Mild Cognitive Impairment in Young Type 1 Diabetes Mellitus Patients and Correlation with Diabetes Control, Lipid Profile, and High-sensitivity C-reactive Protein

Cognitive function 10 years after adolescent bariatric surgery

BACKGROUND

Adolescent bariatric surgery produces substantial weight loss and reduction of medical co-morbidities. Research in adult samples shows improved cognitive function postoperatively, although much less is known about the potential cognitive benefits of bariatric surgery in adolescents-especially at extended follow-up.

OBJECTIVE

Examine cognitive function 10 years after adolescent bariatric surgery.

SETTING

University hospital.

METHODS

A total of 99 young adults who underwent bariatric surgery as adolescents completed a computerized cognitive test battery as part of a larger 10-year postoperative assessment. All had been long-term participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study.

RESULTS

Cognitive dysfunction was prevalent on tests of attention and executive function (e.g., Continuous Performance Test - Reaction Time 30%; Maze Errors - Overrun 30%), and 53.5% met research criteria for mild cognitive impairment (MCI). Modified Poisson regression with robust error variance revealed participants with preoperative hypertension and those completing Roux-en-Y gastric bypass were more likely to meet criteria for MCI at 10-year follow-up.

CONCLUSIONS

The current findings indicate that cognitive deficits are common 10 years after bariatric surgery. Additional studies are needed to clarify possible cohort effects, determine whether these cognitive deficits persist to even later follow-up (e.g., 20 yr after surgery), and identify underlying mechanisms and mitigation strategies.

Dynamic associations between glucose and ecological momentary cognition in Type 1 Diabetes

Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations.

Central nervous system microstructural alterations in Type 1 diabetes mellitus: A systematic review of diffusion Tensor imaging studies

AIMS

Type 1 diabetes mellitus (T1DM) is a chronic childhood disease with potentially persistent CNS disruptions. In this study, we aimed to systematically review diffusion tensor imaging studies in patients with T1DM to understand the microstructural effects of this entity on individuals' brains METHODS: We performed a systematic search and reviewed the studies to include the DTI studies in individuals with T1DM. The data for the relevant studies were extracted and a qualitative synthesis was performed.

RESULTS

A total of 19 studies were included, most of which showed reduced FA widespread in optic radiation, corona radiate, and corpus callosum, as well as other frontal, parietal, and temporal regions in the adult population, while most of the studies in the juvenile patients showed non-significant differences or a non-persistent pattern of changes. Also, reduced AD and MD in individuals with T1DM compared to controls and non-significant differences in RD were noted in the majority of studies. Microstructural alterations were associated with clinical profile, including age, hyperglycemia, diabetic ketoacidosis and cognitive performance.

CONCLUSION

T1DM is associated with microstructural brain alterations including reduced FA, MD, and AD in widespread brain regions, especially in association with glycemic fluctuations and in adult age.

Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus: a narrative review

Type 1 diabetes mellitus (T1DM) is a type of diabetes caused by the destruction of pancreatic β cells and the absolute lack of insulin secretion. T1DM usually starts in adolescence or develops directly as a severe disease state of ketoacidosis. T1DM and its complications make many people suffer and have psychological problems, which make us have to pay more attention to the prevention and early control of T1DM. Cognitive impairment (CI) is one of the major complications of T1DM. It can further develop into Alzheimer's disease, which can seriously affect the quality of life of the elderly. Furthermore, the relationship between T1DM and CI is unclear. Hence, we conducted a narrative review of the existing literature through a PubMed search. We summarized some risk factors that may be associated with the cognitive changes in T1DM patients, including onset age and duration, education and gender, glycemic states, microvascular complications, glycemic control, neuropsychology and emotion, intestinal flora, dyslipidemia, sleep quality. We aimed to provide some content related to CI in T1DM, and hoped that it could play a role in early prediction and treatment to reduce the prevalence.

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Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus.

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Duration and age; Education and gender and Glycemic states.

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Diabetic ketoacidosis; Microvascular complications and Glycemic control–HbA1c.

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Neuropsychology and emotion; Intestinal flora; Dyslipidemia and Sleep Quality.

Retinal Thickness Associates with Cognition Dysfunction in Young Adult with Type 1 Diabetes in Taiwan

BACKGROUND

Several factors could affect the cognitive dysfunction in patients with type 1 diabetes (T1D).

OBJECTIVES

To report the characteristic of cognitive dysfunction in T1D and find its association with the retinal thickness.

SUBJECTS

We recruited one hundred and seven patients with T1D in our study.

METHODS

Detailed clinical and demographic factors and Cambridge Automated Neuropsychological Test Battery (CANTAB) were performed in all participants. The age at onset>5 years old and ≤5 years old groups was defined as old- and young-onset groups. The levels of the average values of 5-year glycated hemoglobin (HbA1c_5) before study were collected. Ophthalmic study and central retinal thickness (CRT) were performed.

RESULTS

The median age of T1D was 24.9 years old and 57 participants were women. The median age at onset was 7.4 years old, and mean disease duration was 17.2 years. After adjusting off multiple covariates by the regression analyses, the young-onset group had significantly a longer latency in sustained attention than old-onset group (P = 0.02). The HbA1c_5 showed a significantly negative association with the sustained attention (P = 0.03). The average values of CRT showed significantly negative correlations with the reaction time in sustained attention and visual searching (P = 0.04 and P < 0.01, respectively).

CONCLUSIONS

Our results suggest that age at onset and glycemic control had significant impacts on different cognitive domains in T1D. The CRT had a significant correlation with sustained attention, which could be a surrogate markers of brain structural changes in T1D.

Relationship Between Self-Care Behavior and Cognitive Function in Hospitalized Adult Patients with Type 2 Diabetes: A Cross-Sectional Study

PURPOSE

To investigate the relationship between diabetes self-care behavior and cognitive function of hospitalized young and middle-aged Chinese patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

In this cross-sectional study, young and middle-aged T2DM patients (age range, 35-65 years) were recruited at 4 tertiary hospitals between July 2016 and January 2017. Data pertaining to self-care behavior and cognitive function were collected using two questionnaires (the Summary of Diabetes Self-care Activities [SDSCA] and the Montreal Cognitive Assessment [MoCA], respectively). Multivariate linear regression analysis was performed to assess the correlation between cognitive function and self-care activities.

RESULTS

A total of 140 patients with diabetes were enrolled (mean age, 53.79±7.96 years). The mean duration of T2DM was 10.83±6.76 years. Regarding SDSCA performance, the mean scores for foot care and blood glucose monitoring were 2.20±2.57 and 1.98±2.45, respectively, which were the worst; scores for exercise (4.01±2.58) and diet (3.16±1.89) were better, while scores for medication administration (5.26±2.79) were the best. The prevalence of cognitive impairment was 37.9% (53 patients). After variables adjustment, delayed recall showed a significant correlation with blood sugar monitoring behavior (B =0.224, P=0.019); visual space and executive function (B=0.255, P=0.009) and abstraction (B=-0.337, P=0.001) showed a correlation with foot care behavior.

CONCLUSION

Cognitive ability affects the self-care behavior of patients with T2DM. Assessment of cognitive function may help inform patient education interventions to improve the self-care behavior of these patients.