Cognitive dysfunction in diabetes: how to implement emerging guidelines

Abstract

Cognitive dysfunction, including mild cognitive impairment and dementia, is increasingly recognised as an important comorbidity and complication of diabetes that affects an individual’s well-being and diabetes management, and is associated with diabetes treatment-related complications. Recent guidelines therefore recommend screening for cognitive impairment in older individuals with diabetes. In addition, these guidelines suggest that glucose-lowering treatment should be tailored in those diagnosed with cognitive impairment, to reduce the risk of hypoglycaemia and improve treatment adherence. This review gives an overview of cognitive dysfunction in people with diabetes, briefly describing the clinical features of different stages of cognitive dysfunction and their epidemiology. In particular, it addresses essential additional steps that need to be taken to fully implement the emerging guidelines on screening and management of cognitive dysfunction in diabetes into daily practice.

Association between diabetes and cognitive function at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA- Brasil)

“…Furthermore, the loss of brain volume has been described in patients with diabetes, particularly in regions of the hippocampus, thalamus, and cerebellar area 42 . Meta-analysis identified reduced resting-state brain activity in all brain regions in individuals with type 2 diabetes 43 be one of the main complications of diabetes, according to the current recommendations for good practice in the care of individuals with diabetes, it has become important to perform cognitive screening or cognitive assessment of these individuals 13,44,45 .…”

Metabolic and Cognitive Effects of Ranolazine in Type 2 Diabetes Mellitus: Data from an in vivo Model

“…Recent data have associated T2DM with an increased risk of developing cognitive impairment and AD [3,4,7,8,33]. The reasons underlying this increased risk have not been fully elucidated to date, therefore the prevention of cognitive comorbidities in patients with T2DM represents a great therapeutic and research challenge.…”

“…A previous study has demonstrated that in both insulin-deficiency and insulin-resistance, diabetes damages hippocampus-dependent memory, and high levels of adrenal steroid corticosterone contribute to these adverse effects; rats treated with streptozotocin have reduced levels of insulin and disablement in hippocampal-neurogenesis, synaptic plasticity, and learning [6]. Despite this strong evidence, established guidelines for the treatment of individuals with both diseases are unfortunately still lacking [7]. Recently, the cognitive dysfunction sub-study of the large CARMELINA international trial has shown that the dipeptidyl peptidase 4 inhibitor linagliptin was unable to prevent cognitive decline in 1545 subjects with T2DM and cardiorenal disease, notwithstanding its effectiveness in improving glycemic control [8].…”

Walking Speed is the Sole Determinant of mild Cognitive Impairment in Japanese Patients with Type 2 Diabetes Mellitus

“…Diabetes is a risk factor for MCI and dementia (Alzheimer's dementia, vascular dementia, and mixed dementia) [7][8][9]. In the Japanese population, the risk of developing Alzheimer's disease and vascular dementia is approximately twice as high in diabetic patients as it is in healthy individuals [10].…”

“…In the Japanese population, the risk of developing Alzheimer's disease and vascular dementia is approximately twice as high in diabetic patients as it is in healthy individuals [10]. The risk factors for MCI in diabetic patients may include hypertension, obesity, presence of dyslipidemia, effects of exogenous and endogenous insulin associated with the treatment of diabetes, degree of chronic hyperglycemia, duration of diabetes, and presence of hypoglycemia [7,8,11]. Sarcopenia is a risk factor for dementia in elderly population without [12,13] or with [14] diabetes mellitus.…”