scholarly journals The Gaze Fixation Assessed by Microperimetry: A Useful Tool for the Monitoring of the Cognitive Function in Patients with Type 2 Diabetes

2021 ◽  
Vol 11 (8) ◽  
pp. 698
Author(s):  
Ángel Michael Ortiz-Zúñiga ◽  
Olga Simó-Servat ◽  
Alba Rojano-Toimil ◽  
Julia Vázquez-de Sebastian ◽  
Carmina Castellano-Tejedor ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Status ◽  
Retinal Sensitivity ◽  
Gaze Fixation ◽  
The Gaze ◽  
State Evaluation

Current guidelines recommend annual screening for cognitive impairment in patients > 65 years with type 2 diabetes (T2D). The most used tool is the mini-mental state evaluation (MMSE). Retinal microperimetry is useful for detecting cognitive impairment in these patients, but there is no information regarding its usefulness as a monitoring tool. We aimed to explore the role of retinal microperimetry in the annual follow-up of the cognitive function of patients with T2D older than 65 years. Materials and Methods: Prospective observational study, comprising patients > 65 years with T2D, attended at our center between March–October 2019. A complete neuropsychological evaluation assessed the baseline cognitive status (mild cognitive impairment, MCI, or normal, NC). Retinal microperimetry (sensitivity, gaze fixation) and MMSE were performed at baseline and after 12 months. Results: Fifty-nine patients with MCI and 22 NC were identified. A significant decline in the MMSE score was observed after 12 months in the MCI group (25.74 ± 0.9 vs. 24.71 ± 1.4; p = 0.001). While no significant changes in retinal sensitivity were seen, all gaze-fixation parameters worsened at 12 months and significantly correlated with a decrease in the MMSE scores. Conclusion: Retinal microperimetry is useful for the monitoring of cognitive decline in patients > 65 years with T2D. Gaze fixation seems a more sensitive parameter for follow-up after 12 months than retinal sensitivity.

scholarly journals Markers of cognitive impairment in patients with type 2 diabetes

2016 ◽  
Vol 24 (2) ◽  
pp. 161-176 ◽  
Author(s):  
Simona Cernea ◽  
Floredana-Laura Şular ◽  
Adina Huţanu ◽  
Septimiu Voidăzan
Keyword(s):  
Type 2 Diabetes ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Statistical Significance ◽  
High Sensitivity ◽  
Cognitive Status ◽  
Cross Sectional ◽  
Delayed Recall ◽  
Significant Difference

Abstract Background. The study aimed to evaluate the correlations of cognitive function with metabolic, nutritional, hormonal and immunologic parameters in patients with type 2 diabetes (T2D), in order to identify markers of cognitive impairment. Material and methods. This cross-sectional study included 216 T2D patients and 23 healthy individuals (HC). The cognitive status was evaluated by the MoCA test. From HC and 145 T2D patients several parameters were also determined: C-peptide, vitamin B12, high-sensitivity CRP (by chemiluminescent immunometric assay), HbA1c, lipids, cortisol, TSH, Mg (by a Cobas 6000 analyzer), glucose (by glucose-oxidase method) and leptin and adiponectin (by ELISA method). Statistical significance was set at p < 0.05. Results. There was a significant difference in the MoCA scores between HC and T2D groups (26.0(17.0-29.0) vs. 23.0(13.0- 31.0) points; p: 0.004). T2D patients with cognitive dysfunction were significantly older and less formally educated (p < 0.0001). Age negatively correlated with MoCA scores (-0.31; 95%CI:-0.42,-0.18; p < 0.0001). T2D patients had significantly lower visuospatial/executive (4.0(0.0-5.0) vs. 5.0(2.0-5.0) points; p: 0.04) and delayed recall scores (2.0(0.0- 5.0) vs. 3.0(1.0-5.0) points; p: 0.03) and lower serum Mg concentrations (0.81(0.12-0.99) vs. 0.92(0.41-1.35) mmol/l, p < 0.0001). Serum Mg levels positively correlated with MoCA scores (0.24, 95%CI: 0.07, 0.39; p: 0.003) and with visuospatial/ executive (0.30; 95%CI: 0.14, 0.45; p: 0.0002) and naming functions (0.18; 95%CI: 0.01, 0.34; p: 0.02). Conclusions. Patients with T2D had significant cognitive impairment, with decrements in the visuospatial/executive and delayed recall domains. Younger age and higher education correlated with better cognitive function. Serum Mg levels correlated positively with overall cognitive function and with visuospatial/executive and naming domains.

