Cognitive impairment in diabetic patients: Can diabetic control prevent cognitive decline?

Takahiko Kawamura, Toshitaka Umemura, Nigishi Hotta, Takahiko Kawamura, Toshitaka Umemura, Nigishi Hotta

Abstract

It is well recognized that the prevalence of dementia is higher in diabetic patients than non-diabetic subjects. The incidence of diabetes has been increasing because of dramatic changes in lifestyles, and combined with longer lifespans as a result of advances in medical technology, this has brought about an increase in the number of elderly diabetic patients. Together, aging and diabetes have contributed to dementia becoming a serious problem. Progression to dementia reduces quality of life, and imposes a burden on both patients themselves and the families supporting them. Therefore, preventing the complication of dementia will become more and more important in the future. Although many mechanisms have been considered for an association between diabetes and cognitive dysfunction, glucose metabolism abnormalities such as hyperglycemia and hypoglycemia, and insulin action abnormalities such as insulin deficiency and insulin resistance can be causes of cognitive impairment. Recent large-scale longitudinal studies have found an association between glycemic control and cognitive decline, although it is still unclear how cognitive decline might be prevented by good glycemic control. However, at an early stage, it is necessary to detect moderate cognitive dysfunction and try to reduce the risk factors for it, which should result in prevention of dementia, as well as vascular events. In the present review, in addition to outlining an association between diabetes and cognitive function, we discuss how glycemic control and cognitive decline are related.

Keywords: Cognitive function; Diabetes mellitus; Glycemic control.

Figures

Figure 1
Figure 1
Possible mechanistic contribution to cognitive impairment seen in diabetes mellitus. Hyperglycemia, hypoglycemia and abnormal insulin action have been implicated as major causes of cognitive impairment in diabetic patients, but many other factors, such as those shown in the figure, are also involved. APOE, apolipoprotein E.
Figure 2
Figure 2
Association between Digit Symbol Substitution Test (DSST) decline and glycosylated hemoglobin A1c levels. A total of 8958 subjects with an average age of 56 years were followed up for 6 years, and the results were adjusted by age, sex, race, income, education, drinking, smoking, body mass index, systolic blood pressure, diastolic blood pressure, hypertension medication use and total cholesterol level. The odds ratio with 95% confidence interval (CI) for yearly DSST decline was 1.42 (1.14–1.75) in diabetic patients as compared with non‐diabetic subjects. This figure is based on a table published in Diabetologia 201112. DM, diabetes mellitus.
Figure 3
Figure 3
Natural history of patients with diabetes mellitus – past, present and future. The figure shows the natural history of patients with diabetes mellitus, whose status is affected by genetic and environmental factors. Thanks to recent advances in medicine, the incidence of vascular events in patients with diabetes has been decreasing; but from now on, both cancer and dementia will become serious problems in elderly diabetic patients. The results of the Framingham Heart Study showed an inverse association between cancer and Alzheimer's disease, with cancer survivors having a lower risk of Alzheimer's disease than those without cancer, and showed that patients with Alzheimer's disease had a lower risk of incident cancer99. IGT, impaired glucose tolerance.

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