Cognitive Impairment and its Association with Glycemic Control in Type 2 Diabetes Mellitus Patients

Association between low cognitive performance and diabetes-related health indicators across racial and ethnic groups in adults with diabetes

AIM

To examine the associations between low cognitive performance (LCP) and diabetes-related health indicators (including body mass index [BMI], HbA1c, systolic blood pressure [SBP], low-density lipoprotein [LDL] and self-reported poor physical health) and whether these associations vary across racial/ethnic subgroups.

METHODS

We identified adults aged 60 years or older with self-reported diabetes from the 2011-2014 National Health and Nutrition Examination Survey. Individuals with cognitive test scores in the lowest quartile were defined as having LCP. We used regression models to measure the associations of LCP with diabetes-related biometrics (BMI, HbA1c, SBP and LDL); and self-reported poor physical health. Moreover, we explored potential variations in these associations across racial/ethnic subgroups.

RESULTS

Of 873 (261 with LCP) adults with diabetes, LCP was associated with higher HbA1c, SBP and LDL (adjusted difference: 0.41%, 5.01 mmHg and 5.08 mg/dL, respectively; P < .05), and greater odds of reporting poor physical health (adjusted odds ratio: 1.59, P < .05). The association between LCP and HbA1c was consistent across racial/ethnic groups, and notably pronounced in Hispanic and Other. BMI worsened with LCP, except for non-Hispanic Black. Excluding the Other group, elevated SBP was observed in people with LCP, with Hispanic showing the most significant association. LDL levels were elevated with LCP for Hispanic and Other. Physical health worsened with LCP for both non-Hispanic Black and Hispanic.

CONCLUSIONS

We quantified the association between LCP and diabetes-related health indicators. These associations were more pronounced in Hispanic and Other racial/ethnic groups.

Cognitive impairment and associated factors among patients with diabetes mellitus in Africa: a systematic review and meta-analysis

Background

Inappropriate management of blood sugar in patients with diabetes mellitus leads to micro-vascular and macro-vascular complications, subsequently leading to high morbidity and mortality rates. In addition, diabetes independently increases the occurrence of cognitive impairment complicated by dementia. Scientific evidence on the magnitude of cognitive impairment will provide a sound basis for the determination of healthcare needs and the planning of effective healthcare services. Despite this, there are no comprehensive data on the prevalence and associated factors of cognitive impairment among patients with diabetes in Africa.

Methods

To identify relevant articles for this review, we searched PubMed, Cochrane Library, Science Direct, African Journals Online, and Google Scholar. After extraction, the data were imported into Stata software version 11 (Stata Corp., TX, USA) for further analysis. The random-effects model, specifically the DerSimonian and Laird (D+L) pooled estimation method, was used due to the high heterogeneity between the included articles. Begg's and Egger's regression tests were used to determine the evidence of publication bias. Sub-group analyses and sensitivity analyses were also conducted to handle heterogeneity.

Results

The pooled prevalence of cognitive impairment among patients with diabetes in Africa is found to be 43.99% (95% CI: 30.15-57.83, p < 0.001). According to our analysis, primary level of education [pooled odds ratio (POR) = 6.08, 95% CI: 3.57-10.36, I 2 = 40.7%], poorly controlled diabetes mellitus (POR = 5.85, 95% CI: 1.64-20.92, I 2 = 87.8%), age above 60 years old (POR = 3.83, 95% 95% CI: 1.36-10.79, I 2 = 63.7%), and diabetes duration greater than 10 years (POR = 1.13; 95% CI: 1.07-1.19, I 2 = 0.0%) were factors associated with cognitive impairment among patients with diabetes.

Conclusion

Based on our systematic review, individuals with diabetes mellitus exhibit a substantial prevalence rate (43.99%) of cognitive impairment. Cognitive impairment was found to be associated with factors such as primary level of education, poorly controlled diabetes mellitus, age above 60 years, and diabetes duration greater than 10 years. Developing suitable risk assessment tools is crucial to address uncontrolled hyperglycemia effectively.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42024561484.

