Cognitive impairment and postural control deficit in adults with Type 2 diabetes

Abstract

Background Diseases induced by metabolic disorders, eg, Type 2 diabetes, has recently been linked to both sensory and motor deficit in the absence of a formal clinical diagnosis of peripheral neuropathy. Studies have demonstrated mild cognitive impairment in diabetic patients, which also plays a role in one's loss of ability to successfully perform basic motor activities. This project focused on evaluating cognitive function while maintaining balance. We hypothesized that simultaneous cognitive and motor deficit would occur among adults with Type 2 diabetes versus healthy age‐ and sex‐matched control during a balance task. Methods A sample of 10 Type 2 diabetes patients and 10 age‐matched and sex‐matched controls underwent a series of sensory, motor, cognitive, and cognitive‐motor evaluations. Blood pressure and A1c levels were assessed. Results Significantly lower cognitive function scores, particularly in the domain of working memory, were exhibited in the diabetic group than controls. Balance in the diabetic group was overall poorer in both single‐ and dual‐tasks than controls. When diabetic patients were asked to verbally recall different words while maintaining their balance, their accuracy rate was significantly lower than controls. Some health state measures were found to co‐vary with motor function. Increased body mass index in the diabetic group did not account for motor function deficit. Significance Our data suggest that: (1) systemic deficit beyond tactile dysfunction and increased body mass index contribute to reduced motor function in diabetes, and (2) both balance and working memory functions are simultaneously impaired in patients with Type 2 diabetes.

Cognitive–Motor Impairment in Manual Tasks in Adults With Type 2 Diabetes

“…Significant differences in force production error rates and signal predictability in the T2D group in motor only tasks were consistent with previous literature (Gorniak et al, 2014; Ochoa et al, 2016; Ochoa & Gorniak, 2014). Baseline cognitive function, assessed via MoCA, was reduced in the T2D group, particularly in the domain of recall/working memory, consistent with recent reports of MCI and working memory deficits in T2D (Christman et al, 2009; Creavin et al, 2011; Gorniak et al, 2019).…”

“…We do note that the 4 s windows between working memory stimuli in the N-back (cognitive) task may have contributed to the lack of group differences in the response rate findings. It is possible that additional cognitive deficits may have emerged if the time interval between cognitive stimuli was decreased or if the duration of each trial had been longer than 30 s, thereby further taxing the central nervous system (e.g., by taxing a limited channel capacity), as found in Gorniak et al (2019). All single task evaluations were performed prior to any dual tasks, which may have induced a learning effect in our study population, and thus a reduction in reaction time in the dual task.…”

“…Presentation of conditions was block randomized across participants. Participants wore a headset with headphone/microphone capabilities (Plantronics Inc., Santa Cruz, CA, USA), through which they heard a randomized sequence of words every 4 s generated by custom software (Visual C++; Microsoft Corp., Redmond, WA, USA; Gorniak et al, 2019). Participants were instructed to repeat the words into the headset in the correct sequence for a task duration of three 30 s trials for each condition.…”

“…Similar deficits have been found in a number of patient populations, particularly in cases where only motor deficits were clinically assumed (e.g., Parkinson’s disease; Frankemolle et al, 2010). Previously, we have found CMI in adults with T2D during tasks involving whole body balance (Gorniak, Lu, Lee, Massman, & Wang, 2019) in which participants stood upright on a force platform and responded to auditory stimuli which stimulated participants’ short-term memory. However, we have not probed for CMI in adults with T2D during performance of hand/finger tasks, despite evidence of subtle hand/finger motor impairment in patients living with T2D (Gorniak et al, 2014; Ochoa et al, 2016; Ochoa & Gorniak, 2014).…”

Sex-based differences and aging in tactile function loss in persons with type 2 diabetes

“…Tactile sensitivity loss due to peripheral neuropathy (PN) has been implicated as the primary cause of both sensory and motor deficits in the hands and feet of PwDM [7][8][9][10]; however, our recent work has demonstrated that motor changes in PwDM occur independent of such tactile impairment, and appear to be unrelated to disease duration and severity [2][3][4][5]11]. Our data indicate other physiological factors such as vascular dysfunction and functional cortical changes as the underlying mechanism for sensorimotor changes in PwDM [2][3][4][5][11][12][13][14]. Due to the confluence of multiple systemic changes in the bodies of PwDM, the contribution of multiple systems−including sex hormone changes and impaired global hemodynamic function−to sensorimotor dysfunction prior to PN diagnosis in PwDM is fully plausible.…”