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Cognitive dysfunction profile and arterial stiffness in type 2 diabetes

Published:August 07, 2012DOI:https://doi.org/10.1016/j.jns.2012.07.046

      Abstract

      Background

      The causative mechanisms of type 2 diabetes (T2D) on cognitive dysfunction are still undergoing development.

      Aim

      To explore the cognitive dysfunction profile and its relation to the potential role of arterial stiffness in later middle age T2D patients.

      Methods

      We studied 37 patients with T2D (age range 45–65 years) and 22 normal controls. All participants underwent comprehensive neuropsychological assessment. The carotid-femoral pulse wave velocity (CF-PWV) measurements were taken with the PulsePen device.

      Results

      Our results showed significantly poorer performance on all tests assessing attention/executive functions and processing speed in patients with T2D. In addition to cognitive slowing T2D patients demonstrated significant deficits in almost all measures of verbal episodic memory after adjustment for age, education and blood pressure (BP) levels (p<0.05). Carotid-femoral pulse wave velocity (CF-PWV) appeared significantly higher in T2D subjects than in normal controls after adjustment for age and BP level (p<0.001). Significant relationship was observed between CF-PWV and cognitive status.

      Conclusion

      We revealed that arterial stiffness was increased and associated with cognitive impairment in T2D. The cognitive profile indicates hippocampal amnestic type mild cognitive impairment associated with a pronounced dysexecutive syndrome suggesting that diabetes may affect cognition through both vascular and neurodegenerative processes. However, neurodegenerative cognitive profile caused by hippocampal atrophy in a pure vascular process could not be excluded.

