The hippocampus plays an important role in human learning and memory and is known to be vulnerable to the effects of stress and disease. 1 Within animal models of type 1 diabetes, 2 significant hyperglycemia and hypoglycemia exposure has been shown to cause complex molecular and structural changes in the hippocampus. 2,3 Within humans with type 1 diabetes, exposure to both extremes of the glycemic spectrum have been inconsistently associated with alterations in hippocampal structure [4][5][6][7][8][9] and worse memory function, [8][9][10][11] but it is unclear whether these two findings relate to each other. Given that the diagnosis of type 1 diabetes and exposure to glycemic extremes often occur at a time of dynamic neurodevelopment, it has been hypothesized that exposure at early ages may have different effects on the brain than exposure in adulthood, which could explain some of these inconsistent findings. However, data addressing this concept are limited. In this article, we review the existing literature on the effects of hyperglycemia and hypoglycemia in type 1 diabetes, with focus on the structure and function of the hippocampus during both development and adulthood.
Hippocampal Structure, Volume, and FunctionThe hippocampus is a subcortical, primarily gray matter structure residing bilaterally within the medial temporal lobes. It consists of several regions, including the cornu ammonis (CA) and its subregions (CA1-CA4), the dentate gyrus (DG), and the subiculum, which connects the hippocampus to the parahippocampal gyrus. 1 These regions contain intra-and interhippocampal connections through multiple synaptic pathways 12 and have been ascribed specialized roles in the processing of information.
13-16Overall, the hippocampus appears to play an important role in laying down and consciously retrieving explicitly learned, novel information. 17 Within this complex process, the CA1 has been selectively associated with long-term and autobiographical memory, 15,18 the CA2 and CA3 with encoding processes, and the DG with early retrieval and episodic memory formation.
15,19The hippocampus develops heterogeneously and nonlinearly up to age 25 20,21 and is a site of sustained neurogenesis throughout the lifespan.
20-22Hippocampal volume is developmentally dynamic, with the posterior and anterior portions increasing and decreasing respectively with age.
20The total volume steeply increases until approximately age 4, followed by a gradual increase and reaching a peak in volume around age 10.
21Hippocampal volume remains fairly stable until age 50 in healthy adults, followed by a variable level of decline and a significant decrease in volume by age 80. 23 The relationship between developmental changes in hippocampal volume and memory function is complex and still unclear. A meta-analysis of the literature examining hippocampal volume and memory performance in healthy children, adolescents, and young adults revealed that smaller hippocampal volume was associated with better memory performance and that this effect could ...