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Yingxu L, Tan X, Fangyi L. Risk factors for mild cognitive impairment in type 2 diabetes mellitus older adult: a systematic review and meta-analysis. J Psychiatr Res 2025; 186:445-457. [PMID: 40318537 DOI: 10.1016/j.jpsychires.2025.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 04/15/2025] [Accepted: 04/21/2025] [Indexed: 05/07/2025]
Abstract
AIMS Numerous of evidence suggest that older adults with diabetes are more likely to experience mild cognitive impairment (MCI), therefore identifying risk factors is crucial. Thus, the purpose of this study was to investigate the risk factors for the development of MCI in older diabetics. METHODS The MEDLINE, Web of Science, Scopus, and Embase databases were searched for pertinent research on the risk factors for the beginning of MCI. The remaining studies were assessed using predetermined inclusion and exclusion criteria after duplicate studies were eliminated. The Comprehensive Meta-Analysis software (version 2) was used to analyze the data. The Egger test was used to examine publication bias, while the I-square statistic was used to evaluate study heterogeneity. 95 % confidence limits and odds ratios were used in the analysis. RESULTS Thirty studies were authorized for assessment and statistical analysis using the systematic review procedure. These studies' findings indicate that, using both univariate and multivariate analyses, the odds ratio for the occurrence of MCI in older people with diabetes is higher for factors like low educational attainment (univariate analysis: OR = 0.706, CI95 %: 0.622-0.801, P ≤ 0.001 and multivariate analysis: OR = 0.753, CI95 %: 0.637-0.831, P = 0.001), duration of diabetes (univariate analysis: OR = 1.249, CI95 %: 1.111-1.405, P ≤ 0.001 and multivariate analysis: OR = 1.174, CI95 %: 1.006-1.370, P = 0.042), abnormal Hemoglobin A1c (HbA1C) levels (univariate analysis: OR = 1.744, CI95 %: 1.277-2.383, P ≤ 0.001 and multivariate analysis: OR = 1.248, CI95 %: 1.091-1.427, P ≤ 0.001), retinopathy(OR = 2.163, CI95 %: 1.686-2.776, P ≤ 0.001), nephropathy(OR = 1.568, CI95 %: 1.151-2.135, P = 0.004), neuropathy(OR = 1.334, CI95 %: 0.686-2.591, P = 0.396), depression(univariate analysis: OR = 1.649, CI95 %: 1.016-2.841, P = 0.046, and multivariate analysis: OR = 1.957, CI95 %: 1.322-2.856, P ≤ 0.001), and stroke(univariate analysis: OR = 1.820, CI95 %: 1.172-2.827, P = 0.008. multivariate analysis: OR = 1.496, CI95 %: 1.184-1.899, P = 0.001). Furthermore, univariate data analysis revealed that age(OR = 1.067, CI95 %: 1.011-1.126, P = 0.019), high total cholesterol(OR = 0.934, CI95 %: 0.866-1.008, P = 0.076), fasting blood sugar(OR = 1.129, CI95 %: 1.017-1.254, P = 0.023), the presence of hypertension(OR = 1.572, CI95 %: 1.147-2.155, P = 0.005), and kidney disease(OR = 1.676, CI95 %: 0.972-2.89, P = 0.063), all affect the odds ratio for the development of MCI in older adults with diabetes. CONCLUSION factors like low education, long-term diabetes, abnormal HbA1C levels, retinopathy, nephropathy, depression, and stroke, as well as high total cholesterol, fasting blood glucose, high blood pressure, and kidney disease, increase the risk of developing MCI in older diabetics. These cases in diabetic patients require special attention.
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Affiliation(s)
- Liu Yingxu
- Department of Endocrinology, Yancheng Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, 224000, China; Department of Endocrinology, Yancheng Traditional Chinese Medicine Hospital, Yancheng, 224000, China
| | - Xinyu Tan
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Li Fangyi
- Department of Endocrinology, Yancheng Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, 224000, China; Department of Endocrinology, Yancheng Traditional Chinese Medicine Hospital, Yancheng, 224000, China.
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Mao S, Wang Y. Risk factors for cognitive decline in type 2 diabetes mellitus adults: a systematic review and meta-analysis. Mol Cell Biochem 2025:10.1007/s11010-025-05306-y. [PMID: 40399638 DOI: 10.1007/s11010-025-05306-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 05/04/2025] [Indexed: 05/23/2025]
Abstract
Cognitive decline (CD) is a common disorder in patients with type 2 diabetes mellitus (T2DM), which is affected by various factors. The present study aimed to investigate the factors affecting its occurrence CD in patients T2DM. The PubMed, Web of Science, Scopus, and Embase databases were searched for pertinent research on the risk factors for the beginning of CD. The remaining studies were assessed using predetermined inclusion and exclusion criteria after duplicate studies were eliminated. The Comprehensive Meta-Analysis software (version 2) was used to analyze the data. The Egger test and Begg and Mazumdar test was used to examine publication bias, while the I-square statistic was used to evaluate study heterogeneity. 95% confidence limits and odds ratios were used in the analysis. 40 studies were authorized for assessment and statistical analysis using the systematic review procedure. These studies' findings indicate that, using both crude and adjusted analyses, the odds ratio for the occurrence of CD in people with diabetes is higher for factors like low educational attainment, men, abnormal Hemoglobin A1c (HbA1C) levels, physical inactivity, depression, and stroke. Factors like low education, abnormal HbA1C levels, depression, and stroke as well increase the risk of developing CD in diabetic patients. These cases in diabetic patients require special attention.