Physio-cognitive decline syndrome among middle-aged diabetes patients: Handgrip strength significantly correlates with glycaemic control and cognitive score

Aims

To investigate the correlation between glycaemic control with component of Physio-Cognitive Decline Syndrome (PCDS) and among each component of PCDS itself.

Methods

A cross sectional study was conducted (January 2021-November 2022) at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia on consecutively recruited T2DM outpatients aged 40-59 years old. Data on the latest three months HbA1c, hand grip strength (HGS), usual gait speed (GS), and Indonesian Montreal Cognitive Assessment (MoCA-Ina) were evaluated. Pearson or Spearman's test was used to analyse the correlations.

Results

There were 133 subjects with median age 53 (40-59) years. The PCDS was found in 48.1 % subjects, of which 64.1 % with uncontrolled glycaemia. Significant correlations were found between HGS and HbA1c (r = -0.24, R2 = 0.06, p < 0.01) and MoCA-Ina score (r = 0.21, R2 = 0.04, p < 0.05).

Conclusion

The higher HbA1c and the lower MoCA-Ina score, the weaker handgrip strength was.

[Association between previous appendectomy and cognitive impairment in adults: a case-control study]

OBJECTIVE

To determine the relationship between appendectomy and cognitive impairment in adults aged 50-70 years.

MATERIAL AND METHODS

A case-control study was carried out with 270 patients between May and July 2023. Ninety cases (with cognitive impairment) and 180 controls (without impairment), diagnosed by the Montreal Cognitive Assessment (MoCA), were assessed.

RESULTS

31.11% of the total cases with cognitive impairment were submitted to an appendectomy, with an average of 25 years since surgery. Regarding other surgeries: 40% with impairment underwent cholecystectomy and 23.33% reported other operations. The analysis revealed significant differences in age, body mass index, hypertension, diabetes and smoking between the groups. However, there was no significant difference by gender. Logistic regression analysis highlighted that age and past appendectomy were strongly associated with cognitive impairment, with an Odds Ratio (OR) of 1.20 and 12.91, respectively. Associations were also found with cholecystectomy (OR 7.33), other surgeries (OR 13.39) and smoking (OR 6.91).

CONCLUSION

Appendectomy might be a significant risk factor for cognitive impairment in adults aged 50-70 years.

Impact of Cardiac Autonomic Dysfunction on Cognitive Event-Related Potential in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

Introduction

Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition that is responsible for various long-term complications. Cognitive impairment is one of the most common complications, but the underlying mechanisms are still undetermined. The autonomic imbalance is a major cause for CVS morbidity in T2DM which could also potentially affect cognition. But there is sparse data available in the literature to prove the association between autonomic dysfunction and cognitive impairment.

Methodology

We recruited 40 T2DM patients and 40 healthy controls. The assessment of cognitive functions was done by cognitive P300 event-related potential (ERP) and MoCA. Heart rate variability (HRV) was done to assess autonomic function.

Results

The P300 ERP latency in Fz, Cz and Pz sites was significantly prolonged in T2DM patients (P < 0.001). We found moderate correlation is present between P300 latency and total power (r = -0.466, P < 0.01) and LFnu (r = -0.423, P < 0.01) in T2DM patients. The total power and HbA1C show independent association with P300 latency after adjustment for confounding factors like age and duration of diabetes (P < 0.05).

Conclusion

As the incidence of Alzheimer's disease is rising among T2DM patients increasing their dependency, making necessary lifestyle measures at earliest to improve autonomic balance may prevent or delay the onset of cognitive decline and alleviate its consequences and improve the quality of life in T2DM patients.

