Is Type II Diabetes Associated With an Increased Risk of Cognitive Dysfunction?: A critical review of published studies

Strachan, Mark W. J.; Deary, Ian J.; Ewing, Fiona M.E; Frier, Brian M.

doi:10.2337/diacare.20.3.438

Cited by 485 publications

(323 citation statements)

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“…Also consistent with previous findings [2,4,32], and as hypothesised, mean performance scores were lower for the diabetic than for the non-diabetic group for MMSE, the similarities subtest and each of the cognitive composite scores, with the exception of the verbal memory composite.…”

Section: Discussionsupporting

confidence: 91%

Presence of the APOE ε4 allele modifies the relationship between type 2 diabetes and cognitive performance: the Maine–Syracuse Study

et al. 2009

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Aims/hypothesis The primary aim of this study was to determine whether the presence of one or more APOE ε4 alleles modifies the association between diabetes (defined by glucose ≥7 mmol/l or treatment) and cognitive function. Methods Diabetic status and APOE genotype interactions were assessed cross-sectionally for 826 communitydwelling, stroke-free, non-demented individuals (526 nondiabetic non-APOE ε4 carriers, 174 non-diabetic APOE ε4 carriers, 87 diabetic APOE ε4 non-carriers, 39 diabetic APOE ε4 carriers) ranging in age from 50 to 98 years. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), the similarities subtest from the Wechsler Adult Intelligence Scale, and four composite scores derived from 17 additional neuropsychological tests. Multiple linear regression analyses were employed to relate diabetes and APOE genotype to cognitive performance and to examine the interaction between these two risk factors as they relate to cognitive performance. Multiple cardiovascular disease risk factors were statistically controlled. Results With adjustment for age, education, sex, race/ ethnicity and APOE genotype, performance level was lower for the diabetic than for the non-diabetic group for the MMSE, the similarities subtest and each of the cognitive composites with the exception of the verbal memory composite. Interactions (p<0.05) between diabetes and APOE genotype were found for all but the visual-spatial memory/organisation composite. The negative association between diabetes and cognitive performance was of a higher magnitude for individuals who carry one or more APOE ε4 alleles. Results were similar with additional adjustment for cardiovascular disease and associated risk factors. Conclusions/interpretation The presence of one or more APOE ε4 alleles modifies the association between diabetes and cognitive function.

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Section: Discussionsupporting

confidence: 91%

Presence of the APOE ε4 allele modifies the relationship between type 2 diabetes and cognitive performance: the Maine–Syracuse Study

et al. 2009

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“…There is accumulating evidence that diabetes, in addition to increasing the risk of cardiovascular disease, stroke and kidney failure, may also adversely affect brain function independently from atherosclerotic disease. To date, numerous studies have demonstrated that type 2 diabetes is associated with cognitive deficits (for example [2][3][4][5]). …”

Section: Introductionmentioning

confidence: 99%

Hippocampal damage and memory impairments as possible early brain complications of type 2 diabetes

et al. 2007

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Aims/hypothesis There is evidence that type 2 diabetes mellitus is associated with cognitive impairment. Most studies investigating this association have evaluated elderly individuals, after many years of diabetes, who generally have poor glycaemic control and significant vascular disease. The aim of the current study was to investigate the early cognitive consequences and associated brain correlates of type 2 diabetes. Materials and methods With regard to cognition and brain measures, we compared 23 age-, sex-and educationmatched control subjects with 23 mostly middle-aged individuals with relatively well-controlled diabetes of less than 10 years from the time of diagnosis. Results We found deficits in hippocampal-based memory performance and preservation of other cognitive domains. Relative to control subjects, individuals with diabetes had reductions in brain volumes that were restricted to the hippocampus. There was an inverse relationship between glycaemic control and hippocampal volume; in multivariate regression analysis, HbA 1c was the only significant predictor of hippocampal volume, accounting for 33% of the observed variance. Other variables commonly associated with type 2 diabetes, such as elevated BMI, hypertension or dyslipidaemia, did not independently contribute to the variance in hippocampal volume. Conclusions/interpretation These results suggest that the medial temporal lobe may be the first brain site affected by type 2 diabetes and that individuals in poorer metabolic control may be affected to a greater extent.

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“…Studies from various populations have consistently shown diabetes to be associated with cognitive deficits and dementia [1][2][3]. The pathophysiological mechanisms underlying this association are not fully understood, mainly because of the wide range of possible aetiologies.…”

Section: Introductionmentioning

confidence: 99%

Predictors of cognitive impairment and dementia in older people with diabetes

et al. 2007

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Aims/hypothesis Diabetes is associated with an increased risk of dementia but the reasons for this association are unclear because there are many potential mechanisms. We explored the relative contribution of diabetes-related variables as predictors of dementia in older individuals with diabetes. Methods Survivors, aged ≥70 or more, were recruited from an existing observational cohort study 7.6±1.0 years after baseline, when they underwent a comprehensive assessment of diabetes, complications and cardiovascular risk factors. Dementia, probable Alzheimer's disease and cognitive impairment without dementia were diagnosed clinically. Logistic regression modelling determined independent predictors of cognitive diagnoses. Results Of 302 participants, aged 75.7±4.6 years, 28 (9.3%) had dementia (16 with probable Alzheimer's disease) and 60 (19.9%) had cognitive impairment without dementia. The major independent longitudinal predictors of dementia were older age (per decade; odds ratio 4.0, 95% CI 1.59-10.10), diabetes duration (for each 5 years; odds ratio 1.69, 95% CI 1.24-2.32), peripheral arterial disease (odds ratio 5.35, 95% CI 2.08-13.72) and exercise (which was protective; odds ratio 0.26, 95% CI 0.09-0.73). For Alzheimer's disease, diabetes duration was an independent predictor in addition to age and diastolic blood pressure. The results of the cross-sectional analyses were similar with respect to diabetes duration and peripheral arterial disease. Conclusions/interpretation Peripheral arterial disease is a strong independent risk factor for dementia in diabetes. After adjustment for a wide range of potential risk factors, diabetes duration remains independently associated with dementia and probable Alzheimer's disease, indicating that factors not measured in this study may be important in the pathogenesis of dementia in diabetes.

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Is Type II Diabetes Associated With an Increased Risk of Cognitive Dysfunction?: A critical review of published studies

Cited by 485 publications

References 0 publications

Presence of the APOE ε4 allele modifies the relationship between type 2 diabetes and cognitive performance: the Maine–Syracuse Study

Presence of the APOE ε4 allele modifies the relationship between type 2 diabetes and cognitive performance: the Maine–Syracuse Study

Hippocampal damage and memory impairments as possible early brain complications of type 2 diabetes

Predictors of cognitive impairment and dementia in older people with diabetes

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