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Affiliation(s)
- Shengcheng Mao
- Department of Endocrinology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yingmin Wang
- Department of Endocrinology, Tongde Hospital of Zhejiang Province, Hangzhou, China.
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Cao X, Peng H, Hu Z, Xu C, Ning M, Zhou M, Mi Y, Yu P, Fazekas-Pongor V, Major D, Ungvari Z, Fekete M, Lehoczki A, Guo Y. Exploring the global impact of obesity and diet on dementia burden: the role of national policies and sex differences. GeroScience 2025; 47:1345-1360. [PMID: 39612068 PMCID: PMC11872863 DOI: 10.1007/s11357-024-01457-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 11/24/2024] [Indexed: 11/30/2024] Open
Abstract
Obesity is a significant modifiable risk factor for dementia. This study aims to quantify the global impact of obesity on dementia burden and examine how national strategies for managing overweight/obesity and dietary factors influence dementia prevalence and mortality, with a focus on sex-specific differences. We used data from the Global Burden of Disease (GBD) and World Health Organization (WHO) to evaluate the association between obesity age-standardized prevalence rate (ASPR) and dementia age-standardized mortality rate (ASMR) and ASPR across 161 countries. A two-step multivariate analysis adjusted for socioeconomic and lifestyle factors was performed. Temporal trends in dementia were analyzed based on the presence of national obesity management strategies and varying dietary scores. A 1% increase in national obesity prevalence was associated with a 0.36% increase in dementia mortality (OR: 1.0036; 95% CI: 1.0028-1.0045) in males and 0.12% in females (OR: 1.0012; 95% CI: 1.0007-1.0018). A 1% increase in national obesity ASPR was associated with an increase in ASPR of dementia by 0.26% for males (OR: 1.0026, 95% CI: 1.0024-1.0028) and 0.05% for females (OR: 1.0005, 95% CI: 1.0004-1.0006). Males exhibited a higher susceptibility to obesity-related dementia. Countries with national obesity management strategies showed a significantly greater reduction in dementia mortality, particularly among females (P = 0.025). Higher dietary scores were associated with a more significant decrease in dementia prevalence across both sexes. Rising obesity prevalence is linked to increased dementia burden globally, with males being more vulnerable to this relationship. National management of overweight/obesity and healthier dietary habits may help mitigate the dementia burden, emphasizing the need for integrated public health interventions.
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Affiliation(s)
- Xueshan Cao
- Department of Occupational Health and Environmental Health, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huiyuan Peng
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ziyi Hu
- Mingde Innovation Class, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chang Xu
- Mingde Innovation Class, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Monan Ning
- Mingde Innovation Class, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Mengge Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yuanqi Mi
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Peixin Yu
- School of Arts and Science, Washington University in St. Louis, St. Louis, MO, USA
| | - Vince Fazekas-Pongor
- Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary
| | - David Major
- Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Monika Fekete
- Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary
| | - Andrea Lehoczki
- Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Program, Semmelweis University, Budapest, Hungary
| | - Yang Guo
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, Hebei, China.
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Cao X, Wang M, Zhou M, Mi Y, Fazekas-Pongor V, Major D, Lehoczki A, Guo Y. Trends in prevalence, mortality, and risk factors of dementia among the oldest-old adults in the United States: the role of the obesity epidemic. GeroScience 2024; 46:4761-4778. [PMID: 38696055 PMCID: PMC11336039 DOI: 10.1007/s11357-024-01180-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/25/2024] [Indexed: 08/22/2024] Open
Abstract
The oldest-old population, those aged ≥ 80 years, is the fastest-growing group in the United States (US), grappling with an increasingly heavy burden of dementia. We aimed to dissect the trends in dementia prevalence, mortality, and risk factors, and predict future levels among this demographic. Leveraging data from the Global Burden of Disease Study 2019, we examined the trends in dementia prevalence, mortality, and risk factors (with a particular focus on body mass index, BMI) for US oldest-old adults. Through decomposition analysis, we identified key population-level contributors to these trends. Predictive modeling was employed to estimate future prevalence and mortality levels over the next decade. Between 1990 and 2019, the number of dementia cases and deaths among the oldest-old in the US increased by approximately 1.37 million and 60,000 respectively. The population growth and aging were highlighted as the primary drivers of this increase. High BMI emerged as a growing risk factor. Females showed a disproportionately higher dementia burden, characterized by a unique risk factor profile, including BMI. Predictions for 2030 anticipate nearly 4 million dementia cases and 160,000 related deaths, with a marked increase in prevalence and mortality anticipated among those aged 80-89. The past 30 years have witnessed a notable rise in both the prevalence and mortality of dementia among the oldest-old in the US, accompanied by a significant shift in risk factors, with obesity taking a forefront position. Targeted age and sex-specific public health strategies that address obesity control are needed to mitigate the dementia burden effectively.