scholarly journals Effect of renal impairment on cognitive function during a 3-year follow up in elderly patients with type 2 diabetes: Association with microinflammation

2014 ◽  
Vol 5 (5) ◽  
pp. 597-605 ◽  
Author(s):  
Takahiko Kawamura ◽  
Toshitaka Umemura ◽  
Hiroyuki Umegaki ◽  
Rui Imamine ◽  
Naoko Kawano ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cognitive Function ◽  
Renal Impairment ◽  
Elderly Patients

scholarly journals Quality of life of mild cognitive impairment patients with type 2 diabetes mellitus and hypertension

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2982-2989
Author(s):  
Sreejith K ◽  
Malarkodi Velraj
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Status ◽  
Practical Concern ◽  
Emotional Concern

Mild cognitive impairment (MCI) is a progressive neurodegenerative disease on which diabetes mellitus and hypertension play an important role as major risk factors. This study aims to assess the quality of life of MCI patients with type 2 diabetes and hypertension.  A cross sectional study was carried out in a tertiary care teaching hospital. Cognitive status of patients were assessed by Addenbrooke’s Cognitive Examination III (ACE-III) and Montreal Cognitive Assessment (MoCA). Mild Cognitive Impairment Questionnaire (MCQ) was used to score the quality of life. SPSS 21.0 was used to perform statistical analysis. Kruskal-Wallis test and Mann Whitney U test were used to analyze the relationship between quality of life and demographic parameters. Totally 1887 patients with type 2 DM and hypertension were screened to detect MCI patients. The prevalence of MCI in the population was found to 24.64%. Mean age of the population was 45.12 ± 10.54. Quality of life of patients was affected due to MCI with diabetes and hypertension in early ages. Patients employed in Govt or private sector (p=0.021) and disease duration less than 10 years (p=0.025) had significantly better quality of life. Two domains of MCQ, such as emotional concern and practical concern were assessed separately found that MCI patient’s practical concern scores did not differ significantly from emotional concern scores (p= 0.874). Quality of life was affected in MCI patients with diabetes and hypertension in early ages. Routine clinical examination should consider the quality of life as an important parameter during the patient visit and necessary modifications should be given to enhance the quality of life as well as patient satisfaction.

scholarly journals Depression, Type 2 Diabetes, and Poststroke Cognitive Impairment

2016 ◽  
Vol 31 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Walter Swardfager ◽  
Bradley J. MacIntosh
Keyword(s):  
Type 2 Diabetes ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Depressive Symptoms ◽  
Processing Speed ◽  
Recurrent Stroke ◽  
Cognitive Status ◽  
Stroke Survivors ◽  
Severe Cognitive Impairment

Background. Ten percent of stroke survivors develop dementia, which increases to more than a third after recurrent stroke. Other survivors develop less severe vascular cognitive impairment. In the general population, depression, and diabetes interact in predicting dementia risk, and they are both prevalent in stroke. Objective. To assess the cumulative association of comorbid depressive symptoms and type 2 diabetes with cognitive outcomes among stroke survivors. Methods. Multicenter observational cohort study of people within 6 months of stroke. Depression and cognitive status were screened using the Center for Epidemiological Studies Depression (CES-D) scale and the Montreal Cognitive Assessment (MoCA), respectively. Processing speed, executive function and memory were assessed using the Trail Making Test parts A and B, and the 5 Word Delayed Free Recall task. Results. Among 342 participants (age 67.0 ± 13.5 years, 43.3% female, 46 ± 35 days poststroke), the prevalence of type 2 diabetes was 32.2% and depressive symptoms (CES-D ≥16) were found in 40.6%. Diabetes and depressive symptoms increased the risk of severe cognitive impairment (MoCA <20) with adjusted odds ratio (OR) 2.12 (95% confidence interval [CI] 1.20-3.74, P = .010) for 1 comorbidity and OR 3.18 (95% CI 1.26-8.02, P = .014) for both comorbidities. Associated cognitive deficits included executive function ( F1, 168 = 3.43, P = .035) but not processing speed ( F1, 168 = 1.86, P = .16) or memory ( F1, 168 = 0.82, P = .44). Conclusions. Diabetes and depressive symptoms were associated cumulatively with poorer cognitive screening outcomes poststroke, particularly deficits in executive function. Having 1 comorbidity doubled the odds of screening for severe cognitive impairment, having both tripled the odds.

