Cognitive function in Type 1 diabetic children with and without episodes of severe hypoglycaemia

Bjørgaas, Marit Rokne; Gimse, R.; Vik, Torstein; Sand, Trond

doi:10.1111/j.1651-2227.1997.tb08856.x

Cited by 114 publications

(97 citation statements)

References 18 publications

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“…Relationships between early disease onset and deficits in processing speed (9,22,27), memory (9,22,24), and executive skills (5,22) have been found before. Attention seems to be particularly vulnerable to early onset of disease; deficits have been reported in a number of studies (6,7,9,22,24,27), and it is possible that attentional deficits contribute to poor performance on memory, processing speed, and executive tasks.…”

Section: Relationship Between Metabolic Control Variables and Neuropsmentioning

confidence: 98%

Neuropsychological Profiles of Children With Type 1 Diabetes 6 Years After Disease Onset

et al. 2001

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OBJECTIVE—To describe neuropsychological profiles and their relationship to metabolic control in children with type 1 diabetes 6 years after the onset of disease. RESEARCH DESIGN AND METHODS—Children with type 1 diabetes (n = 90), aged 6–17 years, who had previously been assessed soon after diagnosis and 2 years later, were reevaluated 6 years after the onset of disease. Their neuropsychological profiles were compared with those of individuals in a community control group (n = 84), who had been assessed at similar intervals. Relationships between illness variables, such as age at the onset of disease and metabolic control history, and neuropsychological status were also examined. RESULTS—Six years after onset of disease, children with type 1 diabetes performed more poorly than control subjects on measures of intelligence, attention, processing speed, long-term memory, and executive skills. Attention, processing speed, and executive skills were particularly affected in children with onset of disease before 4 years of age, whereas severe hypoglycemia was associated with lower verbal and full-scale intelligence quotient scores. CONCLUSIONS—Neuropsychological profiles of children with type 1 diabetes 6 years after the onset of disease are consistent with subtle compromise of anterior and medial temporal brain regions. Severe hypoglycemia, particularly in very young children, is the most plausible explanation for neuropsychological deficits, but the contributory role of chronic hyperglycemia warrants further exploration.

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Section: Relationship Between Metabolic Control Variables and Neuropsmentioning

confidence: 98%

Neuropsychological Profiles of Children With Type 1 Diabetes 6 Years After Disease Onset

et al. 2001

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“…Other abilities examined in the present study (visual perceptual speed, frontal and executive functions, and sustained attention and concentration ability) were not significantly influenced by diabetes onset age. Differences in attention (3,8,9) and executive function have been previously associated with early childhood diabetes onset (7,9,12). Discrepancies may reflect study and control group heterogeneity, sample size, the varied psychometric instruments used to detect performance differences, and diverse definitions of EOD.…”

Section: Cognitive Ability and Eodmentioning

confidence: 99%

“…In other cognitive ability studies of children with type 1 diabetes, EOD onset has been variously defined as occurring anywhere from age 4 to age 7 years (1), with little reference for preferences (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Magnetic resonance imaging (MRI) neurodevelopmental studies have demonstrated that adult brain volumes are attained by age 7-10 years (17).…”

Section: Definition Of Eodmentioning

confidence: 99%

“…Ack et al (1) first identified an association between early-onset type 1 diabetes (EOD) and comparatively lower general intelligence test scores; children with diabetes averaged 10 IQ points lower than their siblings. Subsequent studies identified small-tomoderate permanent differences in nonverbal (2)(3)(4)(5) and verbal (6) intelligence, information processing (3,(7)(8)(9), visuospatial ability (3)(4)(5), attention (7)(8)(9)(10)(11), executive function (7,9,12), and learning and memory ability (2,3,7). Prospective evaluation has confirmed that EOD independently influences verbal and nonverbal intelligence, attention, psychomotor speed, and executive functions (6,9).…”

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confidence: 99%

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Influence of an Early-Onset Age of Type 1 Diabetes on Cerebral Structure and Cognitive Function