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Affiliation(s)
- Xueshan Cao
- Department of Occupational Health and Environmental Health, School of Public Health, Hebei Key Laboratory of Environment and Human Health , Hebei Medical University, Shijiazhuang, Hebei, China
| | - Minmin Wang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Mengge Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yuanqi Mi
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - David Major
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Andrea Lehoczki
- Department of Public Health, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Program, Semmelweis University, Budapest, Hungary
- Department of Haematology and Stem Cell Transplantation, National Institute for Haematology and Infectious Diseases, South Pest Central Hospital, Budapest, Hungary
| | - Yang Guo
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang, Hebei, China.
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Chen T, Liu YL, Li F, Qiu HN, Haghbin N, Li YS, Lin CY, Wu F, Xia LF, Li JB, Lin JN. Association of waist-to-hip ratio adjusted for body mass index with cognitive impairment in middle-aged and elderly patients with type 2 diabetes mellitus: a cross-sectional study. BMC Public Health 2024; 24:2424. [PMID: 39243030 PMCID: PMC11378611 DOI: 10.1186/s12889-024-19985-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Numerous reports indicate that both obesity and type 2 diabetes mellitus (T2DM) are factors associated with cognitive impairment (CI). The objective was to assess the relationship between abdominal obesity as measured by waist-to-hip ratio adjusted for body mass index (WHRadjBMI) and CI in middle-aged and elderly patients with T2DM. METHODS A cross-sectional study was conducted, in which a total of 1154 patients with T2DM aged ≥ 40 years were included. WHRadjBMI was calculated based on anthropometric measurements and CI was assessed utilizing the Montreal Cognitive Assessment (MoCA). Participants were divided into CI group (n = 509) and normal cognition group (n = 645). Correlation analysis and binary logistic regression were used to explore the relationship between obesity-related indicators including WHRadjBMI, BMI as well as waist circumference (WC) and CI. Meanwhile, the predictive power of these indicators for CI was estimated by receiver operating characteristic (ROC) curves. RESULTS WHRadjBMI was positively correlated with MoCA scores, independent of sex. The Area Under the Curve (AUC) for WHRadjBMI, BMI and WC were 0.639, 0.521 and 0.533 respectively, and WHRadjBMI had the highest predictive power for CI. Whether or not covariates were adjusted, one-SD increase in WHRadjBMI was significantly related to an increased risk of CI with an adjusted OR of 1.451 (95% CI: 1.261-1.671). After multivariate adjustment, the risk of CI increased with rising WHRadjBMI quartiles (Q4 vs. Q1 OR: 2.980, 95%CI: 2.032-4.371, P for trend < 0.001). CONCLUSIONS Our study illustrated that higher WHRadjBMI is likely to be associated with an increased risk of CI among patients with T2DM. These findings support the detrimental effects of excess visceral fat accumulation on cognitive function in middle-aged and elderly T2DM patients.
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Affiliation(s)
- Tong Chen
- School of Medicine, Nankai University, Tianjin, China
- Department of Endocrinology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Yan-Lan Liu
- Department of Endocrinology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Fang Li
- Department of Endocrinology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Hui-Na Qiu
- Department of Endocrinology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Nahal Haghbin
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yao-Shuang Li
- Tianjin Union Medical Center, Tianjin Medical University, Tianjin, China
| | - Chen-Ying Lin
- Tianjin Union Medical Center, Tianjin Medical University, Tianjin, China
| | - Fan Wu
- Department of Endocrinology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Long-Fei Xia
- Tianjin Union Medical Center, Tianjin Medical University, Tianjin, China
| | - Jing-Bo Li
- Department of Endocrinology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China.
| | - Jing-Na Lin
- School of Medicine, Nankai University, Tianjin, China.
- Department of Endocrinology, Tianjin Union Medical Center, Nankai University Affiliated Hospital, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China.
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Borovcanin MM, Vesic K, Petrovic I, Jovanovic IP, Mijailović NR. Diabetes mellitus type 2 as an underlying, comorbid or consequent state of mental disorders. World J Diabetes 2023; 14:481-493. [PMID: 37273248 PMCID: PMC10236997 DOI: 10.4239/wjd.v14.i5.481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/21/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
Somatic disturbances that occur in parallel with psychiatric diseases are a major challenge in clinical practice. Various factors contribute to the development of mental and somatic disorders. Type 2 diabetes mellitus (T2DM) is a significant health burden worldwide, and the prevalence of diabetes in adults is increasing. The comorbidity of diabetes and mental disorders is very common. By sharing a bidirectional link, both T2DM and mental disorders influence each other in various manners, but the exact mechanisms underlying this link are not yet elucidated. The potential mechanisms of both mental disorders and T2DM are related to immune and inflammatory system dysfunction, oxidative stress, endothelial dysfunction, and metabolic disturbances. Moreover, diabetes is also a risk factor for cognitive dysfunction that can range from subtle diabetes-associated cognitive decline to pre-dementia and dementia. A complex re-lationship between the gut and the brain also represents a new therapeutic approach since gut-brain signalling pathways regulate food intake and hepatic glucose production. The aim of this minireview is to summarize and present the latest data on mutual pathogenic pathways in these disorders, emphasizing their complexity and interweaving. We also focused on the cognitive performances and changes in neurodegenerative disorders. The importance of implementing integrated approaches in treating both of these states is highlighted, along with the need for individual therapeutic strategies.