scholarly journals Effect of metformin on neurodegenerative disease among elderly adult US veterans with type 2 diabetes mellitus

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e024954 ◽  
Author(s):  
Qian Shi ◽  
Shuqian Liu ◽  
Vivian A Fonseca ◽  
Tina K Thethi ◽  
Lizheng Shi
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Neurodegenerative Disease ◽  
Metformin Treatment ◽  
Us Veterans

ObjectiveThis study aimed to evaluate the association between metformin treatment and the risk of neurodegenerative disease (ND) among elderly adults with type 2 diabetes mellitus (T2DM).Design/Setting/ParticipantsThis retrospective longitudinal cohort study examined the effects of the length of metformin exposure on ND among elderly US veterans with T2DM and insulin treatment using the Veterans Affairs electronic medical record database.Primary and secondary outcome measuresThe primary clinical outcome was defined as diagnosis of ND including dementia, Alzheimer’s disease (AD), Parkinson’s disease (PD), Huntington’s disease (HD) and mild cognitive impairment during the follow-up period. The secondary clinical outcomes were separately measured by AD, PD, HD, dementia and mild cognitive impairment.ResultAdjusted by propensity score weight, a total of 5528 patients (mean age, 63.2±10.9 years; male, 98%; white, 60%) with a median follow-up of 5.2 years were selected. Those with ND or other mental disorders at baseline or who were on insulin for less than two-thirds of the study period were excluded. The incidence rate of ND was 11.48 per 1000 person-years among patients with metformin treatment, compared with 25.45 per 1000 person-years for those without metformin. Compared with no metformin use, 2–4 years and >4 years of metformin exposure were significantly associated with lower risk of ND (adjusted HR (aHR)=0.62, 95% CI 0.45 to 0.85; aHR=0.19, 95% CI 0.12 to 0.31, respectively), while metformin exposure in the first 2 years showed no significant influence.ConclusionWe conclude that long-term metformin therapy (>2 years) was associated with lower incidence of ND among elderly veterans with T2DM. We need to conduct a study with more representative population and more robust method for causal inferences. Further investigation into the mechanism involved is needed along with randomised trials to confirm a potential neuroprotective effect of metformin.

scholarly journals Associations between plasma kynurenines and cognitive function in individuals with normal glucose metabolism, prediabetes and type 2 diabetes: the Maastricht Study

Diabetologia ◽  
2021 ◽  
Vol 64 (11) ◽  
pp. 2445-2457
Author(s):  
Lieke Bakker ◽  
Inez H. G. B. Ramakers ◽  
Martin P. J. van Boxtel ◽  
Miranda T. Schram ◽  
Coen D. A. Stehouwer ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Glucose Metabolism ◽  
Xanthurenic Acid ◽  
Cross Sectional ◽  
Lower Odds ◽  
Normal Glucose ◽  
Hydroxyanthranilic Acid

Abstract Aims/hypothesis Studies investigating associations between kynurenines and cognitive function have generally been small, restricted to clinical samples or have found inconsistent results, and associations in the general adult population, and in individuals with type 2 diabetes in particular, are not clear. Therefore, the aim of the present study was to investigate cross-sectional associations between plasma kynurenines and cognitive function in a cohort of middle-aged participants with normal glucose metabolism, prediabetes (defined as impaired fasting glucose and/or impaired glucose tolerance) and type 2 diabetes. Methods Plasma kynurenines were quantified in 2358 participants aged 61 ± 8 years. Cross-sectional associations of kynurenines with cognitive impairment and cognitive domain scores were investigated using logistic, multiple linear and restricted cubic spline regression analyses adjusted for several confounders. Results Effect modification by glucose metabolism status was found for several associations with cognitive impairment, hence analyses were stratified. In individuals with prediabetes, 3-hydroxykynurenine (OR per SD 0.59 [95% CI 0.37, 0.94]) and 3-hydroxyanthranilic acid (0.67 [0.47, 0.96]) were associated with lower odds of cognitive impairment after full adjustment. In individuals with type 2 diabetes, kynurenine (0.80 [0.66, 0.98]), 3-hydroxykynurenine (0.82 [0.68, 0.99]), kynurenic acid (0.81 [0.68, 0.96]), xanthurenic acid (0.73 [0.61, 0.87]) and 3-hydroxyanthranilic acid (0.73 [0.60, 0.87]) were all associated with lower odds of cognitive impairment. Kynurenic acid (β per SD 0.07 [95% CI 0.02, 0.13]) and xanthurenic acid (0.06 [0.01, 0.11]) were also associated with better executive function/attention. No associations were observed in individuals with normal glucose metabolism. Conclusions/interpretation Several kynurenines were cross-sectionally associated with lower odds of cognitive impairment and better cognitive functioning in type 2 diabetes, while less widespread associations were seen in prediabetes. Low levels of kynurenines might be involved in the pathway of type 2 diabetes and cognitive decline but this needs further studies. Graphical abstract

