Abstract
Background: Diabetes is a complex metabolic disease with devastating effects on multiple organ systems, including the brain. The latter complication is often referred to as "diabetic encephalopathy" and is characterized by mild to moderate impairments in cognitive function , associated with an increased risk of dementia .The aim of our study was to characterize the clinical profile of patients newly diagnosed with Type2 Diabetes (within six months of onset) and to assess the dementia score of these patients by MMSE(Mini Mental state examination) at presentation and to find out the prevalence of cognitive impairment in this population. Also an attempt was made to study the relation of glycemic control with the dementia scores. These patients were also followed up at one year to assess their MMSE scores.
Materials and Methods: 140 patients, newly detected with Type2 Diabetes (within six months of onset) were enrolled in the study. Clinical details were obtained with a structured proforma. MMSE scores of the patients were measured at baseline and after one year. The baseline MMSE score was compared with the clinical profile of these patients.
Results: The mean age of the cases were 56.5 years with slightly higher male predilection (M:F=1.41:1). On detailed evaluation hypertension was seen in 55%, Coronary artery disease in 35.7%, dyslipidemia in 36.4% , alcoholism in 44.1%, and smoking in 45% of cases. There were also microvascular complications like Diabetic Nephropathy in 17.1%, Diabetic Retinopathy in 10.7% of cases. Most of the cases had poor metabolic control with 75.7% having FBS of >130, 68.6% having PPBS >180 and 78.6% having HbA1c >7. The mean MMSE score at baseline were 24.1 and at one year were 24.6. There was statistically significant difference in dementia scores as assessed by MMSE at baseline and one year in our cases (p<0.001).The prevalence of cognitive dysfunction as assessed by MMSE was 30%. There was a statistically significant fall in MMSE with presence of Diabetic Nephropathy (MMSE p=0.002) and Diabetic Retinopathy (MMSE p=0.004). Poor glycemic control was linked statistically to a low MMSE score. For lower MMSE score there was a statistically significant increase in the PPBS values (MMSE,p=0.013) and HbA1c levels (MMSE score,p=0.002).
Conclusion: A significant proportion (30%) of newly diagnosed Type2 Diabetes (within 6 months) patients had impairment of cognitive function. Cognitive dysfunction in patients with Type2 Diabetes was directly related to poor glycemic status. Among the glycemic targets, Post prandial blood glucose values and HbA1C had better correlation with cognitive decline than Fasting plasma glucose levels. Presence of microvascular complications of Type2 Diabetes such as Nephropathy and Retinopathy predicted cognitive decline. No definite association was seen between cognitive dysfunction and macrovascular disease especially Coronary artery disease in newly diagnosed Type 2 Diabetes. Cognitive dysfunction was independent of other vascular risk factors such as Hypertension, Dyslipidemia and Smoking. Adequate glycemic control in early stages of Type 2 Diabetes may result in improvement in cognitive function.
Keywords: Type2 Diabetics, MMSE, Cognitive decline, Glycemic control.
References
- Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res. 2007 Mar;125(3):217–30.
- Awad N, Gagnon M, Messier C. The relationship between impaired glucose tolerance, type 2 diabetes, and cognitive function. J Clin Exp Neuropsychol. 2004 Nov;26(8):1044–80.
- Reis F, Soares, Nunes, Pereira. Diabetic encephalopathy: the role of oxidative stress and inflammation in type 2 diabetes. Int J Interferon Cytokine Mediat Res. 2012 Sep;75.
- Draelos MT, Jacobson AM, Weinger K, Widom B, Ryan CM, Finkelstein DM, et al. Cognitive function in patients with insulin-dependent diabetes mellitus during hyperglycemia and hypoglycemia. Am J Med. 1995 Feb;98(2):135–44.
- Rösen P, Nawroth PP, King G, Möller W, Tritschler HJ, Packer L. The role of oxidative stress in the onset and progression of diabetes and its complications: a summary of a Congress Series sponsored by UNESCO-MCBN, the American Diabetes Association and the German Diabetes Society. Diabetes Metab Res Rev. 2001 Jun;17(3):189–212.
- Taylor VH, MacQueen GM. Cognitive dysfunction associated with metabolic syndrome. Obes Rev Off J Int Assoc Study Obes. 2007 Sep;8(5):409–18.
- Perlmuter LC, Hakami MK, Hodgson-Harrington C, Ginsberg J, Katz J, Singer DE, et al. Decreased cognitive function in aging non-insulin-dependent diabetic patients. Am J Med. 1984 Dec;77(6): 1043–8.
- Kent S. Is diabetes a form of accelerated aging? Geriatrics. 1976 Nov;31(11):140, 145, 149–51.
- Kahle-Wrobleski K, Corrada MM, Li B, Kawas CH. Sensitivity and Specificity of the Mini-Mental State Examination for Identifying Dementia in the Oldest-Old: The 90+ Study. J Am Geriatr Soc. 2007 Feb;55(2):284–9.