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Affiliation(s)
- Milica M Borovcanin
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34 000, Serbia
| | - Katarina Vesic
- Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34 000, Serbia
| | - Ivica Petrovic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34 000, Serbia
| | - Ivan P Jovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34 000, Serbia
| | - Nataša R Mijailović
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34 000, Serbia
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He Q, Wang W, Li H, Xiong Y, Tao C, Ma L, You C. Genetic Insights into the Risk of Metabolic Syndrome and Its Components on Dementia: A Mendelian Randomization. J Alzheimers Dis 2023; 96:725-743. [PMID: 37840498 PMCID: PMC10657705 DOI: 10.3233/jad-230623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The role of metabolic syndrome (MetS) on dementia is disputed. OBJECTIVE We conducted a Mendelian randomization to clarify whether the genetically predicted MetS and its components are casually associated with the risk of different dementia types. METHODS The genetic predictors of MetS and its five components (waist circumference, hypertension, fasting blood glucose, triglycerides, and high-density lipoprotein cholesterol [HDL-C]) come from comprehensive public genome-wide association studies (GWAS). Different dementia types are collected from the GWAS in the European population. Inverse variance weighting is utilized as the main method, complemented by several sensitivity approaches to verify the robustness of the results. RESULTS Genetically predicted MetS and its five components are not causally associated with the increasing risk of dementia (all p > 0.05). In addition, no significant association between MetS and its components and Alzheimer's disease, vascular dementia, frontotemporal dementia, dementia with Lewy bodies, and dementia due to Parkinson's disease (all p > 0.05), except the association between HDL-C and dementia with Lewy bodies. HDL-C may play a protective role in dementia with Lewy bodies (OR: 0.81, 95% CI: 0.72-0.92, p = 0.0010). CONCLUSIONS From the perspective of genetic variants, our study provides novel evidence that MetS and its components are not associated with different dementia types.
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Affiliation(s)
- Qiang He
- Department of Neurosurgery, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, China
| | - Wenjing Wang
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Wuhou District, Chengdu, China
| | - Hao Li
- State Key Laboratory of Proteomics, National Center for Protein Sciences at Beijing, Beijing Institute of Radiation Medicine, Beijing, China
| | - Yang Xiong
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, China
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Alsuwaidi HN, Ahmed AI, Alkorbi HA, Ali SM, Altarawneh LN, Uddin SI, Roueentan SR, Alhitmi AA, Djouhri L, Chivese T. Association Between Metabolic Syndrome and Decline in Cognitive Function: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2023; 16:849-859. [PMID: 36974329 PMCID: PMC10039709 DOI: 10.2147/dmso.s393282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/04/2023] [Indexed: 03/29/2023] Open
Abstract
AIM We investigated whether metabolic syndrome (MetS) is associated with a decline in cognitive function in a cohort of middle-aged and elderly individuals without known cognitive dysfunction diseases in Qatar. METHODS We conducted a cross-sectional study on randomly selected participants aged 40-80 years from the Qatar Biobank, with data on cognitive tests and MetS components. Participants with a history of dementia, stroke, or mental disorders were excluded. MetS was diagnosed using the NCEP-ATP III criteria and cognitive performance was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Two cognitive function domains were assessed. These are speed of reaction, measured using the Reaction Time (RT), and short-term visual memory, measured using the Paired Associate Learning (PAL) test. Multivariable logistic regression models were used to determine associations between MetS and poor speed of reaction and poor memory performance. RESULTS The mean age of the participants included was 49.8 years (SD 6.7). Of these, 51.9% were females and 88.0% were of Qatari nationality. Most of the 1000 participants had MetS (n=302) or 1-2 MetS components (n=523), whereas only 170 had no MetS components. There was a strong association between MetS and poor memory performance (OR 1.76, 95% CI 1.04-2.96, P=0.034), but a weaker association with poor speed of reaction (OR 1.5, 95% CI 0.89-2.50, P=0.125). CONCLUSION In middle-aged and elderly individuals, MetS was strongly associated with diminished short-term visual memory, psychomotor coordination and motor speed.
