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BackgroundThis study was performed to examine whether patients with type 2 diabetes have cognitive deficits associated with the prefrontal cortex (PFC).MethodsTwenty-seven middle-aged patients with newly diagnosed type 2 diabetes and 27 healthy controls underwent physical measurements and neuropsychological tasks. Response inhibition, reward prediction, and executive function were assessed by the Go/NoGo task, the reversal and extinction tasks, and the Wisconsin Card Sorting Test (WCST). To examine the interactions of being overweight with diabetes on cognitive performance, performance data were analysed by two-way ANCOVA with diabetes and overweight as factors and age as a covariate.ResultsPatients with type 2 diabetes showed significantly decreased response inhibition in the Go/NoGo task (discriminability index: P = 0.001). There was an interaction of being overweight with diabetes on reaction time in the Go trials of the Go/NoGo task (P = 0.009). Being overweight was related to retained responses to the presentiment of reward in the extinction task (P = 0.029). The four groups showed normal cognitive performance in the WCST.ConclusionsOur results showed that middle-aged, newly diagnosed and medication-free patients with type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight.

Progressive loss of complexity in the glycemic profile occurred from the short-term range and spread to the long-term range concomitantly with the progression of the DM state.

ObjectiveWe conducted this cross-sectional study to investigate the relationship between stage of diabetic nephropathy and likelihood or severity of depression in patients with diabetes.Research design and methodsWe studied 2212 patients with diabetes (mean age 60.9 years; 928 women; 1838 patients with type 2 diabetes). Presence and severity of depression was examined using the Patient Health Questionnaire-9 (PHQ-9). Patients were classified into 5 stages of nephropathy, according to albuminuria and estimated glomerular filtration rate (eGFR); patients in stage 5 undergoing dialysis and kidney transplantation were analyzed separately (stages 5D and 5T). The relationship between stage of nephropathy and depression was examined using analysis of covariance and multivariate logistic regression analysis.ResultsBoth least square mean PHQ-9 scores and prevalence of patients with PHQ-9 scores ≥5 points (mild depression) and ≥10 points (moderate or severe depression) increased from stage 1 to 5D, and then declined in stage 5T. Multivariate ORs for mild or greater depression increased in patients in stages 3, 4, and 5D in reference to those in stage 1, which declined in patients in stage 5T. Albuminuria was significantly, but eGFR was not, associated with higher PHQ-9 scores and the PHQ-9 scores ≥5 or ≥10 after adjustment for clinical findings.ConclusionsIn patients with diabetes, progression of nephropathy is likely to be associated with increased risk and severity of depression, which may be reduced after successful kidney transplantation. Albuminuria may be more strongly associated with depression than eGFR.

The effects of subclinical hypothyroidism (SCH) on cognitive function in older people are controversial. 1,2 This unresolved issue presents a problem in clinical practice because SCH is prevalent among older patients, many of whom have already had some cognitive decline. 2 Therefore, in this longitudinal study, we sought to clarify the effects on cognitive function of SCH without dementia in very old people. MethodsIn August 2009, we recruited 229 subjects aged 75 years or older at the healthcare center of Tosa Town, Japan. All were free of diagnosed dementia. They were receiving no treatment for thyroid-related disease and did not take thyroid or anti-thyroid drugs. Subjects were divided into two groups based on their baseline thyroid function. SCH was defined by a high level of thyroid stimulating hormone (TSH) in the presence of free thyroxine (FT4) within a normal range at baseline, and the control group defined as less TSH and FT4 within a normal range. Comprehensive geriatric assessments including cognitive function tests and thyroid function were performed. The Mini-Mental Status Examination (MMSE) and Revised Hasegawa Dementia Scale (HDSR) were administered to the participants initially, with re-evaluation in August 2010 as follow up. All participants provided informed consent. ANOVA and paired t-test analyses were conducted using software (JMP Version 8.0, SAS Institute Inc., Cary, NC, USA). Statistical significance was inferred at P < 0.05. Table 1 presents the obtained data. Fifteen participants showed SCH (TSH > 4.0 i/mL and normal FT4) and 224 participants were classified as controls. TSH was significantly higher in the SCH group (SCH vs control = 6.35 1 3.44 vs. 1.94 1 0.84 points, P < 0.001). The ratios of complications and motor function did not change in either group from the baseline. The MMSE and HDSR results did not differ between groups at baseline (27.0 1 2.8 vs. 28.0 1 1.6 points, 26.6 1 3.2 vs. 27.7 1 1.8 points, respectively). After one year, MMSE and HDSR scores had decreased significantly in both groups compared to baseline (baseline vs. follow up = 27.0 1 2.8 vs. 26.0 1 3.9 points, P = 0.0001 and 28.0 1 1.6 vs. 26.7 1 2.4 points, P = 0.001). The change of MMSE and HDSR scores did not differ between groups (-0.9 1 0.2 vs. -1.0 1 0.7 points and -0.7 1 0.2 vs. -1.0 1 0.8 points). Stepwise regression analyses incorporating the baseline value included gender, age, body mass index, physical status, other complications (diabetes mellitus, cardiovascular disease, hypertension, dyslipidemia), points of the baseline cognitive function test, and arterial stiffness; they showed that the MMSE and HDSR changes were independently and solely related to aging (standard b = 0.22, P < 0.001). Results DiscussionElderly people with SCH show the effects of aging on the progress of cognitive decline. Cognitive function deteriorated significantly over time. That change over time might show the strongest effect on cognition in N Yamamoto et al. very old people without dementia is age. 3 Moreover, arterial s...