Short-Term, Delayed, and Working Memory Are Impaired During Hypoglycemia in Individuals With Type 1 Diabetes

Sommerfield, Andrew J.; Deary, Ian J.; McAulay, Vincent; Frier, Brian M.

doi:10.2337/diacare.26.2.390

Cited by 94 publications

(70 citation statements)

References 39 publications

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“…Immediate recall performance for the two verbal memory tasks (AVLT and logical memory) was impaired significantly during hypoglycaemia, which is consistent with previous studies [15,16]. Delayed recall was always tested during euglycaemia, and it can be inferred that the significant impairment in delayed recall following hypoglycaemia resulted from a hypoglycaemic effect on learning and/or consolidation.…”

Section: Discussionsupporting

confidence: 90%

“…We have studied previously the effects of hypoglycaemia on various components of memory using consistent experimental techniques and validated memory tasks. Hypoglycaemia impairs the auditory and visual processing subsystems of sensory memory, short-term memory, working memory and delayed memory in both diabetic and nondiabetic subjects [11][12][13][14][15][16]. Working memory and delayed memory are particularly susceptible to hypoglycaemia [17].…”

Section: Introductionmentioning

confidence: 99%

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The effects of acute hypoglycaemia on memory acquisition and recall and prospective memory in type 1 diabetes

et al. 2006

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Aims/hypothesis Global memory performance is impaired during acute hypoglycaemia. This study assessed whether moderate hypoglycaemia disrupts learning and recall in isolation, and utilised a novel test of prospective memory which may better reflect the role of memory in daily life than conventional tests. Subjects and methods Thirty-six subjects with type 1 diabetes participated, 20 with normal hypoglycaemia awareness (NHA) and 16 with impaired hypoglycaemia awareness (IHA). Each underwent a hypoglycaemic clamp with target blood glucose 2.5 mmol/l. Prior to hypoglycaemia, subjects attempted to memorise instructions for a prospective memory task, and recall was assessed during hypoglycaemia. Subjects then completed the learning and immediate recall stages of three conventional memory tasks (word recall, story recall, visual recall) during hypoglycaemia. Euglycaemia was restored and delayed memory for the conventional tasks was tested. The same procedures were completed in euglycaemic control studies (blood glucose 4.5 mmol/l). Results Hypoglycaemia impaired performance significantly on the prospective memory task (p=0.004). Hypoglycaemia also significantly impaired both immediate and delayed recall for the word and story recall tasks (p<0.01 in each case). There was no significant deterioration of performance on the visual memory task. The effect of hypoglycaemia did not differ significantly between subjects with NHA and IHA. Conclusions/interpretation Impaired performance on the prospective memory task during hypoglycaemia demonstrates that recall is disrupted by hypoglycaemia. Impaired performance on the conventional memory tasks demonstrates that learning is also disrupted by hypoglycaemia. Results of the prospective memory task support the relevance of these findings to the everyday lives of people with diabetes.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The effects of acute hypoglycaemia on memory acquisition and recall and prospective memory in type 1 diabetes

et al. 2006

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“…We interpret this regional increase in uptake to reflect activation of brain regions concerned with the monitoring of internal state, as has recently been identified in regional cerebral blood flow studies of hypoglycaemia which identify strong and unequivocal activation in the anterior cingulate cortex [48]. While the dorsolateral prefrontal cortex is concerned with working memory processing and engages in a variety of working memory tasks [49], attention and working memory are cerebral functions susceptible to impairment during hypoglycaemia [50]. The increase in relative CMG uptake in this region is puzzling, but may reflect diversion of processing resources to the monitoring of internal state from conscious working memory processes.…”

Section: Discussionmentioning

confidence: 59%

Differential changes in brain glucose metabolism during hypoglycaemia accompany loss of hypoglycaemia awareness in men with type 1 diabetes mellitus. An [11C]-3-O-methyl-d-glucose PET study

et al. 2005

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Differential changes in brain glucose metabolism during hypoglycaemia accompany loss of hypoglycaemia awareness in men with type 1 diabetes mellitus. An Abstract Aims/hypothesis: Hypoglycaemia unawareness in type 1 diabetes increases the risk of severe hypoglycaemia and impairs quality of life for people with diabetes. To explore the central mechanisms of hypoglycaemia awareness, we used [ 11 C]-3-O-methyl-D-glucose (CMG) positron emission tomography (PET) to measure changes in global and regional brain glucose metabolism between euglycaemia and hypoglycaemia in aware and unaware diabetic subjects. Materials and methods: Twelve men with type 1 diabetes, of whom six were characterised as aware and six as unaware of hypoglycaemia, underwent two CMG-PET brain scans while plasma glucose was controlled by insulin and glucose infusion either at euglycaemia (5 mmol/l) or at hypoglycaemia (2.6 mmol/l) in random order. Results: With hypoglycaemia, symptoms and sweating occurred only in the aware group. Brain glucose content fell in both groups (p=0.0002; aware, 1.18± 0.45 to 0.02±0.2 mmol/l; unaware, 1.07±0.46 to 0.19±0.23 mmol/l), with a relative increase in tracer uptake in prefrontal cortical regions, including the anterior cingulate. No detectable differences were found between groups in global brain glucose transport parameters (K 1 , k 2 ). The cerebral metabolic rate for glucose (CMRglc) showed a relative rise in the aware subjects (11.839±2.432 to 13.958± 2.372) and a fall in the unaware subjects (from 12.457± 1.938 to 10.16±0.801 μmol 100 g −1 min −1 , p=0.043). Conclusions/interpretation: Hypoglycaemia is associated with reduced brain glucose content in aware and unaware subjects, with a relative preservation of metabolism in areas associated with sympathetic activation. The relative rise in global glucose metabolic rate seen in aware subjects during hypoglycaemia contrasted with the relative fall in the unaware subjects and suggests that cortical neuronal activation is a necessary correlate of the state of hypoglycaemia awareness.

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“…45 Immediate and delayed memory were impaired in 16 type 1 diabetic patients during controlled hypoglycemia of 2.5 mmol/l as assessed by the Trail Making B Test, and the Digit Symbol Test. 46 Similar tests have shown impairment in visuospatial ability during hypoglycemia. 47 Tests of sensory perceptual processing, simple motor abilities, attention, learning, memory, language, and spatial and constructional abilities at plasma glucose levels of 2.2 mmol/l were diminished when compared to basal levels of performance at 8.9 mmol/L among 42 type 1 diabetics.…”

Section: Cognitive Disturbance and Dementiamentioning

confidence: 95%

Neurologic Manifestations of Hypoglycemia

Neil¹,

Hemmen²

2011

Diabetes - Damages and Treatments

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Short-Term, Delayed, and Working Memory Are Impaired During Hypoglycemia in Individuals With Type 1 Diabetes

Cited by 94 publications

References 39 publications

The effects of acute hypoglycaemia on memory acquisition and recall and prospective memory in type 1 diabetes

The effects of acute hypoglycaemia on memory acquisition and recall and prospective memory in type 1 diabetes

Differential changes in brain glucose metabolism during hypoglycaemia accompany loss of hypoglycaemia awareness in men with type 1 diabetes mellitus. An [11C]-3-O-methyl-d-glucose PET study

Neurologic Manifestations of Hypoglycemia

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