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Affiliation(s)
| | - Ashraf I Ahmed
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Hamad A Alkorbi
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sara M Ali
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Shooq I Uddin
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Asmaa A Alhitmi
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Laiche Djouhri
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Tawanda Chivese
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Correspondence: Tawanda Chivese, College of Medicine, Qatar University, PO BOX, Doha, 2713, Qatar, Email
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 234] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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10
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Park KY, Nam GE, Han K, Hwang HS. Body weight variability and the risk of dementia in patients with type 2 diabetes mellitus: A nationwide cohort study in Korea. Diabetes Res Clin Pract 2022; 190:110015. [PMID: 35907508 DOI: 10.1016/j.diabres.2022.110015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
AIMS This study aimed to examine the association between body weight variability and dementia risk using a large-scale cohort data of Korean patients with type 2 diabetes mellitus (T2DM). METHODS A population-based cohort of 1,206,764 individuals with T2DM aged ≥ 40 years who underwent ≥ 3 Korean national health screenings were followed up until the end of 2019. Body weight variability was assessed using variability independent of the mean (VIM). A multivariate Cox proportional hazard regression was performed with calculating hazard ratios (HRs) with 95 % confidence intervals (CIs) of dementia incidence. RESULTS During a median follow-up of 7.9 years, 162,615 (13.4 %) individuals developed dementia. Individuals with greater body weight variability tended to be associated with higher risk of all types of dementia (P for trend < 0.001). Individuals in the highest quartile of VIM showed 26 % (HR: 1.26, 95 % CI: 1.24-1.28), 33 % (HR: 1.33, 95 % CI: 1.30-1.36) and 28 % (HR: 1.28, 95 % CI: 1.23-1.33) higher risk for all-cause dementia, Alzheimer's disease, and vascular dementia, compared with those in the lowest quartile. These associations persisted in all body mass index categories (P for trend < 0.001). CONCLUSIONS Maintaining an appropriate body weight may help mitigate dementia risk in patients with T2DM.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea.
| | - Ga Eun Nam
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea.
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea.
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea.
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11
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Xing Z, Long C, Hu X, Chai X. Obesity is associated with greater cognitive function in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2022; 13:953826. [PMID: 36353230 PMCID: PMC9637978 DOI: 10.3389/fendo.2022.953826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The impact of obesity on cognitive function in patients with type 2 diabetes mellitus (T2DM) remains controversial. This study aimed to evaluate whether obesity, assessed by body mass index (BMI) was associated with cognitive function among T2DM patients and whether the effect of obesity on cognitive function was through brain structure. METHODS This was a post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) study. The cognitive test battery included the Digit Symbol Substitution Test (DSST), Mini-Mental State Exam (MMSE), Rey Auditory Verbal Learning Test (RAVLT), and STROOP test, which were administered at baseline, and at 20, 40, and 80 months. A subgroup (n = 614) of the ACCORD-MIND study underwent MRI scanning at baseline and at 40 and 80 months. The total brain volume (TBV), abnormal white matter volume (AWM), abnormal gray matter volume (AGM), and abnormal basal ganglia volume (ABG) were estimated. The outcomes of this study were cognitive function and brain structure. RESULTS In the adjusted analyses, BMI was positively associated with the MMSE (β:0.08, 95%CI,0.01-0.16, per standard deviation [SD] increase) and RAVLT scores (β:0.09, 95%CI,0.01-0.18). It was also associated with a greater TBV (β:7.48, 95%CI,0.29-14.67). BMI was not associated with the DSST or STROOP scores, and AWM, AGM, ABG. Mediation analysis found that the effect of BMI on MMSE/RAVLT was mediated through TBV. CONCLUSION Obesity may be associated with greater cognitive function and the effect of BMI on cognitive function may be mediated by TBV among patients with T2DM. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov, identifier NCT00000620.
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Affiliation(s)
- Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha, China
| | - Chen Long
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinqun Hu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Xinqun Hu,
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Central South University, Changsha, China
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12
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Gong J, Harris K, Hackett M, Peters SAE, Brodaty H, Cooper M, Hamet P, Harrap S, Mancia G, MacMahon S, Chalmers J, Woodward M. Sex differences in risk factors for cognitive decline and dementia, including death as a competing risk, in individuals with diabetes: Results from the ADVANCE trial. Diabetes Obes Metab 2021; 23:1775-1785. [PMID: 33783955 DOI: 10.1111/dom.14391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 12/18/2022]
Abstract
AIM To estimate the associations between risk factors and cognitive decline (CD)/dementia, and the sex differences in these risk factors in individuals with type 2 diabetes, while accounting for the competing risk of death. MATERIALS AND METHODS The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial of 11,140 individuals with type 2 diabetes was used to estimate the odds of CD/dementia using multinomial logistic regression. RESULTS During a median 5-year follow-up, 1827 participants (43.2% women) had CD/dementia (1718 with CD only; 21 with dementia only; 88 with CD and dementia), and 929 (31.0% women) died without CD/dementia. Women had lower odds of CD/dementia than men (odds ratio [OR] [95% confidence interval], 0.88 [0.77, 1.00]); older age, higher total cholesterol, HbA1c, waist circumference, waist-to-height ratio, moderately increased albumin-creatinine ratio, stroke/transient ischaemic attack and retinal disease were each associated with greater odds of CD/dementia; higher years at education completion, baseline cognitive function, taller stature and current alcohol use were inversely associated. Higher waist circumference (women-to-men ratio of ORs [ROR], 1.05 [1.00, 1.10] per 5 cm) and presence of anxiety/depression (ROR, 1.28 [1.01, 1.63]) were associated with greater ORs for CD/dementia in women than men. CONCLUSIONS Several risk factors were associated with CD/dementia. Higher waist circumference and mental health symptoms were more strongly associated with CD/dementia in women than men. Further studies should examine the mechanisms that underlie these sex differences.
