Recurrent severe hypoglycemia, intelligence, and speed of information processing

Deary, Ian J.; Langan, S. J.; Graham, Kim S.; Hepburn, David; Frier, Brian M.

doi:10.1016/0160-2896(92)90014-i

Cited by 42 publications

(18 citation statements)

References 36 publications

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“…We and others have previously shown that mental and motor slowing is a nearly ubiquitous sequela of both Type 1 and Type 2 diabetes [2,3,5,30,31]. This prospective assessment confirms those earlier cross-sectional findings by showing that over time, 39% of our diabetic sample showed a marked (more than 0.5 SD units) decline on a composite measure of psychomotor efficiency, whereas only 9% of our non-diabetic comparison group showed a similar decline.…”

Section: Discussionsupporting

confidence: 89%

Cognitive efficiency declines over time in adults with Type 1 diabetes: effects of micro- and macrovascular complications

2003

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Aims/hypothesis. Mild cognitive dysfunction is not uncommon in adults with Type 1 diabetes, but its pathogenesis remains unclear. Previous cross-sectional studies had suggested that microangiopathy might affect brain integrity and lead to 'central neuropathy.' To assess the relationship between changes in cognitive performance and the incidence of new micro-and macrovascular complications, 103 young and middle-aged adults (mean age: 40 yrs) with childhood-onset Type 1 diabetes were followed over a 7-year period, and were compared to 57 demographically-similar adults without diabetes. Methods. All subjects completed a comprehensive battery of neurocognitive tests on two occasions. Diabetic subjects also received repeated medical assessments to diagnose the onset of clinically significant complications.Results. Relative to control subjects, diabetic adults showed significant declines on measures of psychomotor efficiency; no between-group differences were evident on learning, memory, or problem-solving tasks. The development of proliferative retinopathy and autonomic neuropathy during the follow-up period predicted decline in psychomotor speed (p<0.01), as did incident macrovascular complications (p<0.05), systolic blood pressure at follow-up (p<0.01), and duration of diabetes (p<0.01). Conclusion/interpretation. This study shows that cognitive efficiency may decline over time in diabetic adults, and that this neurocognitive change may be linked, at least in part, to the occurrence of complications like proliferative retinopathy and elevated blood pressure. Therapeutic interventions that reduce the risk of vascular complications may have a similarly beneficial effect on the brain and reduce the risk of neurocognitive dysfunction in diabetic patients. [Diabetologia (2003)

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Section: Discussionsupporting

confidence: 89%

Cognitive efficiency declines over time in adults with Type 1 diabetes: effects of micro- and macrovascular complications

2003

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“…There was also a tendency for children with history of seizures to make more errors on timed, complex tasks under conditions of stimulus overload, for example, when required to make rapid decisions about competing response choices. The association between history of seizures and language deficits has been found before (6,7,22) and forms an intriguing contrast to studies in adult patients (26), which report greater sensitivity of performance IQ to hypoglycemia. Considering findings from both pediatric and adult studies, it seems that seizures may disrupt the development of language skills but not their maintenance.…”

Section: Relationship Between Metabolic Control Variables and Neuropscontrasting

confidence: 48%

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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“…Significant reductions in psychomotor efficiency are not restricted to adults with type 2 diabetes but can be found in both children (41,42) and adults (4,(43)(44)(45) with type 1 diabetes. Because our previous work demonstrated a strong association between peripheral neuropathy and psychomotor slowing in adults with type 1 diabetes (43), we suggested that mental slowing may be a common manifestation of a "central neuropathy" induced by chronic hyperglycemia.…”

Section: Univariate Test Resultsmentioning

confidence: 99%

Circumscribed cognitive dysfunction in middle-aged adults with type 2 diabetes.

2000

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OBJECTIVE -To examine the extent to which type 2 diabetes is associated with poorer performance on measures of learning, memory, psychomotor speed, and problem-solving in middle-aged adults. RESEARCH DESIGN AND METHODS-This cross-sectional study evaluated 50 adults (age range 34-65 years, mean 50.8) with type 2 diabetes and 50 demographically similar community control subjects without diabetes. Each subject received a thorough physical examination and a detailed neuropsychological assessment. Factor analysis was used to assign specific tests to 1 of 4 cognitive domains (learning, memory for stories, problem-solving, and psychomotor speed). Hierarchical regression analysis was used to identify demographic and biomedical variables associated with cognitive dysfunction.RESULTS -Learning, memory, and problem-solving skills were unaffected by type 2 diabetes. In contrast, psychomotor slowing was predicted by a diagnosis of diabetes (r 2 change = 0.075, P Ͻ 0.002) with additional variance in psychomotor efficiency explained independently by HbA 1 (r 2 = 0.064, P Ͻ 0.003) and vibratory threshold (r 2 = 0.112, P Ͻ 0.0001). The magnitude of psychomotor slowing on specific tests ranged from 12% (Digit Vigilance) to 23% (Grooved Pegboard).CONCLUSIONS -Middle-aged adults with type 2 diabetes manifest psychomotor slowing that is associated with poorer metabolic control, whereas learning, memory, and problemsolving skills appear to be largely intact. The development of psychomotor slowing may be a manifestation of a "central neuropathy" induced by chronic hyperglycemia.

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Recurrent severe hypoglycemia, intelligence, and speed of information processing

Cited by 42 publications

References 36 publications

Cognitive efficiency declines over time in adults with Type 1 diabetes: effects of micro- and macrovascular complications

Cognitive efficiency declines over time in adults with Type 1 diabetes: effects of micro- and macrovascular complications

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

Circumscribed cognitive dysfunction in middle-aged adults with type 2 diabetes.

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