HbA1C with the cognitive status among the diabetics. MATERIALS AND METHODS Thirty males and females above the age of 50 years, with and without diabetes, were included in the study. Both the groups underwent a cognition assessment by MMSE and 3MS and they scored 30 and 100 respectively. The correlation of age, sex, the duration of diabetes and HbA1C among the diabetics with 3MS was also done. STATISTICAL ANALYSIS The analysis was done by using the SPSS software, version 13. The unpaired t test and one way ANOVA were used for various analyses. A p value of < 0.05 was considered to be statistically significant. RESULTS The diabetics showed decreased MMSE and 3MS scores (p<0.001). 63.33% of the diabetics had a decreased cognition, based on the MMSE and 70% of the diabetics had a decreased cognition, based on the 3MS. The correlation of age, sex, the duration of diabetes and HbA1C among the diabetics with cognition status was not significant. CONCLUSION Diabetes is associated with lower levels of the cognitive function. By the early implementation of MMSE, we can detect even a mild cognitive impairment, so that adequate treatment can be given, to prevent dementia.
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Affiliation(s)
- Shuba N
- Assistant Professor, Department of Physiology, PSG IMS&R.
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Hanyu H. [Treatment of vascular risk factors]. Nihon Ronen Igakkai Zasshi 2012; 49:284-287. [PMID: 23268964 DOI: 10.3143/geriatrics.49.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
We reviewed 143 papers that described the relationship between moderate drinking of alcohol and some aspect of cognition. Two types of papers were found: (1) those that provided ratios of risk between drinkers and nondrinkers (74 papers in total) and (2) those that, although they did not provide such ratios, allowed cognition in drinkers to be rated as "better," "no different," or "worse" than cognition in nondrinkers (69 papers in total). The history of research on moderate drinking and cognition can be divided into two eras: 1977-1997 and 1998-present. Phase I (1977-1997) was the era of neuropsychological evaluation involving mostly young to middle-aged (18-50 years old) subjects. Although initial studies indicated moderate drinking impaired cognition, many later studies failed to confirm this, instead finding no difference in cognition between drinkers and nondrinkers. Phase II (1998-present) was and is the era of mental status exam evaluation involving mostly older (≥55 years old) subjects. These studies overwhelmingly found that moderate drinking either reduced or had no effect on the risk of dementia or cognitive impairment. When all the ratios of risk from all the studies in phase II providing such ratios are entered into a comprehensive meta-analysis, the average ratio of risk for cognitive risk (dementia or cognitive impairment/decline) associated with moderate "social" (not alcoholic) drinking of alcohol is 0.77, with nondrinkers as the reference group. The benefit of moderate drinking applied to all forms of dementia (dementia unspecified, Alzheimer's disease, and vascular dementia) and to cognitive impairment (low test scores), but no significant benefit against cognitive decline (rate of decline in test scores) was found. Both light and moderate drinking provided a similar benefit, but heavy drinking was associated with nonsignificantly higher cognitive risk for dementia and cognitive impairment. Although the meta-analysis also indicated that wine was better than beer or spirits, this was based on a relatively small number of studies because most studies did not distinguish among these different types of alcohol. Furthermore, a number of the studies that did make the distinction reported no difference among the effects of these different types of alcohol. Therefore, at present this question remains unanswered. Analysis also showed that the presence of the apolipoprotein E epsilon 4 allele eliminated the benefit of moderate drinking. However, this was based on a relatively small number of studies and several other studies have found a beneficial effect of the epsilon e4 allele. Further studies are necessary to settle this question. The benefit of moderate alcohol for cognition was seen in both men and women, although the amount and pattern of drinking is very different between the two sexes. Lastly, the finding of unaffected or significantly reduced cognitive risk in light to moderate drinkers was seen in 14/19 countries for which country-specific ratio data were available, with three of the five remaining countries showing nonsignificant reductions as well. Overall, light to moderate drinking does not appear to impair cognition in younger subjects and actually seems to reduce the risk of dementia and cognitive decline in older subjects.
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Affiliation(s)
- Edward J Neafsey
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
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