Impaired cognitive processing speed in type 1 diabetic patients who had severe/recurrent hypoglycaemia

Bortolotti, Stefano; Zarantonello, Lisa; Uliana, Ambra; Vitturi, Nicola; Schiff, Sami; Bisiacchi, Patrizia; Avogaro, Angelo; Amodio, Piero; Maran, Alberto

doi:10.1016/j.jdiacomp.2018.08.005

Cited by 10 publications

(19 citation statements)

References 33 publications

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“…SH in the older age group was associated with larger deficits in overall cognition and cognitiveprocessing speed (effect size 6.6 SD). 43,54,56,57 Strengths and limitations The strengths of this study include the use of a multidatabase search culminating in the summary of 62 relevant articles. To the best of our knowledge, this is the first systematic review focusing specifically on the relation between hypoglycaemia and CF in type 1 diabetes across all age groups and thus providing an in-depth review of this topic.…”

Section: Cognitive Domains Affected By Prior Exposure To Shmentioning

confidence: 99%

A systematic review of the effect of prior hypoglycaemia on cognitive function in type 1 diabetes

Chandran

Jacob

Choudhary

2020

Therapeutic Advances in Endocrinology

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Background: The effect of prior hypoglycaemia on cognitive function in type 1 diabetes is an important unresolved clinical question. In this systematic review, we aimed to summarize the studies exploring the impact of prior hypoglycaemia on any aspect of cognitive function in type 1 diabetes. Methods: We used a multidatabase search platform Healthcare Database Advanced Search to search Medline, PubMed, EMBASE, EMCARE, CINAHL, PsycINFO, BNI, HMIC, and AMED from inception until 1 May 2019. We included studies on type 1 diabetes of any age. The outcome measure was any aspect of cognitive function. Results: The 62 studies identified were grouped as severe hypoglycaemia (SH) in childhood (⩽18 years) and adult-onset (>18 years) diabetes, nonsevere hypoglycaemia (NSH) and nocturnal hypoglycaemia (NH). SH in early childhood-onset diabetes, especially seizures and coma, was associated with poorer memory (verbal and visuospatial), as well as verbal intelligence. Among adult-onset diabetes, SH was associated with poorer cognitive performance in the older age (>55 years) group only. Early versus late exposure to SH had a significant association with cognitive dysfunction (CD). NSH and NH did not have any significant association with CD, while impaired awareness of hypoglycaemia was associated with poorer memory and cognitive-processing speeds. Conclusion: The effect of SH on cognitive function is age dependent. Exposure to SH in early childhood (<10 years) and older age groups (>55 years) was associated with a moderate effect on the decrease in cognitive function in type 1 diabetes [PROSPERO ID: CRD42019141321].

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Section: Cognitive Domains Affected By Prior Exposure To Shmentioning

confidence: 99%

A systematic review of the effect of prior hypoglycaemia on cognitive function in type 1 diabetes

Chandran

Jacob

Choudhary

2020

Therapeutic Advances in Endocrinology

View full text Add to dashboard Cite

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“…Interestingly, alterations in the frontal cortex have been previously linked to T1D‐IAH using other imaging modalities 9,14,36 . Moreover, even though the presence of a neuropsychological compromise in this population is not well‐established, some studies reporting cognitive alterations in T1D‐IAH were suggestive of frontal dysfunction 7,8 . For its part, the precuneus region is one of the most metabolically active brain area, and is considered to be the core node of the default mode network (DMN) 37,38 .…”

Section: Discussionmentioning

confidence: 99%

“…9,14,36 Moreover, even though the presence of a neuropsychological compromise in this population is not well-established, some studies reporting cognitive alterations in T1D-IAH were suggestive of frontal dysfunction. 7,8 For its part, the precuneus region is one of the most metabolically active brain area, and is considered to be the core node of the default mode network (DMN). 37,38 The DMN, for which the two main nodes are the precuneus and the prefrontal cortex, is known to play a major role in cognition.…”

Section: Discussionmentioning

confidence: 99%

“…IAH has been associated to cognitive deficits in some (but not all) studies 6‐8 . Moreover, it has been suggested that IAH leads to neural damage in the long term because structural brain alterations have been associated with this condition 9 .…”