et al. 2005

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OBJECTIVE -Children who develop type 1 diabetes before age 7 years (early-onset diabetes; EOD) have comparatively poorer cognitive abilities. Whether this relates to psychosocial consequences of chronic illness or organic factors related to diabetes and its complications remains unresolved. We hypothesized that if differences in neuroradiological structure and cognitive ability coexisted in those who had EOD, then an organic component to their etiology was likely. RESEARCH DESIGN AND METHODS-A cohort of 71 young adults with longduration type 1 diabetes diagnosed during childhood or adolescence participated in a crosssectional evaluation of cognitive ability (neuropsychological test battery) and brain structure (magnetic resonance imaging). Diabetes onset age, preceding severe hypoglycemia exposure, retinopathy status, and diabetes duration were examined as potential correlates of cognitive and neuroradiological differences. No participants had previous neuropsychological pathology.RESULTS -In EOD participants (n ϭ 26), current intellectual ability (Wechsler Adult Intelligence ScaleϪRevised performance IQ; P ϭ 0.03) and information processing ability (Choice Reaction Time; P ϭ 0.006) were comparatively poorer than was observed in those with lateronset diabetes (n ϭ 45). Furthermore, lateral ventricular volumes were 37% greater (P ϭ 0.002) and ventricular atrophy was more prevalent (61 vs. 20%; P ϭ 0.01) in the EOD group than in those who had later-onset type 1 diabetes.CONCLUSIONS -An early childhood onset of type 1 diabetes was associated with mild central brain atrophy and significant differences in intellectual performance in adulthood, implying that neurodevelopment may be adversely affected by EOD. The differences observed in brain structure support an organic contribution to their etiology but do not exclude a coexistent contribution of psychosocial factors. Diabetes Care 28:1431-1437, 2005O ptimal intellectual development may be compromised by early childhood onset type 1 diabetes. The diabetes-related factor most consistently related to later intellectual ability is the onset age of type 1 diabetes; children developing the disorder in early childhood are more likely to score relatively poorly on cognitive tests, independent of diabetes duration. Ack et al.(1) first identified an association between early-onset type 1 diabetes (EOD) and comparatively lower general intelligence test scores; children with diabetes averaged 10 IQ points lower than their siblings. Subsequent studies identified small-tomoderate permanent differences in nonverbal (2-5) and verbal (6) intelligence, information processing (3,7-9), visuospatial ability (3-5), attention (7-11), executive function (7,9,12), and learning and memory ability (2,3,7). Prospective evaluation has confirmed that EOD independently influences verbal and nonverbal intelligence, attention, psychomotor speed, and executive functions (6,9). Some researchers have suggested that the differences in intellectual ability may reflect chronic hyperglycemia, severe hypog...

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“…Since only individuals with early onset of diabetes would be expected to experience early severe hypoglycemia, age of onset can be confounded with the age of first severe hypoglycemia. Although previous studies (6,7) have examined the impact of age of onset and of severe hypoglycemia history on cognitive function in children, none have established whether the age at which severe hypoglycemia occurs is important in determining cognitive outcome. It is possible that severe hypoglycemia frequency and timing are both important contributors to cognitive dysfunction in children with type 1 diabetes.…”

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confidence: 99%

Frequency and Timing of Severe Hypoglycemia Affects Spatial Memory in Children With Type 1 Diabetes

et al. 2005

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OBJECTIVE -Repeated severe hypoglycemia has been reported to reduce long-term spatial memory in children with type 1 diabetes. Early exposure to hypoglycemia may be more damaging to cognitive function than later exposure. Our goal was to determine whether the age at which severe hypoglycemia occurs modulates the impact of severe hypoglycemia frequency on long-term spatial memory.RESEARCH DESIGN AND METHODS -We combined data from three independent studies to obtain a sample of children aged 6 -18 years with type 1 diabetes (n ϭ 103) and nondiabetic control subjects (n ϭ 60). Each study evaluated previous severe hypoglycemia and tested short (5 s)-and long (60 s)-delay spatial memory with the spatial delayed response task. Type 1 diabetic participants were categorized as having zero, one to two, or three or more severe hypoglycemic episodes and as having their first severe hypoglycemic episode before or after 5 years of age. Information on chronic hyperglycemia (HbA 1c values) was also collected.RESULTS -We found that repeated severe hypoglycemia (more than three episodes) reduced long-delay spatial delayed response performance, particularly when severe hypoglycemic episodes began before the age of 5 years. Age of type 1 diabetes onset and estimates of chronic hyperglycemia did not influence performance.CONCLUSIONS -High frequency of and early exposure to severe hypoglycemia during development negatively affects spatial long-term memory performance. Diabetes Care 28:2372-2377, 2005S evere hypoglycemia is a significant and relatively common complication of insulin treatment in children with type 1 diabetes (1). The long-term cognitive effects of such episodes have been debated. One hypothesis is that severe hypoglycemia occurring early in development is more harmful to cognitive function than severe hypoglycemia later in development, but few data address this issue directly. If this hypothesis was correct, it could explain the consistent finding that early onset of type 1 diabetes predicts poorer cognitive function (2-5). Since only individuals with early onset of diabetes would be expected to experience early severe hypoglycemia, age of onset can be confounded with the age of first severe hypoglycemia. Although previous studies (6,7) have examined the impact of age of onset and of severe hypoglycemia history on cognitive function in children, none have established whether the age at which severe hypoglycemia occurs is important in determining cognitive outcome. It is possible that severe hypoglycemia frequency and timing are both important contributors to cognitive dysfunction in children with type 1 diabetes.We combined data from three studies, all of which found that severe hypoglycemia preferentially decreased spatial long-term memory in children with type 1 diabetes (8,9). We used these data to determine how the effects of severe hypoglycemia on spatial memory were modulated by the age at which severe hypoglycemia occurred. Further, we wanted to determine whether exposure to chronic hyperglycemia contributed t...

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Cognitive function in Type 1 diabetic children with and without episodes of severe hypoglycaemia

Cited by 114 publications

References 18 publications

Neuropsychological Profiles of Children With Type 1 Diabetes 6 Years After Disease Onset

Neuropsychological Profiles of Children With Type 1 Diabetes 6 Years After Disease Onset

Influence of an Early-Onset Age of Type 1 Diabetes on Cerebral Structure and Cognitive Function

Frequency and Timing of Severe Hypoglycemia Affects Spatial Memory in Children With Type 1 Diabetes

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