Associations between depression and cognition, mild cognitive impairment and dementia in persons with diabetes mellitus: A systematic review and meta-analysis

Abstract

This systematic review aimed to examine whether persons with diabetes and depression had poorer cognition and higher dementia risk than persons with diabetes only. Moreover, the impact of timing, frequency of depressive episodes throughout life, and antidepressant treatment were examined. Methods: PubMed, Embase and PsycINFO were searched to obtain observational studies between August 2015 and June 2021 that examined the association between depression and cognition, mild cognitive impairment or dementia in people with diabetes. Studies published before August 2015 were retrieved from a previous systematic review. Findings were pooled using meta-analyses. Results: 10 out of 19 included articles were appropriate for the meta-analyses. Persons with diabetes and depression experienced greater declines in executive function (SMD = − 0.39 (− 0.69, − 0.08)), language (SMD = − 0.80 (− 1.52, − 0.09)), memory (SMD = − 0.63 (− 1.12, − 0.14)) and overall cognition (SMD = − 0.77 (− 1.33, − 0.20)), and greater dementia risk (HR = 1.82 (1.79, 1.85)) than persons with diabetes only. No significant differences were observed for complex attention. No studies examined the role of timing and frequency of depressive episodes and antidepressant treatment. Conclusion:In persons with diabetes, depression is associated with worse cognition and higher dementia risk. The potential mitigating effect of antidepressant treatment remains unclear.

The Nexus Between Diabetes and Depression: A Narrative Review

“…As per the meta-analysis of van Steenbergen-Weijenburg et al of 596 (63%) patients with T2DM in the outpatient clinic, patients with T2DM with two or more complications (OR: 2.23; 95% CI: 1.02-2.94), including neuropathy (OR: 1.7; 95% CI: 1.10-2.77) and nephropathy (OR: 1.68; 95% CI: 1.00-2.48), had more than twofold increase in the risk of depression [78]. Persons with depression in diabetes have poorer cognition and higher dementia risk than those with only diabetes, as evidenced by the study of Chow et al [79]. They performed an observational meta-analysis on 10 studies from August 2015 to June 2021 (six years) on the adult population and found that persons with comorbid diabetes and depression had worse cognition (SMD: -0.77 (-1.33, -0.20)) and greater dementia risk (HR: 1.82 (1.79, 1.85)) than persons with only diabetes [79].…”

“…Persons with depression in diabetes have poorer cognition and higher dementia risk than those with only diabetes, as evidenced by the study of Chow et al [79]. They performed an observational meta-analysis on 10 studies from August 2015 to June 2021 (six years) on the adult population and found that persons with comorbid diabetes and depression had worse cognition (SMD: -0.77 (-1.33, -0.20)) and greater dementia risk (HR: 1.82 (1.79, 1.85)) than persons with only diabetes [79]. Although these data cannot speak to causality, the consistency of findings linking depressive symptoms to poor diabetes health outcomes suggests that elevations should be seen as a marker of increased health risk; more longitudinal studies are needed to understand this causal relationship [35].…”

Rapid Reduction of HbA1c and Weight in Elderly Patient with Type 2 Diabetes (T2D) And Depression by Oral Semaglutide (Rybelsus)

“…Regarding sex differences, females (with and without diabetes) showed a higher prevalence of depression than males. Further, regarding the relationships between diabetes, depression, and dementia, a systematic review was conducted over 6 years [25]. The protocol included Embase, PubMed, and PsycINFO, and 10 articles from 19 papers were analyzed.…”

Why do we not reverse the path? Stress can cause depression, reduction of brain-derived neurotrophic factor and increased inflammation

“…Low BDNF levels are present in dementia patients[ 18 , 19 ] and patients with T2D are approximately two to four times more likely to develop dementia than individuals without T2D. These associations might explain why T2D, depression and dementia are often associated in the same patient[ 20 - 23 ]. We are aware that these are hypotheses, but we can consider them as useful reflections inspired by the article by Porter and O’Connor[ 1 ] to be validated in future studies.…”