Mild Cognitive Impairment among Type II Diabetes Mellitus Patients Attending University Teaching Hospital
DOI:
https://doi.org/10.3889/oamjms.2020.4245Keywords:
Diabetic, Non-diabetic, Mild cognitive impairment, Montreal cognitive assessment, Healthy, LifestyleAbstract
BACKGROUND: Type II diabetes mellitus (TIIDM) has been associated with structural and functional changes in the brain. TIIDM is commonly associated with obesity, insulin resistance, hypertension, and dyslipidemia, all of which can have negative impact on brain.
AIM: The aim of the study was to study the risk of mild cognitive impairment (MCI) among both diabetics and non-diabetics and to identify risk factors to MCI among both groups.
METHODS: Two comparative cross-sectional studies were carried out enrolling 100 diabetics and 100 age, sex, and education matching non-diabetics. Cognitive function was assessed using Montreal Cognitive Assessment (MoCA) test and risk factors for MCI were assessed.
RESULTS: The subjective complaint of memory impairment among diabetics was significantly higher (34%) compared to non-diabetics (13.0%), p < 0.05. The mean of objective MoCA score was significantly lower among diabetics (25.9 ± 2.5) compared to non-diabetics (27.4 ± 2.4), p < 0.001. The rate of MCI was significantly higher among TIIDM patients (22%) compared to non-diabetics (9%), p < 0.01 and odds ratio (OR) 2.8 (95% confidence interval 1.2–6.5). Among the two studied groups, the rate of MCI was significantly higher among those aged over 50 years compared to younger age as well as among hypertensive compared to non-hypertensive persons, (p < 0.05). Among diabetics, the MCI was significantly higher among those with secondary education, having heart diseases, longer duration of DM, or repeated hypoglycemia attack, p < 0.05. A healthy diet, brain training, and social activities were found to be significantly associated with normal cognition. Logistic analysis revealed that diabetics aged above 50 was the only significant predicting factor for MCI with an OR 2.9 (95% CI: 3.8–123.3), p < 0.001.
CONCLUSION: TIIDM is significantly associated with 3-times increasing risk of having MCI compared to non-diabetics. The age, hypertension, cardiovascular diseases, duration of diabetes, and frequency of hypoglycemic episodes are risk factors for cognitive impairment. A healthy diet, brain training, and social activities were associated with better cognitive function.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Sheinerman KS, Tsivinsky VG, Abdullah L, Crawford F, Umansky SR. Plasma microRNA biomarkers for detection of mild cognitive impairment: Biomarker validation study. Aging (Albany NY). 2013;5(12):925-38. https://doi.org/10.18632/aging.100624 PMid:24368295
Kayano M, Higaki S, Satoh J, Matsumoto K, Matsubara E, Takikawa O, et al. Plasma microRNA biomarker detection for mild cognitive impairment using differential correlation analysis. Biomark Res. 2016;4:22. https://doi.org/10.1186/ s40364-016-0076-1 PMid:27999671.
Zhao X, Han Q, Lv Y, Sun L, Gang X, Wang G. Biomarkers for cognitive decline in patients with diabetes mellitus: Evidence from clinical studies. Oncotarget. 2017;9(7):7710-26. https://doi. org/10.18632/oncotarget.23284 PMid:29484146
Lisi DM. Diabetes and the psychiatric patient. US Pharm. 2010;35(11):62-79.
King H, Rewers M. Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. WHO Ad Hoc Diabetes Reporting Group. Diabetes Care. 1993;16(1):157-77. https://doi.org/10.2337/diacare.16.1.157 PMid:8123057
International Diabetes Federation. Diabetes Atlas. 9th ed. Brussels, Belgium: International Diabetes Federation; 2019. Available from: https://www.diabetesatlas.org/en/sections/ demographic-and-geographic-outline.html.
Hegazi R, El-Gamal M, Abdel-Hady N, Hamdy O. Epidemiology of and risk factors for Type 2 diabetes in Egypt. Ann Glob Health. 2015;81(6): 814-20. https://doi.org/10.1016/j.aogh.2015.12.011 PMid:27108148
Feinkohl I, Price JF, Strachan MW, Frier BM. The impact of diabetes on cognitive decline, potential vascular, metabolic, and psychosocial risk factors. Alzheimers Res Ther. 2015;7(1):46. https://doi.org/10.1186/s13195-015-0130-5 PMid:26060511
Munshi MN. Cognitive dysfunction in older adults with diabetes: What a clinician needs to know. Diabetes Care. 2017;40(4):461-7. https://doi.org/10.2337/dc16-1229 PMid:28325796
Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the national institute on aging Alzheimer’s association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):270-9. https://doi.org/10.1016/j. jalz.2011.03.008 PMid:21514249
Lara E, Koyanagi A, Olaya B, Lobo A, Tyrovolas S, Ayuso- Mateos JL, et al. Mild cognitive impairment in a Spanish representative sample: Prevalence and associated factors. Int J Geriatr Psychiatry. 2016;31(8):858-67. https://doi.org/10.1002/ gps.4398 PMid:26923809
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-9. https://doi. org/10.1111/j.1532-5415.2005.53221.x PMid:15817019
Nasreddine ZS. The Montreal Cognitive Assessment (MoCA). Available from: http://www.mocatest.org. [Last accessed on 2016 Jan 12].
