Lambros Messinis PhD. Neuropsychology Section, Department of Neurology, University of Patras Medical School

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1 Lambros Messinis PhD Neuropsychology Section, Department of Neurology, University of Patras Medical School

2 Type 2 Diabetes Mellitus is a modern day epidemic

3 Age is a significant predictor of diabetes Males have higher prevalence of diabetes in all age groups

4 While the deleterious effects of diabetes Mellitus on the retinal, renal, cardiovascular and peripheral nervous systems are widely acknowledged, more recently attention has been given to the effects of diabetes on neurocognitive functions

5 There is strong evidence that Diabetes increases the risk for cognitive decline Ann. N.Y. Acad. Sci (2015) 1 12 C 2015 New York Academy of Sciences.

6 Recent literature has shown that both type 1 and type 2 diabetes mellitus have been associated with reduced performance on multiple neurocognitive domains and with structural abnormalities on neuroimaging Vol 14 March 2015

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9 Cognitive function in adults with type 1 diabetes Meta-analysis of 33 case-control studies Magnitude of cognitive dysfunction is moderate Cognitive slowing is fundamental deficit Differences emerge early, within 2y of diagnosis and children s brain is more susceptible than adults (those with onset age <7y have higher risk than those older) McCrimmon RJ et al. Lancet 2012; 379:2291-9

10 Cognitive function and decline in type 2 diabetes Visual attention Verbal memory Facial recognition Attention Psychomotor speed Visual memory Logical reasoning Auditory attention Prospective cohort study of 961 community dwelling people aged (mean age 64yrs for those with diabetes), with MMSE>26 at baseline After 4 years, compared to those who had normal glucose or impaired fasting glucose, people with type 2 diabetes had lower scores on tests of psychomotor speed, attention and verbal memory Fontbonne et al. Diab Care 2001; 24:

11 Cognitive Profile of type 1 vs type 2 diabetes

12 Potential causes of cognitive impairment in type 2 diabetes

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18 Types of Cognitive Tests Cognitive Screening Tests Brief Neuropsychological Batteries Comprehensive neuropsychological Battery (flexible) time restrictions (5-10 min) inability of the patient to complete comprehensive neuropsychological evaluation non availability of clinical neuropsychologists Screening tests should prioritize Sensitivity (i.e. not miss anyone with cognitive impairment) time restrictions (approx min) Necessary when more detailed cognitive screening is required Psychometrist or other clinician may usually carry out testing but clinical neuropsychologist is required to interpret results adequately no time restrictions ( approx hrs) necessary in order to determine nature and severity of deficits differential diagnosis plan rehabilitation requires clinical neuropsychological interpretation

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20 3MS = modified MMSE Test s wider variety of cognitive functions and difficulty levels

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24 Motor function visuomotor function Manual dexterity of the dominant and non dominant hand GROOVED PEGBOARD TEST Klove H. Med Clin N America 1963;47: Lafayette Instrument Grooved Pegboard Test User s Manual; Lafayette, USA

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26 Rey Auditory Verbal learning Test RAVLT

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29 Visuospatial construction and visual memory

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31 Attention - Concentration STROOP Green Red Yellow

32 Name the font colour of incongruous colour words

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40 With an aging population and the growing epidemic of diabetes, complications related to Central Nervous System functioning and neurocognition may prove challenging for future public health implications

41 Accelerated progression of mild cognitive impairment (MCI) to dementia in people with diabetes 302 subjects, age >75y, with MCI followed for 9y in the Kungsholmen Project: 155 subjects progressed to dementia. Cumulative hazard for the progression from MCI to dementia by diabetes status in MCI cohort (adjusted for age, sex, and education). In a Kaplan-Meier survival analysis, diabetes and prediabetes accelerated the progression from MCI to dementia by 3.18 y. Xu W et al. Diabetes, 2010; 59:

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43 THANK YOU