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Affiliation(s)
- Jessica Gong
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maree Hackett
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Health and Wellbeing, the University of Central Lancashire, Lancashire, UK
| | - Sanne A E Peters
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Imperial College London, London, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Pavel Hamet
- Montréal Diabetes Research Centre, Centre Hospitalier de l'Université de Montréal, Quebec, Montreal, Canada
| | - Stephen Harrap
- Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Giuseppe Mancia
- Policlinico di Monza and IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy
| | - Stephen MacMahon
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Imperial College London, London, UK
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Imperial College London, London, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
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13
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Liu X, Chen X, Hou L, Xia X, Hu F, Luo S, Zhang G, Dong B. Associations of Body Mass Index, Visceral Fat Area, Waist Circumference, and Waist-to-Hip Ratio with Cognitive Function in Western China: Results from WCHAT Study. J Nutr Health Aging 2021; 25:903-908. [PMID: 34409969 DOI: 10.1007/s12603-021-1642-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study examined the relationship between cognitive performance and obesity parameters, such as body mass index (BMI), visceral fat area (VFA), waist circumference (WC), and waist-to-hip ratio (WHR) in western China. STUDY DESIGN A cross-sectional study. METHODS 3914 participants, aged ≥50 years, were recruited in this study. Anthropometrics measurements, life-style factors, chronic disease comorbidities, and sleep qualities were recorded for each participant. Among the anthropometrics, BMI, WC, and WHR were assessed using standard procedures, while VFA was calculated using bioelectrical impedance analysis. Cognitive performance was estimated using the Short Portable Mental Status Questionnaire (SPMSQ). Finally, relationships between cognitive abilities and BMI, VFA, WC, and WHR were evaluated using univariate and multivariate regression analyses. RESULTS Cognitive decline (CD) occurred at a rate of 13.29% among the 3914 participants. A strong correlation was observed between cognitive abilities and BMI of male patients aged 50-59 yrs (OR 1.116,95% CI1.002-1.242), in the adjusted model. Alternately, WHR was shown to be significantly related to CD in females aged ≥70 years (OR 0.041, 95% CI0.002-0.671). WC was shown to have a strong association with CD in males (OR 1.023,95% CI1.003-1.024). Lastly, WHR was closely connected to CD in participants with BMI < 25 kg/m2 (OR 0.022,95% CI0.002-0.209). CONCLUSIONS Our findings suggest that a higher middle age BMI is associated with CD, whereas, in the elderly population, a higher WHR is related to improved cognitive performance. Further investigation is warranted to elucidate a relationship between VFA and CD.
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Affiliation(s)
- X Liu
- Birong Dong, MD, Professor, Director, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang Renmin Nan Lu Chengdu, Sichuan, China, Fax: 86-28-85422321, 610041, Email address:
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14
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Zhou J, Zhang Z, Zhou H, Qian G. Diabetic Cognitive Dysfunction: From Bench to Clinic. Curr Med Chem 2020; 27:3151-3167. [PMID: 30727866 DOI: 10.2174/1871530319666190206225635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/30/2018] [Accepted: 01/30/2019] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes increases the risk of developing cognitive dysfunction in the elderly in the form of short-term memory and executive function impairment. Genetic and diet-induced models of type 2 diabetes further support this link, displaying deficits in working memory, learning, and memory performance. The risk factors for diabetic cognitive dysfunction include vascular disease, hypoglycaemia, hyperlipidaemia, adiposity, insulin resistance, lifestyle factors, and genetic factors. Using neuronal imaging technologies, diabetic patients with cognitive dysfunction show atrophy of the whole brain, particularly the grey matter, hippocampus and amygdala; increased volume of the ventricular and white matter; brain infarcts; impaired network integrity; abnormal microstructure; and reduced cerebral blood flow and amplitude of low-frequency fluctuations. The pathogenesis of type 2 diabetes with cognitive dysfunction involves hyperglycaemia, macrovascular and microvascular diseases, insulin resistance, inflammation, apoptosis, and disorders of neurotransmitters. Large clinical trials may offer further proof of biomarkers and risk factors for diabetic cognitive dysfunction. Advanced neuronal imaging technologies and novel disease animal models will assist in elucidating the precise pathogenesis and to provide better therapeutic interventions and treatment.