Dalrymple-Alford JC, MacAskill MR, Nakas CT, Livingston L, Graham C, Crucian GP, Melzer TR, et al. The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology. 2010;75(19):1717-25. https://doi.org/10.1212/ wnl.0b013e3181fc29c9 PMid:21060094
Ojo O, Brooke J. Evaluating the association between diabetes, cognitive decline and dementia. Int J Environ Res Public Health. 2015;12:8281-94. https://doi.org/10.3390/ijerph120708281 PMid:26193295
Li W, Sun L, Li G, Xiao S. Prevalence, influence factors and cognitive characteristics of mild cognitive impairment in Type 2 diabetes mellitus. Front Aging Neurosci. 2019;11:180. https://doi.org/10.3389/fnagi.2019.00180 PMid:31417393
Peng J, Qu H, Peng J, Luo TY, Lv FJ, Wang ZN. Abnormal spontaneous brain activity in Type 2 diabetes with and without microangiopathy revealed by regional homogeneity. Eur J Radiol. 2016;85(3):607-15. https://doi.org/10.1016/j.ejrad.2015.12.024 PMid:26860674
Gao Y, Xiao Y, Miao R, Zhao J, Cui M, Huang G, et al. The prevalence of mild cognitive impairment with Type 2 diabetes mellitus among elderly people in China: A cross-sectional study. Arch Gerontol Geriatr. 2016;62:138-142. https://doi. org/10.1016/j.archger.2015.09.003 PMid:26381432
Salama II, Rabah TM, Salama SI, Elmosalami DM, Saleh RM. Obesity and predictors affecting occurrence of mild cognitive impairment. Res J Pharm Biol Chem Sci. 2018;9(1):748-56.
Ding D, Zhao O, Guo O, Meng H, Wang B, Luo J, et al. Prevalence of mild cognitive impairment in an urban community in China: A cross-sectional analysis of the Shanghai aging study. Alzheimers Dement. 2015;11(3):300-9.e2. https://doi. org/10.1016/j.jalz.2013.11.002 PMid:24613707
Khater MS, Abouelezz NF. Nutritional status in older adults with mild cognitive impairment living in elderly homes in Cairo, Egypt. J Nutr Health Aging. 2011;15(2):104-8. https://doi. org/10.1007/s12603-011-0021-9 PMid:21365162
Amer M, Khater MS, Mousa S, Abdelwahab W. Prevalence of mild cognitive impairment among older adults living in Mansoura city, Egypt. Middle East Curr Psychiatry. 2012;19(1):3-7. https:// doi.org/10.1097/01.xme.0000407821.18381.3c PMid:25471192
Salinas RM, Hiriart M, Acosta I, Sosa AL, Prince MJ. Type 2 diabetes mellitus as a risk factor for dementia in a Mexican population. J Diabetes Complications. 2016;30(7):1234-9. https://doi.org/10.1016/j.jdiacomp.2016.06.005 PMid:27344092
Mindy JK, Erin E, Richard P. Sex differences in the relationship between depressive symptoms and risk of amnestic mild cognitive impairment. Am J Geriatric Psychiatry. 2016;11(7):19-23. PMid:27986237
Roberts RO, Knopman DS, Cha RH, Mielke MM, Pankratz VS, Boeve BF, et al. Diabetes and elevated hemoglobin A1C levels are associated with brain hypometabolism but not amyloid accumulation. J Nucl Med. 2014;55(5):759-64. https://doi. org/10.2967/jnumed.113.132647 PMid:24652830
Tuligenga RH, Dugravot A, Tabák AG, Elbaz A, Brunner EJ, Kivimäki M, et al. Midlife Type 2 diabetes and poor glycaemic control as risk factors for cognitive decline in early old age: A post-hoc analysis of the Whitehall II cohort study. Lancet Diabetes Endocrinol. 2014;2(3):228-35. https://doi.org/10.1016/ s2213-8587(13)70192-x PMid:24622753
Feinkohl I, Aung PP, Keller M, Robertson CM, Morling JR, McLachlan S, et al. Severe hypoglycemia and cognitive decline in older people with Type 2 diabetes: The Edinburgh Type 2 diabetes study. Diabetes Care. 2014;37(2):507-15. https://doi. org/10.2337/dc13-1384 PMid:24103900
Lin CH, Sheu WH. Hypoglycaemic episodes and risk of dementia in diabetes mellitus: 7-year follow-up study. J Intern Med. 2013;273(1):102-10. https://doi.org/10.1111/joim.12000 PMid:23003116
