4.22 - Cognitive Dysfunction in Diabetes Mellitus

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Abstract

The brain has long been considered to be insensitive to end-organ damage in diabetes mellitus, but there is now much evidence to indicate that diabetic children and adults can manifest mild cerebral dysfunction and structural brain changes as a consequence of diabetes. This chapter delineates neurocognitive phenotypes associated with diabetes, reviewing studies that have used neuropsychological, electrophysiological, and neuroimaging techniques. The message is that there are subtle diabetes-associated cognitive decrements that can be found among patients with diabetes of all age groups and that are only slowly progressive over time. In addition, in the elderly, diabetes is associated with increased dementia risk. Further, unraveling the etiology that underlies these neurocognitive phenotypes should provide leads for treatment.

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Geert Jan Biessels is a Professor of Neurology and chairs the cerebrovascular disease and cognition program at the Department of Neurology at the Brain Center Rudolf Magnus, University Medical Centre Utrecht, the Netherlands. He received his medical training in Utrecht, obtained his PhD in 1997, and was certified as a neurologist in 2004.

The development and application of novel imaging markers to unravel the pathophysiology of vascular cognitive impairment and studies on cognition and dementia in people with diabetes are his two key areas of interest. His research group has evaluated the severity and course of development of cognitive reductions in the presence of diabetes and prediabetic stages and has identified brain MRI correlates of impaired cognition. He is currently also involved in intervention studies. In 2015 he was awarded the European Stroke Organisation (ESO) Senior Investigator Award for this work, and in 2016 he was appointed Fellow of the Royal College of Physicians Edinburgh.

His Utrecht Vascular Cognitive Impairment Study Group comprises a multidisciplinary team of researchers with backgrounds in neurology, neuropsychology, radiology, image sciences, geriatrics, epidemiology, and primary care.

Christopher Ryan is currently a professor of Psychiatry at the University of California, San Francisco (UCSF), and professor emeritus at the University of Pittsburgh School of Medicine. A clinical neuropsychologist by training, he received his PhD at the University of California, Berkeley in 1976, and completed postdoctoral training in Boston, under the direction of Dr Nelson Butters. In 1980 he joined the Department of Psychiatry at the University of Pittsburgh School of Medicine and initiated a series of research studies on cognitive function in adolescents with type 1 diabetes. His subsequent work focused on individuals with a variety of chronic conditions including diabetes, hypertension, alcoholism, hypercholesterolemia, and breast cancer, as well as exposure to neurotoxins in the workplace (solvents; heavy metals) and in utero (tobacco; alcohol; and other drugs). He has also been responsible for overseeing the longitudinal cognitive assessments of participants followed for more than 25 years in the Diabetes Control and Complications, as well as for developing cognitive assessments for several Pharma-sponsored clinical trials. His experimental research has examined the effects of acute hypo- and hyperglycemia on changes in cognition in children and adults. He has actively collaborated with multiple groups of researchers around the world and has published more than 150 peer-reviewed articles and book chapters. In addition to his active research program, he has taken on research administration responsibilities and has served as the Director of the University of Pittsburgh Institutional Review Board (IRB). He is currently the Director of the UCSF IRB, as well as the Director of the UCSF Regulatory Knowledge and Support Core within the UCSF Clinical and Translational Science Institute.

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