Neurocognitive Functioning in Children and Adolescents at the Time of Type 1 Diabetes Diagnosis: Associations With Glycemic Control 1 Year After Diagnosis

Schwartz, David D.; Axelrad, Marni E.; Anderson, Barbara J.

doi:10.2337/dc14-0103

Cited by 26 publications

(19 citation statements)

References 35 publications

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“…Another recent DTI study [30••] found a significant association between white-matter structure and A1c at study baseline, but not with a “lifetime” index of A1c, suggesting insult was more likely related to acute (versus chronic) effects of hyperglycemia nearer the time of diagnosis. Our group found a high incidence of impairment in bilateral fine-motor speed, visuomotor integration, and phonemic fluency in children within days of T1D diagnosis [31]. While we do not know whether these acute deficits resolve with a return to euglycemia, impairments in motor speed and working memory were associated with diabetes outcomes over 1 year post-diagnosis, which suggests that acute cognitive dysfunction may be an early marker of neurobehavioral vulnerability.…”

Section: Neurodevelopmental Frameworkmentioning

confidence: 94%

Neurocognitive Outcomes in Pediatric Diabetes: a Developmental Perspective

et al. 2014

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The impact of diabetes on the developing brain is well-accepted. Effects on neurocognitive functioning are moderate but have larger functional implications, especially when considered through a developmental lens. Pathophysiological factors such as severe hypoglycemia and chronic hyperglycemia can alter developmental trajectories in early childhood and perhaps at later periods. In this paper, we selectively review neurocognitive outcomes in pediatric diabetes (largely type 1), integrating recent research from developmental neuroscience and neuroimaging. We examine the effects of diabetes at different stages and place findings within a neurodevelopmental diathesis/stress framework. Early-onset diabetes is associated with specific effects on memory and more global cognitive late-effects, but less is known about cognitive outcomes of diabetes in later childhood and in adolescence, a time of increased neurobehavioral vulnerability that has received relatively limited empirical attention. Studies are also needed to better elucidate risk and protective factors that may moderate neurodevelopmental outcomes in youth with diabetes.

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Section: Neurodevelopmental Frameworkmentioning

confidence: 94%

Neurocognitive Outcomes in Pediatric Diabetes: a Developmental Perspective

et al. 2014

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“…In one study of children newly diagnosed with diabetes (32), deficits were found in psychomotor speed that were associated with metabolic control 1 year later, suggesting that impaired motor speed may be an early marker for cognitive changes that can have a long-term effect on diabetes control.…”

Section: When Should Screening Occur?mentioning

confidence: 99%

“…Nursing staff were taught to administer the measure with a high degree of reliability, and empirically derived cutoffs identified cognitive impairment with good accuracy (49). No comparable tests have been identified as gold-standard instruments for cognitive screening in type 1 diabetes, although there is evidence that the Grooved Pegboard Test (50) may be particularly sen-sitive to diabetes-related cognitive dysfunction (32,51–53). …”

Section: How To Screen For Neurocognitive and Executive Dysfunctionmentioning

confidence: 99%

“…In addition to the Grooved Pegboard Test, a version of the Digit Span Test with forward and backward spans is familiar to many clinicians (e.g., as part of the Wechsler Intelligence Scales for children and adults [54,55]) and can provide a quick assessment of attention and working memory. Using these measures to screen for acute cognitive dysfunction at diagnosis is feasible and acceptable to families (32), and evidence is growing that the findings may be predictive of subsequent outcomes (23,32). …”

Section: How To Screen For Neurocognitive and Executive Dysfunctionmentioning

confidence: 99%

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Screening of Neurocognitive and Executive Functioning in Children, Adolescents, and Young Adults With Type 1 Diabetes

2016

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“…(8) In elderly non-diabetic populations, psychomotor slowing warns of future disability,(9, 10) dementia, (11) and death. (12) Characterizing psychomotor slowing in T1D is likely to become a public health priority in future years, considering the rising incidence of T1D (13) in conjunction with the increased life expectancy of people with T1D.…”

Section: Introductionmentioning

confidence: 99%

Regional Gray Matter Volumes as Related to Psychomotor Slowing in Adults with Type 1 Diabetes

et al. 2017

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OBJECTIVE Psychomotor slowing is a common cognitive complication in type 1 diabetes (T1D), but its neuroanatomical correlates and risk factors are unclear. In non-diabetic adults, smaller gray matter volume (GMV) and presence of white matter hyperintensities (WMH) are associated with psychomotor slowing. We hypothesize that smaller GMV in prefronto-parietal regions explains T1D-related psychomotor slowing. We also inspect the contribution of microvascular disease and hyperglycemia. METHODS GMV, WMH, and glucose levels were measured concurrently with a test of psychomotor speed (Digit Symbol Substitution Test, DSST) in 95 adults with childhood-onset T1D (mean age/duration=49/41 years) and 135 similarly-aged non-T1D adults. Linear regression models tested associations between DSST and regional GMV, controlling for T1D, sex, and education; a bootstrapping method tested whether regional GMV explained between-group differences in DSST. For the T1D cohort, voxel-based and a priori regions-of-interest methods further tested associations between GMV and DSST, adjusting for WMH, hyperglycemia, and age. RESULTS Bilateral putamen, but not other regions, significantly attenuated DSST differences between the cohorts (bootstrapped unstandardized indirect effects: −3.49, −3.26; 95% confidence limits [−5.49, −1.80], [−5.29 −1.44], left and right putamen, respectively). Among T1D, DSST was positively associated with GMV of bilateral putamen and left thalamus. Neither WMH, hyperglycemia, age, nor other factors substantially modified these relationships. CONCLUSIONS For middle-aged adults with T1D and cerebral microvascular disease, GMV of basal ganglia may play a critical role in regulating psychomotor speed, as measured via DSST. Studies to quantify the impact of basal ganglia atrophy concurrent with WMH progression on psychomotor slowing are warranted.

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Neurocognitive Functioning in Children and Adolescents at the Time of Type 1 Diabetes Diagnosis: Associations With Glycemic Control 1 Year After Diagnosis

Cited by 26 publications

References 35 publications

Neurocognitive Outcomes in Pediatric Diabetes: a Developmental Perspective

Neurocognitive Outcomes in Pediatric Diabetes: a Developmental Perspective

Screening of Neurocognitive and Executive Functioning in Children, Adolescents, and Young Adults With Type 1 Diabetes

Regional Gray Matter Volumes as Related to Psychomotor Slowing in Adults with Type 1 Diabetes

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