scholarly journals Improvement of cognitive impairment in female type 2 diabetes mellitus mice by spironolactone

2011 ◽  
Vol 13 (1) ◽  
pp. 84-90 ◽  
Author(s):  
Akiko Sakata ◽  
Masaki Mogi ◽  
Jun Iwanami ◽  
Kana Tsukuda ◽  
Li-Juan Min ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Water Maze ◽  
Morris Water Maze Test ◽  
Kkay Mice

Patients with type 2 diabetes mellitus (T2DM) exhibit more severe cognitive decline in females compared with males; however, the preventive approach to this gender-specific cognitive decline is still an enigma. Spironolactone is a potassium-sparing diuretic that also acts as an androgen receptor antagonist. Here, we investigated whether spironolactone attenuates cognitive impairment observed in female T2DM mice. Adult wild-type (WT) mice and an obese T2DM model, KKAy mice, were employed in this study. Cognitive function was evaluated by the shuttle avoidance test and Morris water maze test. Administration of spironolactone (50 mg/kg per day in chow) had no significant effect on blood pressure, glucose tolerance or insulin resistance. In WT mice, no significant sex difference in cognitive function was observed; however, treatment with spironolactone improved spatial memory in the water maze, especially in female WT mice. Administration of spironolactone markedly improved the cognitive decline in female KKAy mice up to the level in male KKAy mice. Spironolactone treatment also improved cognitive function in ovariectomized-KKAy mice, but failed to improve it in those with administration of estradiol (200 µg/kg per day). In diabetic mice, spironolactone improved impaired cognitive function observed in female mice, suggesting that spironolactone may prevent cognitive impairment associated with diabetes in females clinically.

scholarly journals Evaluation of Cognitive Function in Patients with Type 2 Diabetes and Overt Hypothyroidism

2018 ◽  
Vol 25 (1) ◽  
pp. 83-89
Author(s):  
Rucsandra Dănciulescu Miulescu ◽  
Denisa Margină ◽  
Anca Ungurianu ◽  
Roxana Irina Roșca ◽  
Alina Nicolau ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Thyroid Stimulating Hormone ◽  
Control Group ◽  
Overt Hypothyroidism ◽  
Study Group ◽  
State Examination ◽  
Test Serum

AbstractBackground and Aims. Previous studies report the presence of cognitive impairment in patients with overt hypothyroidism. The thyroid hormones are essential for neurological and intellectual functions. Type 2 diabetes mellitus (T2DM) subjects are exposed to higher risk of cognitive function alteration compared to nondiabetic subjects. The aim of the present study was to analyze the cognitive function of T2DM subjects with overt hypothyroidism.Materials and Methods. We performed an observational study between 2015-2017. A total of 12 patients (11 women and 1 men) with overt hypothyroidism and T2DM were recruited for this study. Their cognitive function was compared with that of subjects of a control group (16 patients - 12 women and 4 men with T2DM but without overt hypothyroidism). Cognitive function was evaluated using the Mini Mental State Examination (MMSE) test. Serum thyroid stimulating hormone (TSH) levels were measured by immunoradiometric assay, free thyroxine (FT4) by radioimmunoassay while fasting plasma glucose (FPG) levels were evaluated using automated devices.Results. There were no significant differences between the two groups in respect of age and FPG. In the study group, mean TSH and FT4 levels were 11.76±4.43 mIU/L, resepectively 0.53±0.08 ng/dL while in the control group these were 2.60±0.40 mIU/L, respectively 1.12±0.19 ng/dL (p<0.001). Moderate cognitive impairment was present in 3 patients of the study group (25.00%) and in 2 subjects from the control group (12.50%). Mild cognitive impairment was present in 4 patients (33.33%) of the study group and in 2 subjects from the control group (12.50%).Conclusion. This study showed that MMSE scores are significantly reduced in subjects with T2DM and hypothyroidism compared to subjects with T2DM without hypothyroidism (p<0.004). The study revealed a negative correlation between TSH and MMSE score in the study group.