Evaluation of Dietary Intake in Individuals with Mild Cognitive Impairment

The phase of mild cognitive impairment (MCI) holds significant importance for postponing the onset of dementia. Therefore, MCI has become a central focus in research related to dementia prevention. The purpose of this study was to investigate the dietary intake and dietary patterns of MCI patients in Taiwan. In total, 40 subjects were enrolled in this cross-sectional study that was conducted from July 2019 to September 2021 at the Linkou Chang Gung Memorial Hospital. The results of the clinical dementia rating (CDR) and mini-mental state examination (MMSE) were obtained from medical records. Participants were divided into two groups: a healthy group (MMSE ≥ 26 points, CDR = 0) and an MCI group (MMSE ≥ 26 points, CDR = 0.5). Results indicated that the MCI group had significantly higher copper and lower low-fat meat intake compared to the healthy group. Furthermore, the high MIND (Mediterranean dietary approaches to stop hypertension intervention for neurodegenerative delay) diet score represented a lower risk of MCI. After adjusting for age, gender, diabetes mellitus, hypertension, and calorie intake in the multivariate regression analysis, calcium and fruit intake levels were positively associated with the MMSE, whereas low-fat meat intake was negatively associated with the CDR. In conclusion, the prevalence of MCI demonstrated a close correlation with nutrient intake, including copper and calcium. Furthermore, a MIND diet, particularly one high in n-3 polyunsaturated fatty acids, might be useful for preventing MCI. However, more extensive research with larger populations is needed to confirm this potential.

Correlations between Cognitive Evaluation and Metabolic Syndrome

One of the most common medical diseases is metabolic syndrome (MetS), which encompasses diabetes and obesity. It has a systemic effect, which has long-lasting consequences on the body that are still not fully understood. The objectives of the study were to investigate the association between the severity of metabolic imbalances, insulin resistance, leptin concentration, and the presence of cognitive disorders and to assess the possible protective role of some classes of drugs used in the treatment of type 2 diabetes mellitus (T2D) and dyslipidemia in order to identify a viable target in the near future. The study included 148 diabetic patients. Standardized tests for the evaluation of cognition, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), were applied to all study participants. Serum concentrations of leptin and insulin were determined using the enzyme-linked immunosorbent assay method (ELISA), and insulin resistance was calculated using the homeostatic model assessment for insulin resistance (HOMA-IR). We found that MMSE and MoCA scores were associated with anthropometric parameters, and MoCA was associated with glycemic control parameters and leptin levels. Further research is needed in order to establish the magnitude of the relationship between metabolic syndrome components and cognitive decline in diabetic patients.

Prevalence of Cognitive Decline in Type 2 Diabetes Mellitus Patients: A Real-World Cross-Sectional Study in Mysuru, India

The goal of this research is to study the prevalence of cognitive impairment in diabetes mellitus (DM) patients and establish the necessity of detecting and treating it early in these patients. A cross-sectional study was conducted at a tertiary care hospital in Mysuru for 4 months examined diabetic patients (test) and nondiabetic subjects (control) for cognitive decline using the Montreal Cognitive Assessment (MoCA) tool. Cognitive functions such as visuospatial/executive function, naming, attention, language, abstraction, delayed recall, and orientation were assessed in both groups. The diabetic group showed a significantly lower total MoCA score than the non-diabetic group (18.99 ± 0.48 and 26.21 ± 0.46, respectively; p < 0.001). Assessment of scores in diabetic patients demonstrated the significant influence of age demographics on cognitive impairment (p-value < 0.001). Furthermore, a higher proportion of diabetic patients displayed cognitive impairment despite a higher score in a single subdomain, making it evident that diabetes is diverse and multifactorial in origin, where oxidative stress and inflammatory responses play a predominant role. This study suggested that the local T2DM population residing in Mysuru (India) has a high prevalence of cognitive impairment, evident from poor performance in almost all cognitive domains assessed by MoCA. Future studies could examine the generalizability of cognitive function findings in diabetic patients across diverse geographic regions and ethnic groups, as well as investigate interventions such as lifestyle modifications and medication to prevent or delay cognitive decline in those with diabetes.

