Yeungnam Univ J Med.  2019 Sep;36(3):183-191. 10.12701/yujm.2019.00255.

Cognitive dysfunctions in individuals with diabetes mellitus

• Kim HG

• KMID: 2460186
• DOI: http://doi.org/10.12701/yujm.2019.00255

Abstract

Some patients with type 1 and type 2 diabetes mellitus (DM) present with cognitive dysfunctions. The pathophysiology underlying this complication is not well understood. Type 1 DM has been associated with a decrease in the speed of information processing, psychomotor efficiency, attention, mental flexibility, and visual perception. Longitudinal epidemiological studies of type 1 DM have indicated that chronic hyperglycemia and microvascular disease, rather than repeated severe hypoglycemia, are associated with the pathogenesis of DM-related cognitive dysfunction. However, severe hypoglycemic episodes may contribute to cognitive dysfunction in high-risk patients with DM. Type 2 DM has been associated with memory deficits, decreased psychomotor speed, and reduced frontal lobe/executive function. In type 2 DM, chronic hyperglycemia, long duration of DM, presence of vascular risk factors (e.g., hypertension and obesity), and microvascular and macrovascular complications are associated with the increased risk of developing cognitive dysfunction. The pathophysiology of cognitive dysfunction in individuals with DM include the following: (1) role of hyperglycemia, (2) role of vascular disease, (3) role of hypoglycemia, and (4) role of insulin resistance and amyloid. Recently, some investigators have proposed that type 3 DM is correlated to sporadic Alzheimer's disease. The molecular and biochemical consequences of insulin and insulin-like growth factor resistance in the brain compromise neuronal survival, energy production, gene expression, plasticity, and white matter integrity. If patients claim that their performance is worsening or if they ask about the effects of DM on functioning, screening and assessment are recommended.

Keyword

Alzheimer’s disease; Cognition; Dementia; Diabetes

MeSH Terms

Amyloid
Automatic Data Processing
Brain
Cognition
Dementia
Diabetes Mellitus*
Diabetes Mellitus, Type 2
Epidemiologic Studies
Gene Expression
Humans
Hyperglycemia
Hypertension
Hypoglycemia
Insulin
Insulin Resistance
Mass Screening
Memory Disorders
Neurons
Plastics
Pliability
Research Personnel
Risk Factors
Vascular Diseases
Visual Perception
White Matter
Amyloid
Insulin
Plastics

Figure

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  Fig. 1. Factors affecting cognitive dysfunction in type 1 DM. Chronic hyperglycemia and coronary microvascular disease, rather than repeated severe hypoglycemia, are associated with the pathogenesis of diabetes-related cognitive dysfunction in type 1 DM. Diagnosis of type 1 DM at a younger age (<4 years) is associated with an increased risk of cognitive dysfunction. DM, diabetes mellitus.

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  Fig. 2. Factors affecting cognitive dysfunction in type 2 DM. Chronic hyperglycemia, long duration of diabetes, presence of vascular risk factors (e.g., hypertension and obesity), and microvascular and macrovascular complications are associated with an increased risk of developing cognitive dysfunction in type 2 DM. Some authors have claimed that AD is type 3 DM with a combination of insulin deficiency and insulin resistance, particularly in patients with sporadic AD without the APOE e4 allele. DM, diabetes milletus; AD, Alzheimer’s disease; APOE, apolipoprotein E.

Reference

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