scholarly journals Rapid Acting Insulin Use and Persistence among Elderly Type 2 Diabetes Patients Adding RAI to Oral Antidiabetes Drug Regimens

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Usha Sambamoorthi ◽  
Arijita Deb ◽  
Steve Zhou ◽  
Rahul Garg ◽  
Tao Fan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Real World ◽  
Basal Insulin ◽  
Acting Insulin ◽  
Insulin Use ◽  
Out Of Pocket Costs

We examined the real-world utilization and persistence of rapid acting insulin (RAI) in elderly patients with type 2 diabetes who added RAI to their drug (OAD) regimen. Insulin-naïve patients aged ≥65 years, with ≥1 OAD prescription during the baseline period, who were continuously enrolled in the US Humana Medicare Advantage insurance plan for 18 months and initiated RAI were included. Among patients with ≥2 RAI prescriptions (RAIp), persistence during the 12-month follow-up was assessed. Multivariate logistic regression analyses identified factors affecting RAI use and persistence. Of 3734 patients adding RAI to their OAD regimen, 2334 (62.5%) had a RAIp during follow-up. Factors associated with RAIp included using ≤2 OADs; cognitive impairment, basal insulin use during follow-up; and higher RAI out-of-pocket costs ($36 to <$56 versus$0 to$6.30). Patients were less likely to persist with RAI when on ≤2 OADs versus ≥3 OADs and when having higher RAI out-of-pocket costs ($36 to <$56 versus$0 to$6.30) and more likely to persist when they had cognitive impairment and basal insulin use during follow-up. Real-world persistence of RAI in insulin-naïve elderly patients with type 2 diabetes was very poor when RAI was added to an OAD regimen.

scholarly journals Analysis of cognitive status in patients with type 2 diabetes

2018 ◽  
Vol 20 (6) ◽  
pp. 434-440
Author(s):  
Irina V. Gatckikh ◽  
Marina M. Petrova ◽  
Olga F. Veselova ◽  
Tatyana P. Shalda ◽  
Artem N. Narkevich ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cognitive Impairment ◽  
Carbohydrate Metabolism ◽  
Disease Duration ◽  
Short Term Memory ◽  
Memory Function ◽  
Cognitive Status ◽  
Control Group ◽  
The Impact

Background: Cognitive impairment is a common complication of type 2 diabetes, greatly reduce the quality of life and daily functioning of patients, as well as have an impact on their compliance to therapy. Aim: Explore the nature and frequency of cognitive impairment in patients with type 2 diabetes, their relation to carbohydrate metabolism. Materials and methods: The study involved 113 patients with type 2 diabetes aged 4070 years, with disease duration of more than 12 months; Control group consisted of 33 persons, stateless persons with type 2 diabetes, matched by age, sex, level of education, the presence of cardiovascular diseases such as hypertension and coronary heart disease. The complex included a survey of clinical and laboratory tests, instrumental, neuropsychological testing. To screen for cognitive impairment used by the Montreal Cognitive Assessment Scale (MоСа test), for the study of the frontal functions FAB (frontal dysfunction battery). Results: The study of cognitive impairment were diagnosed in 53,1 9,2% of patients with type 2 diabetes, which is statistically significantly higher than in those in the control group 15,2 12,2%. In patients with type 2 diabetes prevailed violations fronto-subcortical type with a reduction in short-term memory function, attention and constructive praxis. Cognitive impairment correlated with indices of carbohydrate metabolism (HbA1c, fasting glucose), disease duration 7 [5, 12] years and the patient's. Conclusions: These data confirm the impact of hyperglycemia as a major pathogenic factor and duration of the disease on the formation and progression of cognitive impairment in patients with type 2 diabetes.

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