Section: Introductionmentioning

confidence: 99%

“…IAH has been associated to cognitive deficits in some (but not all) studies. [6][7][8] Moreover, it has been suggested that IAH leads to neural damage in the long term because structural brain alterations have been associated with this condition. 9 Perhaps of more interest is the investigation of whether IAH induces specific metabolic alterations in the brain, which could be potentially detectable in euglycaemic states, revealing potentially reversible pathological mechanisms.…”

Section: Introductionmentioning

confidence: 99%

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Increased cerebral FDG‐PET uptake in type 1 diabetes patients with impaired awareness of hypoglycaemia

Sampedro

Stantonyonge

Martínez‐Horta

et al. 2020

J Neuroendocrinology

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Approximately 20% of type 1 diabetes (T1D) patients have an impaired awareness of hypoglyceamia (IAH). IAH represents a risk factor for severe and recurrent hypoglycaemic events, which can lead to brain damage. Because no effective treatments are currently available to prevent IAH in this population, characterising the set of brain alterations associated with IAH may reveal novel preclinical diagnostic or therapeutic strategies. Using state‐of‐the art neuroimaging techniques, we compared 18F‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET) uptake at rest between 10 T1D patients with IAH and nine patients with normal awareness of hypoglycaemia (NAH). T1D‐IAH patients showed a pattern of increased FDG‐PET uptake with respect to NAH patients (P < .05 corrected). Topographically, glucose metabolism was increased in the frontal and precuneus regions. Importantly, within the IAH group, this abnormal hypermetabolism correlated with IAH severity. This hypermetabolic state appeared to be unrelated to compensatory mechanisms as a result of reduced grey matter density or a neuroinflammatory state. We observed an abnormal increase in FDG‐uptake in T1D patients with IAH in brain regions strongly related to cognition. Because this hypermetabolic state correlated with IAH severity, its biological characterisation could reveal new preventive or therapeutic strategies. A possible mechanism could be that glucose transport is increased in hypoglycaemia unawareness to compensate for recurrent hypoglycaemia, although this need to be confirmed in further research.

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Cognitive function in individuals with and without painful and painless diabetic polyneuropathy—A cross‐sectional study in type 1 diabetes

Croosu

Gjela

Røikjer

et al. 2023

Endocrino Diabet & Metabol

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Introduction Previous studies suggest that cognitive impairment is more prevalent in individuals with painful and painless diabetic peripheral neuropathy (DPN). However, the current evidence is not well described. This study investigated cognitive function in adults with type 1 diabetes mellitus (T1DM) and the association to painful/painless DPN and clinical parameters. Methods This cross‐sectional, observational, case–control study included 58 participants with T1DM, sub‐grouped into 20 participants with T1DM and painful DPN, 19 participants with T1DM and painless DPN, 19 participants with T1DM without DPN, and 20 healthy controls were included. The groups were matched for sex and age. The participants performed Addenbrooke's examination III (ACE‐III), which assesses attention, memory, verbal fluency, language and visuospatial skills. Working memory was evaluated using an N‐back task. Cognitive scores were compared between the groups and correlated to age, diabetes duration, HbA1c and nerve conduction measurements. Results Compared to healthy controls, T1DM participants showed lower total ACE‐III (p = .028), memory (p = .013) and language scores (p = .028), together with longer reaction times in the N‐back task (p = .041). Subgroup analyses demonstrated lower memory scores in those with painless DPN compared with healthy controls (p = .013). No differences were observed between the three T1DM subgroups. Cognitive scores and clinical parameters were not associated. Conclusions This study supports the notion of cognitive alterations in T1DM and indicates that cognitive function is altered in T1DM regardless of underlying neuropathic complications. The memory domain appears altered in T1DM, particularly in those with painless DPN. Further studies are needed to verify the findings.

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Impaired cognitive processing speed in type 1 diabetic patients who had severe/recurrent hypoglycaemia

Cited by 10 publications

References 33 publications

A systematic review of the effect of prior hypoglycaemia on cognitive function in type 1 diabetes

A systematic review of the effect of prior hypoglycaemia on cognitive function in type 1 diabetes

Increased cerebral FDG‐PET uptake in type 1 diabetes patients with impaired awareness of hypoglycaemia

Cognitive function in individuals with and without painful and painless diabetic polyneuropathy—A cross‐sectional study in type 1 diabetes

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