      Keywords

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      References

        • International Diabetes Federation
        IDF Diabetes Atlas. 5th edition. 2011
        • Saczynski J.S.
        • Jónsdóttir M.K.
        • Garcia M.E.
        • Jonsson P.V.
        • Peila R.
        • Eiriksdottir G.
        • et al.
        Cognitive impairment: an increasingly important complication of type 2 diabetes: the age, gene/environment susceptibility—Reykjavik study.
        Am J Epidemiol. 2008; 168: 1132-1139
        • Fontbonne A.
        • Berr C.
        • Ducimetiere P.
        • Alpérovitch A.
        Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the epidemiology of vascular aging study.
        Diabetes Care. 2001; 24: 366-370
        • Arvanitakis Z.
        • Wilson R.
        • Li Y.
        • Aggarwal N.
        • Bennett D.
        Diabetes and function in different cognitive systems in older individuals without dementia.
        Diabetes Care. 2006; 29: 560-565
        • Yaffe K.
        • Blackwell T.
        • Kanaya A.M.
        • Davidowitz N.
        • Barrett-Connor E.
        • Krueger K.
        Diabetes, impaired fasting glucose, and development of cognitive impairment in older women.
        Neurology. 2004; 63: 658-663
        • Luchsinger J.A.
        • Reitz C.
        • Patel B.
        • Tang M.
        • Manly J.J.
        • Mayeux R.
        Relation of diabetes to mild cognitive impairment.
        Arch Neurol. 2007; 64: 570-575
        • Bruce D.G.
        • Davis W.A.
        • Casey G.P.
        • Starkstein S.E.
        • Clarnette R.M.
        • Almeida O.P.
        • et al.
        Predictors of cognitive decline in older individuals with diabetes.
        Diabetes Care. 2008; 31: 2103-2107
        • Cukierman T.
        • Gerstein H.C.
        • Williamson J.D.
        Cognitive decline and dementia in diabetes: systematic overview of prospective studies.
        Diabetologia. 2005; 48: 2460-2469
        • Biessels G.J.
        Cognition in type 2 diabetes: brain imaging correlates and vascular and metabolic risk factors.
        in: Craft S. Christen Y. Diabetes, insulin and Alzheimer's disease. Springer, Heidelberg2010: 81-88
        • Peila R.
        • Rodriguez B.L.
        • Launer L.J.
        Type2 diabetes, APOE gene and the risk for dementia and related pathologies: the Honolulu–Asia Aging Study.
        Diabetes. 2002; 51: 1256-1262
        • Yeung S.E.
        • Fischer A.L.
        • Dixon R.A.
        Exploring effects of type 2 diabetes on cognitive functioning in older adults.
        Neuropsychology. 2009; 23: 1-9
        • Laurent S.
        • Cockcroft J.
        • Van Bortel L.
        • Boutouyrie P.
        • Giannattasio C.
        • Hayoz D.
        • et al.
        Expert consensus document on arterial stiffness: methodological issues and clinical applications.
        Eur Heart J. 2006; 27: 2588-2605
        • Zhang M.
        • Bai Y.
        • Ye P.
        • Luo L.
        • Xiao W.
        • Wu H.
        • et al.
        Type 2 diabetes is associated with increased pulse wave velocity measured at different sites of the arterial system but not augmentation index in a Chinese population.
        Clin Cardiol. 2011; 34: 622-627
        • Shin J.Y.
        • Lee H.R.
        • Lee D.C.
        Increased arterial stiffness in healthy subjects with high-normal glucose levels and in subjects with pre-diabetes.
        Cardiovasc Diabetol. 2011; 10: 30
        • Diabetes Association American
        Standards of medical care in diabetes.
        Diabetes Care. 2009; 32: S13-S61
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        Mini-mental state. A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Strauss E.
        • Sherman E.M.S.
        • Spreen O.
        A compendium of neuropsychological tests.
        Oxford University Press, New York2006
      1. Consensus statement on the definition of orthostatic hypertension, pure autonomic failure and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology.
        Neurology. 1996; 46: 1470-1472
        • Salvi P.
        • Lio G.
        • Labat C.
        • Ricci E.
        • Pannier B.
        • Benetos A.
        Validation of a new non-invasive portable tonometer for determining arterial pressure wave and pulse wave velocity: the PulsePen device.
        J Hypertens. 2004; 22: 2285-2293
        • Portet F.
        • Ousset P.J.
        • Visser P.J.
        • Frisoni G.B.
        • Nobili F.
        • Scheltens P.
        • et al.
        Mild cognitive impairment (MCI) in medical practice: a critical review of the concept and new diagnostic procedure. Report of the MCI Working Group of the European Consortium on Alzheimer's Disease.
        J Neurol Neurosurg Psychiatry. 2006; 77: 714-718
        • Awad N.
        • Gagnon M.
        • Messier C.
        The relationship between impaired glucose tolerance, type 2 diabetes, and cognitive function.
        J Clin Exp Neuropsychol. 2004; 26: 1044-1080
        • Debette S.
        • Seshadri S.
        • Beiser A.
        • Au R.
        • Himali J.J.
        • Palumbo C.
        • et al.
        Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline.
        Neurology. 2011; 77: 461-468
        • van de Pol L.
        • Gertz H.J.
        • Scheltens P.
        • Wolf H.
        Hippocampal atrophy in subcortical vascular dementia.
        Neurodegener Dis. 2011; 8: 465-469
        • Korf E.S.C.
        • White L.R.
        • Scheltens P.
        • Launer L.J.
        Brain aging in very old men with type 2 diabetes: the Honolulu-Asia Aging Study.
        Diabetes Care. 2006; 29: 2268-2274
        • Craft S.
        • Watson G.S.
        Insulin and neurodegenerative disease: shared and specific mechanisms.
        Lancet Neurol. 2004; 3: 169-178
        • Klein J.P.
        • Waxman S.G.
        The brain in diabetes: molecular changes in neurons and their implications for end-organ damage.
        Lancet Neurol. 2003; 2: 548-554
        • den Heijer T.
        • Vermeer S.E.
        • Dijk E.J.
        • Prins N.D.
        • Koudstaal P.J.
        • Hofman A.
        • et al.
        Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI.
        Diabetologia. 2003; 46: 1604-1610
        • Schmidt R.
        • Launer L.J.
        • Nilsson L.-G.
        • Pajak A.
        • Sans S.
        • Berger K.
        • et al.
        Magnetic resonance imaging of the brain in diabetes: the Cardiovascular Determinants of Dementia (CASCADE) Study.
        Diabetes. 2004; 53: 687-692
        • Launer L.J.
        Diabetes and the brain — an epidemiologic perspective.
        in: Craft S. Christen Y. Diabetes, insulin and Alzheimer's disease. Springer, Heidelberg2010: 73-80
        • Manschot S.M.
        • Brands A.M.A.
        • van der Grond J.
        • Kessels R.P.C.
        • Algra A.
        • Kappelle L.J.
        • et al.
        Brain magnetic resonance imaging correlates of impaired cognition in patients with type 2 diabetes.
        Diabetes. 2006; 55: 1106-1113
        • de la Monte S.M.
        Insulin resistance and Alzheimer's disease.
        BMB Rep. 2009; 42: 475-481
        • Gregg E.W.
        • Yaffe K.
        • Cauley J.A.
        • Rolka D.B.
        • Blackwell T.L.
        • Narayan K.M.
        • et al.
        Is diabetes associated with cognitive impairment and cognitive decline among older women?.
        Arch Intern Med. 2000; 160: 174-180
        • Munshi M.
        • Grande L.
        • Hayes M.
        • Ayres D.
        • Suhl E.
        • Capelson R.
        • et al.
        Cognitive dysfunction is associated with poor diabetes control in older adults.
        Diabetes Care. 2006; 29: 1794-1799