The Association Between Diabetes Duration and Domain-Specific Cognitive Impairment: A Population-Based Study

BACKGROUND

Diabetes is a risk factor for cognitive impairment, and disease duration is associated with geriatric decline and functional disabilities.

OBJECTIVE

This study aimed to examine the association of diabetes duration with domain-specific cognitive impairment in elderly.

METHODS

A total of 3,142 participants from the National Health and Nutrition Examination Survey (NHANES) from the period between 2011 and 2014 were included. We assessed cognitive function using the Digit Symbol Substitution Test (DSST), the CERAD Word Learning (CERAD-WL) test, the CERAD Delayed Recall (CERAD-DR) test and animal fluency (AF) test.

RESULTS

After adjusting for age, sex, race/ethnicity, education level, and annual household income, we found that diabetes with a duration longer than 20 years were at 3.32-fold increased risk of DSST impairment (OR = 3.32, 95% CI: 1.95 to 5.67), 1.72-fold increased risk of CERAD-WL impairment (OR = 1.72, 95% CI: 1.13 to 2.62), and 1.76-fold increased risk of AF impairment (OR = 1.76, 95% CI: 1.23 to 2.53), compared with those with no diabetes. Associations were generally stronger in women than in men. Participants with diabetes, who were diagnosed at 50-59 years old were at increased risk of DSST impairment, CERAD-WL impairment, CERAD-DR impairment, and AF impairment per 5 years longer duration of diabetes.

CONCLUSION

Longer diabetes duration was associated with the increased risk of cognitive impairment, especially in processing speed and attention. The presence of chronic kidney disease was associated with the increased risk of DSST impairment.

Molecular mechanisms underlying hyperglycemia associated cognitive decline

Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia. DM can lead to a number of secondary complications affecting multiple organs in the body including the eyes, kidney, heart, and brain. The most common effect of hyperglycemia on the brain is cognitive decline. It has been estimated that 20-70% of people with DM have cognitive deficits. High blood sugar affects key brain areas involved in learning, memory, and spatial navigation, and the structural complexity of the brain has made it prone to a variety of pathological disorders, including T2DM. Studies have reported that cognitive decline can occur in people with diabetes, which could go undetected for several years. Moreover, studies on brain imaging suggest extensive effects on different brain regions in patients with T2D. It remains unclear whether diabetes-associated cognitive decline is a consequence of hyperglycemia or a complication that co-occurs with T2D. The exact mechanism underlying cognitive impairment in diabetes is complex; however, impaired glucose metabolism and abnormal insulin function are thought to play important roles. In this review, we have tried to summarize the effect of hyperglycemia on the brain structure and functions, along with the potential mechanisms underlying T2DM-associated cognitive decline.

Sweet Memories or Not? A Comparative Study on Cognitive Impairment in Diabetes Mellitus

Introduction

Type 2 Diabetes Mellitus is a modern-day epidemic and dementia has been declared as a global challenge. It is, therefore, worthwhile to investigate the effect that Diabetes has on cognition. Although effective screening is routinely carried out for various complications of Diabetes, its effect on Higher Mental Functions is often overlooked.

Methodology

A cross-sectional analytical study to assess Cognitive Impairment was carried out on 800 participants, 400 diabetics and 400 non-diabetics attending a tertiary care center. The Addenbrooke's Cognitive Examination- III was used, which is a validated, highly sensitive tool having a maximum score of 100. Patients with a score &lt; /= 82 were considered to have impaired Cognition. Statistical analysis was done using SPSSv.21. Suitable statistical tests like Mann–Whitney U, t-test, ROC curve and Logistic regression analysis were done.