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Affiliation(s)
- Jiyin Zhou
- National Drug Clinical Trial Institution, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Zuo Zhang
- National Drug Clinical Trial Institution, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Hongli Zhou
- National Drug Clinical Trial Institution, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Guisheng Qian
- Institute of Respiratory Diseases, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
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15
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Moh MC, Low S, Ng TP, Wang J, Ang SF, Tan C, Ang K, Tavintharan S, Sum CF, Kwan PY, Lee SBM, Tang WE, Lim SC. Association of traditional and novel measures of central obesity with cognitive performance in older multi-ethnic Asians with type 2 diabetes. Clin Obes 2020; 10:e12352. [PMID: 32020768 DOI: 10.1111/cob.12352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 01/04/2023]
Abstract
Literature evaluating the relationship between central obesity and cognitive deficits in type 2 diabetes (T2DM) remains scarce. This cross-sectional analysis explored the association of novel and traditional central obesity measures with cognitive performance in older (aged ≥60 years) non-demented multi-ethnic Asians with T2DM, including a stratified analysis by body mass index (BMI). Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status. Central obesity measures including visceral fat area (VFA), waist circumference, waist:hip ratio, waist:height ratio, abdominal volume index, body roundness index and conicity index were measured and/or computed. In our cohort (N = 677; mean age = 67 ± 5 years, 51.7% men), VFA emerged as an associate of overall cognitive performance after covariate adjustment and Bonferroni correction (β = -.10, 95% CI = -0.18, -0.03), outperforming the other adiposity indices. Specifically, VFA was inversely associated with delayed memory and language scores. Additionally, compared with normal-weight individuals, excess visceral obesity (VFA ≥100 cm2 ) was independently associated with lower cognitive scores to a greater extent in normal BMI (<23 kg/m2 ) adults than in those with high BMI (≥23 kg/m2 ). Assessment and management of visceral adiposity may help to prevent cognitive decline in older people with T2DM, and reduce the global burden of dementia in ageing populations.
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Affiliation(s)
- Mei Chung Moh
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Serena Low
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
- Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiexun Wang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Su Fen Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Clara Tan
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Subramaniam Tavintharan
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
- Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Pek Yee Kwan
- National Healthcare Group Polyclinics, Singapore, Singapore
| | | | - Wern Ee Tang
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
- Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University Hospital, Singapore, Singapore
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16
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Moh MC, Low S, Ng TP, Ang K, Subramaniam T, Sum CF, Kwan PY, Lee SBM, Tang WE, Lim SC. Role of endothelium-independent vasodilation in the relationship between visceral adiposity and reduced cognitive performance in older adults with type 2 diabetes. Microcirculation 2020; 27:e12609. [PMID: 31999860 DOI: 10.1111/micc.12609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/30/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In this cross-sectional analysis, we sought to assess the relationship of adiposity and forearm microvascular reactivity with cognitive dysfunction among older Asians with type 2 diabetes (T2D). METHODS Subjects with T2D aged ≥ 55 years were analyzed (N = 907). Cognitive performance was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Mini-Mental State Exam (MMSE). Visceral fat area (VFA) was estimated by tetrapolar multi-frequency bioimpedance. Forearm microvascular endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIV) were assessed by laser Doppler imaging with iontophoresis. RESULTS RBANS total score was correlated with VFA, EDV, and EIV (all P < .05). However, VFA was correlated with EIV, but not with EDV. Multivariable linear regression showed significant association between VFA and RBANS total score (B = -0.02, 95% CI= -0.03 to -0.01) or memory (immediate and delayed) index scores. These associations were attenuated after adjustment for EIV. Mediation analysis showed that EIV partially mediated the relationship between visceral adiposity and RBANS scores (all Sobel tests P < .05). EIV also mediated the relationship between VFA and MMSE score. CONCLUSIONS Impaired endothelium-independent vascular smooth muscle reactivity may exert a mediatory effect on the association between increased visceral adiposity and decreased cognitive performance in older adults with T2D.
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Affiliation(s)
- Mei Chung Moh
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Serena Low
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.,Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Pek Yee Kwan
- National Healthcare Group Polyclinics, Singapore, Singapore
| | | | - Wern Ee Tang
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.,Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University Hospital, Singapore, Singapore
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17
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Cho GJ, Hwang SY, Lee KM, Choi KM, Hyun Baik S, Kim T, Han SW, Yoo HJ. Association Between Waist Circumference and Dementia in Older Persons: A Nationwide Population-Based Study. Obesity (Silver Spring) 2019; 27:1883-1891. [PMID: 31689005 DOI: 10.1002/oby.22609] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/05/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined whether a positive association exists between waist circumference (WC) and dementia among older persons. METHODS The study population comprised 872,082 participants aged 65 years and older who participated in a Korean national health screening examination between January 1, 2009, and December 31, 2009. Adjusted hazard ratios and 95% CIs for dementia during follow-up from 2009 to 2015 were calculated according to baseline BMI and WC categories. RESULTS After a multivariate adjustment that included BMI, the hazard ratios for dementia showed a stepwise increase according to the increase in WC categories by 5 cm from 85 to 90 cm in men and from 80 to 85 cm in women until ≥ 110 cm (from 1.06 [95% CI: 1.03-1.09] to 1.64 [95% CI: 1.37-1.94] in men and from 1.04 [95% CI: 1.02-1.07] to 1.58 [95% CI: 1.36-1.84] in women). The influence of the current WC category for abdominal obesity on the risk of dementia was different according to BMI; especially, the normal weight men and women with abdominal obesity had a prominent increased risk of dementia compared with those without abdominal obesity. CONCLUSIONS Abdominal obesity, as measured by WC, was associated with significantly increased risk of dementia after adjustment for general obesity.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Soon Young Hwang