- Priyam M,Srijan M, Soumik G, Jayeeta B, Subhro C, Sumanto M ,et al. Cognitive dysfunction in diabetic patients with special reference to age of onset, duration and control of diabetes.
- Reaven GM, Thompson LW, Nahum D, Haskins E. Relationship between hypergly-cemia and cognitive function in older NIDDM patients. Diabetes Care. 1990 Jan;13(1):16–21.
- Ott A, Stolk RP, van Harskamp F, Pols HA, Hofman A, Breteler MM. Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology. 1999 Dec 10;53(9):1937–42.
- Ruis C, Biessels GJ, Gorter KJ, Donk M van den, Kappelle LJ, Rutten GEHM. Cognition in the Early Stage of Type 2 Diabetes. Diabetes Care. 2009 Jul 1;32(7):1261–5.
- Cohort Profile: The Doetinchem Cohort Study [Internet]. [cited 2015 Nov 14]. Available from: http://ije.oxfordjournals.org/content/37/6/1236.full
- Agarwal N, Sengar NS, Jain PK, Khare R. Nephropathy in newly diagnosed type 2 diabetics with special stress on the role of hypertension. J Assoc Physicians India. 2011 Mar;59:145–7.
- Barzilay JI, Lovato JF, Murray AM, Williamson J, Ismail-Beigi F, Karl D, et al. Albuminuria and cognitive decline in people with diabetes and normal renal function. Clin J Am Soc Nephrol CJASN. 2013 Nov;8(11):1907–14.
- de Bresser J, Reijmer YD, van den Berg E, Breedijk MA, Kappelle LJ, Viergever MA, et al. Microvascular determinants of cognitive decline and brain volume change in elderly patients with type 2 diabetes. Dement Geriatr Cogn Disord. 2010;30(5):381–6.
- Abdollahi MHM. Prevalence of diabetic retinopathy in patients with newly diagnosed type II diabetes mellitus. Acta Med Iran. 2006;44(6).
- Lee KMC, Sum WMR. Prevalence of diabetic retinopathy in patients with recently diagnosed diabetes mellitus. Clin Exp Optom. 2011 Jul;94(4):371–5.
- Crosby-Nwaobi RR, Sivaprasad S, Amiel S, Forbes A. The relationship between diabetic retinopathy and cognitive impairment. Diabetes Care. 2013 Oct;36(10):3177–86.
- Prevalence and Pattern of Cognitive Dysfunction In Type 2 Diabetes Mellitus JuniorResident JuniorResident [Internet]. [cited 2015 Nov 14]. Available from: http://www.academia.edu/5260180/PREVALENCE_AND_PATTERN_OF_COGNITIVE_DYSFUNCTION_IN_TYPE_2_DIABETES_MELLITUS_JuniorResident_JuniorResident
- O Eze C. The Prevalence of Cognitive Impairment amongst Type 2 Diabetes Mellitus Patients at Abakaliki South-East Nigeria. J Metab Syndr [Internet]. 2015 [cited 2015 Nov 14];04(01). Available from: http://www.omicsgroup.org/journals/the-prevalence-of-cognitive-impairment-amongst-type-2-diabetes-mellituspatients-at-abakaliki-southeast-nigeria-2167-0943-1000171.php?aid=44861
- Tiwari SC, Tripathi RK, Farooqi SA, Kumar R, Srivastava G, Kumar A. Diabetes mellitus: A risk factor for cognitive impairment amongst urban older adults. Ind Psychiatry J. 2012;21(1):44–8.
- Ohara T, Doi Y, Ninomiya T, Hirakawa Y, Hata J, Iwaki T, et al. Glucose tolerance status and risk of dementia in the community: the Hisayama study. Neurology. 2011 Sep 20;77(12):1126–34.
- Ravona-Springer R, Moshier E, Schmeidler J, Godbold J, Akrivos J, Rapp M, et al. Changes in Glycemic Control are Associated with Changes in Cognition in Non-Diabetic Elderly. J Alzheimers Dis JAD. 2012;30(2):299–309.
- Meneilly GS, Cheung E, Tessier D, Yakura C, Tuokko H. The effect of improved glycemic control on cognitive functions in the elderly patient with diabetes. J Gerontol. 1993 Jul;48(4): M117–21.
- Launer LJ, Miller ME, Williamson JD, Lazar RM, Gerstein HC, Murray AM, et al. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy. Lancet Neurol. 2011 Nov;10(11):969–77.
- Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME, et al. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care. 2009 Feb;32(2):221–6.
- Tuligenga RH. Intensive glycaemic control and cognitive decline in patients with type 2 diabetes: a meta-analysis. Endocr Connect. 2015 Jun 1;4(2):R16–24.
Corresponding Author
Dr Sunil Prasobh P
Department of Internal Medicine, Government Medical College Thiruvananthapuram-695011, Kerala, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.05