Results

Cognitive Impairment was present in 63.8% of the diabetics when compared to only 10.8% in the non-diabetics, with an Odds Ratio-8.78 (CI-4.47–17.22). The total ACE score in diabetics [median-82 (IQR-4), mean rank-270.06] was less compared to the non-diabetic patients [median- 85 (IQR-3), mean rank-530.94] (U = 27822, p-0.001). Attention, Memory, Language, and Visuospatial domains were significantly lower in the diabetics compared to the non-diabetics. However, the fluency domain was not affected. Hypertension and the presence of macrovascular diseases were significantly associated with Cognitive Impairment (p &lt; 0.005). Those with Cognitive dysfunction also had higher mean RBS values and longer duration of Diabetes (p-0.001). The cut-off value for RBS (to distinguish people with and without Cognitive Impairment) from ROC curve was 142.5 (AUC = 0.834, Youden's Index-0.586, p-0.001) and for duration of Diabetes was 7.5 years (AUC = 0.847, Youden's Index-0.529, p-0.001).

Conclusion

This paper highlights that Cognitive Impairment exists in a very high proportion of diabetic patients in Kerala. So, it is important that we do an early assessment of cognitive function in diabetes patients and manage them prudently. Early interventions may prove to be beneficial in the long run, considering the burden of diabetes and cognitive dysfunction associated with the disease.

Metformin improves cognitive impairment in diabetic mice induced by a combination of streptozotocin and isoflurane anesthesia

To investigate the protective effects of metformin on the diabetic mice with cognitive impairment induced by the combination of streptozotocin (STZ) and isoflurane anesthesia. The isoflurane-anesthetized cognitive impairment model mice were established and then observed via behavioral tests and histopathological examination. Then these model mice were randomly assigned to three groups, which received the PBS, low and high doses of metformin, respectively. The body weight, food and water consumption of model mice were measured every other day. The mechanisms of metformin on ameliorating the cognitive dysfunction were further investigated by histomorphological, biochemical and Western blot analysis. After 14-days treatment of metformin, the diabetic symptoms in STZ-induced diabetic mice were significantly alleviated. Metformin could restore the isoflurane- and STZ-induced hippocampal tissue damage, cognitive and memory impairment in exposed space via improving the oxidative stress, upregulating the contents of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) in the hippocampus tissues of diabetic mice. Furthermore, chronic treatment of metformin significantly down-regulated the expression of AGEs, RAGE, pNF-κB, iNOS, and COX-2. In conclusion, metformin can improve the isoflurane- and STZ-induced cognitive impairment in diabetic mice via improving oxidative stress and inhibiting the AGEs/RAGE/NF-κB signaling pathway.

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.

Cognitive impairment in type 2 diabetes and its impact on daily living and self-care: A case - Control study in Kanpur, North India

BACKGROUND AND AIM

There have been few studies from South Asia which have shown increased prevalence of cognitive impairment (CI) in diabetes. CI may further hamper self-care and independent living. The present study was designed to evaluate the impairment in cognition and self-care among patients with type 2 diabetes.

MATERIALS AND METHODS

We assessed cognitive function in 54 type 2 diabetes participants and compared them with 54 healthy controls, using Addenbrooke's Cognitive Examination-III (ACE-III) test. Assessment of self-care was done by using Katz index of independence in activities of daily living and revised Summary of Diabetes Self-Care Activities (SDSCA) measures.

RESULTS

The mean age and HbA1c of cases was 64.5 ± 5.3 years and 8.8 ± 2.5%, respectively. Cognitive impairment was more prevalent among type 2 diabetes participants (Odds ratio 31.3, CI: 10-100, P < 0.0001) with mean Addenbrooke's score of 74.9 ± 11.2 compared to 86.9 ± 5.3 in controls (t-statistic = 7.09, 95% CI: 8.6 to 15.3, P < 0.0001). The adjusted Odds ratio for CI was 9.46 after adjustment for hypertension. All the sub-domains of cognition were affected. The burden of CI was more among females and in those with poor glycemic control (HbA1C > 7.5%) when compared to controls. The diabetic participants with CI had poor SDSCA scores compared to those with no CI.