Chen RH, Jiang XZ, Zhao XH, Qin YL, Gu Z, Zhou B, et al. Risk factors of mild cognitive impairment in middle aged patients with Type 2 diabetes: A cross section study. Ann Endocrinol. 2012;73(2):208-12. https://doi.org/10.1016/j.ando.2012.04.009 PMid:22704263
Weinstein AA, de Avila L, Paik J, Escheik C, Gerber L, Younossi ZM. Cognitive performance in individuals with non alcoholic fatty liver disease and/or Type 2 diabetes mellitus. Psychosomatics. 2018;59(6):567-74. https://doi.org/10.1016/j. psym.2018.06.001 PMid:30086995
Daly E, Zaitchik D, Copeland M, Schmahmann J, Gunther J, Albert M. Predicting conversion to Alzheimer disease using standardized clinical information. Arch Neurol. 2000;57(5):675- 80. https://doi.org/10.1001/archneur.57.5.675 PMid:10815133
Rawlings AM, Juraschek SP, Heiss G, Hughes T, Meyer ML, Selvin E, et al. Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline. Neurology. 2018;91(8):e759-68. https://doi.org/10.1212/ wnl.0000000000006027 PMid:30045960
Devore E, Grodstein F, Hofman A. Dietary antioxidants and long-term risk of dementia. Arch Neurol. 2010;67(7):819-25. PMid:20625087
Ylilauri MP, Voutilainen S, Lönnroos E, Mursu J, Virtanen HE, Koskinen TT, et al. Association of dietary cholesterol and egg intakes with risk of incident dementia or Alzheimer’s disease: The Kuopio Ischaemic heart disease risk factor study. Am J Clin Nutr. 2017;105(2):476-84. https://doi.org/10.3945/ ajcn.116.146753 PMid:28052883
Park KM, Fulgoni VL 3rd. The association between dairy product consumption and cognitive function in the national health and nutrition examination survey. Br J Nutr. 2013;109(6):1135-42. https://doi.org/10.1017/s0007114512002905 PMid:23168329
Qin B, Plassman BL, Edwards LJ, Popkin BM, Adair LS, Mendez MA. Fish intake is associated with slower cognitive decline in Chinese older adults. J Nutr. 2014;144(10):1579-85. https://doi.org/10.3945/jn.114.193854 PMid:25080536
Modugula SNS, Srinivasa SV, Abhishek KV, Prabhakar K. Study of risk factors of mild cognitive impairment in patients with Type 2 diabetes mellitus. Int J Sci Res Publ. 2017;7(11):2250-3153. PMid:30655669
Shankar A, Hamer M, McMunn A, Steptoe A. Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English longitudinal study of ageing. Psychosom Med. 2013;75(2):161-70. https://doi.org/10.1097/ psy.0b013e31827f09cd PMid:23362501
Choi Y, Park S, Cho KH, Chun SY, Park EC. A change in social activity affect cognitive function in middle-aged and older Koreans: Analysis of a Korean longitudinal study on aging (2006-2012). Int J Geriatr Psychiatry. 2016;31(8):912-9. https:// doi.org/10.1002/gps.4408 PMid:26833847
Fu C, Li Z, Mao Z. Association between social activities and cognitive function among the elderly in China: A cross-sectional study. Int J Environ Res Public Health. 2018;15(2):E231. https:// doi.org/10.3390/ijerph15020231 PMid:29385773
Sattler C, Toro P, Schönknecht P, Schröder J. Cognitive activity, education and socioeconomic status as preventative factors for mild cognitive impairment and Alzheimer’s disease. Psychiatry Res. 2012;196(1):90-5. https://doi.org/10.1016/j.psychres.2011.11.012 PMid:22390831
Li W, Wang T, Xiao S. Type 2 diabetes mellitus might be a risk factor for mild cognitive impairment progressing to Alzheimer’s disease. Neuropsychiatr Dis Treat. 2016;12:2489-95. https:// doi.org/10.2147/ndt.s111298 PMid:27729793
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2020 Ghada A. Abdellatif, Azza M. Hassan, Mohamed S. Gabal, Samia A. Hemeda, Nada H. El-Chami, Iman I. Salama (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0