Lambros Messinis PhD Neuropsychology Section, Department of Neurology, University of Patras Medical School
Type 2 Diabetes Mellitus is a modern day epidemic
Age is a significant predictor of diabetes Males have higher prevalence of diabetes in all age groups
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
There is strong evidence that Diabetes increases the risk for cognitive decline Ann. N.Y. Acad. Sci. 0000 (2015) 1 12 C 2015 New York Academy of Sciences.
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 www.thelancet.com/neurology Vol 14 March 2015
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
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 59-71 (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: 366-70
Cognitive Profile of type 1 vs type 2 diabetes
Potential causes of cognitive impairment in type 2 diabetes
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 25-30 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 2 2.5 hrs) necessary in order to determine nature and severity of deficits differential diagnosis plan rehabilitation requires clinical neuropsychological interpretation
3MS = modified MMSE Test s wider variety of cognitive functions and difficulty levels
Motor function visuomotor function Manual dexterity of the dominant and non dominant hand GROOVED PEGBOARD TEST Klove H. Med Clin N America 1963;47:1647 58 Lafayette Instrument Grooved Pegboard Test User s Manual; Lafayette, USA
Rey Auditory Verbal learning Test RAVLT
Visuospatial construction and visual memory
Attention - Concentration STROOP Green Red Yellow
Name the font colour of incongruous colour words
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
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: 2928-35
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