CONCLUSION

Diabetes may cause CI and is related to poor self-care. Considering a high prevalence of CI in diabetes, cognitive assessment should be a part of overall evaluation. ACE-III is a sensitive and convenient tool for this purpose.

Use of time-to-boundary to assess postural instability and predict functional mobility in people with diabetes mellitus and peripheral neuropathy

BACKGROUND

People with diabetes mellitus and peripheral neuropathy (DMPN) often have balance and mobility deficits. Time-to-boundary (TTB) is a parameter of postural control that combines position and velocity center of pressure data. While not previously investigated, assessment of TTB may provide new insight regarding postural control in people with DMPN.

RESEARCH QUESTION

Is TTB reduced and related to a measure of mobility in people with DMPN?

METHODS

Thirteen people with DMPN without fall history and 13 healthy matched controls participated in this case-control study. Participants stood in double-limb stance on a force plate. The anterior-posterior and medial-lateral center of pressure position and velocity relative to the boundaries of the base of support were used to calculate TTB (s). Lower values indicate less postural control. Time-to-failure during single-limb stance was a secondary measure of postural control. Time to complete the Timed Up and Go (TUG) was our measure of mobility. Longer TUG times correspond to decreased mobility, strength, and balance. Independent t-tests or Mann-Whitney U tests were conducted to assess group differences. Bivariate correlations between task outcomes were conducted.

RESULTS

Anterior-posterior TTB and single-limb stance times were shorter in people with DMPN (p ≤  0.04). TUG times were longer in the DMPN group (p =  0.04). In the DMPN group, inverse relationships were observed between TTB and TUG (anterior-posterior R² = .34; medial-lateral R² = .49; both p =  0.01), but not between single-limb stance times and TTB or TUG.

SIGNIFICANCE

TTB was a sensitive measure of postural control in people with DMPN. The detected relationship between TTB and TUG newly establishes TTB as a clinically meaningful indicator of balance and function. Study findings may serve to further guide balance screening and rehabilitation efforts in people with DMPN.

Effect of poor glycemic control in cognitive performance in the elderly with type 2 diabetes mellitus: The Mexican Health and Aging Study

Background

Cognitive impairment is twice more frequent in elderly with type 2 diabetes mellitus (DM). This study was conducted to determine the association between glycemic control and cognitive performance among community-dwelling elderly persons in Mexico.

Methods

Cross-sectional study conducted in individuals aged 60 years or elderly participating in the 2012 Mexican Health and Aging Study. Type 2 DM participants were classified in 3 groups according to their glycated hemoglobin levels (Hb_A1c): < 7% (intensive control), 7–7.9% (standard control) or ≥ 8% (poor control), and cognitive performance: low (CCCE ≤44 points), intermediate (44.1–59.52 points), or high (≥59.53 points). Multinomial logistic regression models were constructed to determine this association.

Results

Two hundred sixteen community-dwelling adults aged 60 and older with type 2 diabetes were selected. Subjects in the low cognitive performance group were older (69.7 ± 6.6 vs 65.86 ± 5.18 years, p < .001) and had a lower educational level (2.5 ± 2.6 vs 7.44 ± 4.15 years, p < .000) when compared to the high cognitive performance participants. Hb_A1c ≥ 8% was associated with having low (Odds Ratio (OR) 3.17, 95% CI 1.17–8.60, p = .024), and intermediate (OR 3.23, 95% CI 1.27–8.20, p = .014) cognitive performance; this trend was not found for Hb_A1c 7.0–7.9% group.

The multinomial regression analysis showed that the presence of Hb_A1c ≥ 8% (poor glycemic control) was associated with low (OR 3.17, 95% CI = 1.17–8.60, p = .024), and intermediate (OR 3.23, 95% CI = 1.27–8.20, p = .014) cognitive performance. After adjusting for confounding variables.

Conclusions

Glycemic control with a Hb_A1c ≥ 8% was associated with worse cognitive performance.