- •
As population ages, the prevalence of comorbid diabetes and cognitive dysfunction increases.
- •
The development of cognitive dysfunction will have significant consequences on the care for older people with diabetes.
- •
Health care professionals and health care systems should develop policies that ensure delivering of a holistic care plans that focus on quality of life of these patients with complex needs.
Cognitive Dysfunction in Older Adults with Type 2 Diabetes: Links, Risks, and Clinical Implications
Section snippets
Key points
Diabetes and dementia: the link
Diabetes and dementia may share a common pathogenic link. In Alzheimer disease (AD), increased cerebral insulin resistance appears to be the central feature of this metabolic-cognitive syndrome, suggesting that AD is an insulin-resistant brain state or type 3 diabetes.10 The increased cerebral insulin resistance is due to impaired insulin signaling.10 Adequate insulin signaling is responsible for the regulation of acetylcholine production, learning, and memory, therefore, impairment of insulin
Diabetes and dementia: the risk
Diabetes increases the risk of cognitive dysfunction. Previous and recent meta-analyses have demonstrated that diabetes increased the risk of all types of dementia by almost twofold.24, 25, 26, 27, 28, 29, 30, 31 Type 1 diabetes also increases the risk of dementia by almost 80% in those older than 60 years.32 The presence of diabetes at a younger age appears to increase the risk of dementia in later life.33,34 Diabetes also increases the risk of MCI as well as its progression to dementia, which
Diabetes and dementia: clinical implications
Diabetes mellitus is a chronic condition that requires good cognitive function to execute self-care tasks, to achieve good glycemic control, and to avoid acute and long-term diabetes-related complications. With memory and executive function impairments associated with dementia, older people with comorbid diabetes and dementia will be less compliant with the prescribed regimens, have an erratic eating pattern, and are at risk of weight loss and malnutrition. In a cross-sectional study of 1398
Summary
Cognitive dysfunction is an important complication in older people with diabetes, and both index conditions may share a common pathogenic pathway. We also recognize that the global prevalence of comorbid diabetes and dementia is increasing, which poses important personal and public health issues. With the progression of dementia and the development of behavioral abnormalities, diabetes management will continue to represent a unique challenge for health care professionals.
Future research
Disclosure
The authors have nothing to disclose.
References (59)
- et al.
IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045
Diabetes Res Clin Pract
(2018) - et al.
Update on cognitive decline and dementia in elderly patients with diabetes
Diabetes Metab
(2014) - et al.
Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases
Lancet Diabetes Endocrinol
(2014) - et al.
Oral disease in relation to future risk of dementia and cognitive decline: prospective cohort study based on the Action in Diabetes and Vascular Disease: preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial
Eur Psychiatry
(2013) - et al.
Increased blood-brain barrier permeability is associated with dementia and diabetes but not amyloid pathology or APOE genotype
Neurobiol Aging
(2017) - et al.
An updated meta-analysis of cohort studies: diabetes and risk of Alzheimer’s disease
Diabetes Res Clin Pract
(2017) - et al.
Association of diabetes with amnestic and non-amnestic mild cognitive impairment
Alzheimers Dement
(2014) - et al.
Hypoglycemia is associated with dementia in elderly patients with type 2 diabetes mellitus: an analysis based on the Korea National Diabetes Program Cohort
Diabetes Res Clin Pract
(2016) - et al.
Over effective control of glycemic levels could cause cognitive decline in diabetic geriatric population
Neurol Neurosci Res
(2017) - et al.
Long-term subclinical hyperglycemia and hypoglycemia as independent risk factors for mild cognitive impairment in elderly people
Tohoku J Exp Med
(2017)
The characteristic of cognitive function in Type 2 diabetes mellitus
Diabetes Res Clin Pract
Cognitive frailty: rational and definition from an (IANA/IAGG) international consensus group
J Nutr Health Aging
Receipt of monitoring of diabetes mellitus in older adults with comorbid dementia
J Am Geriatr Soc
People living with diabetes resident in nursing homes–assessing levels of disability and nursing needs
Diabet Med
Promising strategies for the prevention of dementia
Arch Neurol
Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function
Arch Neurol
Relation of diabetes to mild cognitive impairment
Arch Neurol
Diabetes, Alzheimer disease and vascular dementia: a population-based neuropathologic study
Neurology
Is insulin resistant brain state a central feature of the metabolic cognitive syndrome?
J Alzheimers Dis
Insulin resistance and Alzheimer's disease
BMB Rep
Molecular interaction between type 2 diabetes and Alzheimer’s disease through cross-seeding of protein misfolding
Mol Psychiatry
Diabetes mellitus and Alzheimer’s disease: shared pathology and treatment?
Br J Clin Pharmacol
Brain-derived neurotrophic factor plasma levels: relationship with dementia and diabetes in the elderly population
J Gerontol A Biol Sci Med Sci
The role of cerebrovascular disease and the association between diabetes mellitus and dementia among aged Medicare beneficiaries
Int J Geriatr Psychiatry
Relationship between type 2 diabetes mellitus and cognitive change in a multi-ethnic elderly cohort
J Am Geriatr Soc
Apolipoprotein E and central nervous system disorders: reviews of clinical findings
Psychiatry Clin Neurosci
Low intakes of carotene, vitamin B2, pantothenate and calcium predict cognitive decline among elderly patients with diabetes mellitus: the Japanese Elderly Diabetes Intervention Trial
Geriatr Gerontol Int
Glucose levels and risk of dementia
N Engl J Med
Higher glucose levels associated with lower memory and reduced hippocampal microstructure
Neurology
Cited by (16)
Metabolic perspective of astrocyte dysfunction in Alzheimer's disease and type 2 diabetes brains
2023, Biomedicine and PharmacotherapyThe role of neurovascular coupling dysfunction in cognitive decline of diabetes patients
2024, Frontiers in Neuroscience