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyu-Min Lee
- School of Industrial Management Engineering, Korea University, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sung Won Han
- School of Industrial Management Engineering, Korea University, Seoul, Republic of Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
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18
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The relationship between adiposity and cognitive function in a large community-dwelling population: data from the Trinity Ulster Department of Agriculture (TUDA) ageing cohort study. Br J Nutr 2018; 120:517-527. [DOI: 10.1017/s0007114518001848] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractPrevious reports investigating adiposity and cognitive function in the population allude to a negative association, although the relationship in older adults is unclear. The aim of this study was to investigate the association of adiposity (BMI and waist:hip ratio (WHR)) with cognitive function in community-dwelling older adults (≥60 years). Participants included 5186 adults from the Trinity Ulster Department of Agriculture ageing cohort study. Neuropsychological assessment measures included the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multi-variable linear regression models were used to assess the association between adiposity and cognitive function adjusting for insulin resistance, inflammation and cerebrovascular disease. The mean ages were 80·3 (sd6·7), 71·0 (sd7·3) and 70·2 (sd6·3) years on the cognitive, bone and hypertensive cohorts, respectively. In the cognitive cohort, BMI was positively associated with immediate and delay memory, visuospatial/constructional ability, language and MMSE, and negatively with FAB (log-transformed), whereas WHR was negatively associated with attention. In the bone cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with visuospatial/constructional ability, attention and MMSE. In the hypertensive cohort, BMI was not associated with any cognitive domain, whereas WHR was negatively associated with immediate and delayed memory, visuospatial/constructional ability, language and MMSE and positively with FAB (log-transformed). In the cognitive and bone cohorts, the association of WHR and attention disappeared by further controlling for C-reactive protein and HbA1C. In this study of older adults, central adiposity was a stronger predictor of poor cognitive performance than BMI. Older adults could benefit from targeted public health strategies aimed at reducing obesity and obeseogenic risk factors to avoid/prevent/slow cognitive dysfunction.
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Feinkohl I, Lachmann G, Brockhaus WR, Borchers F, Piper SK, Ottens TH, Nathoe HM, Sauer AM, Dieleman JM, Radtke FM, van Dijk D, Pischon T, Spies C. Association of obesity, diabetes and hypertension with cognitive impairment in older age. Clin Epidemiol 2018; 10:853-862. [PMID: 30100759 PMCID: PMC6064155 DOI: 10.2147/clep.s164793] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Age-related cognitive impairment is rising in prevalence but is not yet fully characterized in terms of its epidemiology. Here, we aimed to elucidate the role of obesity, diabetes and hypertension as candidate risk factors. Methods Original baseline data from 3 studies (OCTOPUS, DECS, SuDoCo) were obtained for secondary analysis of cross-sectional associations of diabetes, hypertension, blood pressure, obesity (body mass index [BMI] ≥30 kg/m2) and BMI with presence of cognitive impairment in log-binomial regression analyses. Cognitive impairment was defined as scoring more than 2 standard deviations below controls on at least one of 5–11 cognitive tests. Underweight participants (BMI<18.5 kg/m2) were excluded. Results were pooled across studies in fixed-effects inverse variance models. Results Analyses totaled 1545 participants with a mean age of 61 years (OCTOPUS) to 70 years (SuDoCo). Cognitive impairment was found in 29.0% of participants in DECS, 8.2% in SuDoCo and 45.6% in OCTOPUS. In pooled analyses, after adjustment for age, sex, diabetes and hypertension, obesity was associated with a 1.29-fold increased prevalence of cognitive impairment (risk ratio [RR] 1.29; 95% CI 0.98, 1.72). Each 1 kg/m2 increment in BMI was associated with 3% increased prevalence (RR 1.03; 95% CI 1.00, 1.06). None of the remaining risk factors were associated with impairment. Conclusion Our results show that older people who are obese have higher prevalence of cognitive impairment compared with normal weight and overweight individuals, and independently of co-morbid hypertension or diabetes. Prospective studies are needed to investigate the temporal relationship of the association.
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Affiliation(s)
- Insa Feinkohl
- Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin-Buch, Germany,
| | - Gunnar Lachmann
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wolf-Rüdiger Brockhaus
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friedrich Borchers
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sophie K Piper
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas H Ottens
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne-Mette Sauer
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan M Dieleman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Finn M Radtke
- Department of Anesthesiology, Naestved Hospital, Naestved, Denmark
| | - Diederik van Dijk
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin-Buch, Germany, .,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,MDC/BIH Biobank, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), and Berlin Institute of Health (BIH), Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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de Oliveira MFB, Yassuda MS, Aprahamian I, Neri AL, Guariento ME. Hypertension, diabetes and obesity are associated with lower cognitive performance in community-dwelling elderly: Data from the FIBRA study. Dement Neuropsychol 2017; 11:398-405. [PMID: 29354220 PMCID: PMC5769998 DOI: 10.1590/1980-57642016dn11-040009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Systemic hypertension (SH), diabetes mellitus (DM) and abdominal obesity may negatively impact cognitive performance. Objective To evaluate the association between SH, DM and abdominal obesity and cognitive performance among cognitively unimpaired elderly. Methods A cross-sectional study of individuals aged 65+ from seven Brazilian cities was conducted. SH and DM diagnoses were self-reported and abdominal circumference was objectively measured. Individuals who scored below the education-adjusted cutoff scores on the Mini-Mental State Examination (MMSE) were excluded. Results Among 2,593 elderly, 321 (12.38%) had SH, DM and abdominal obesity concomitantly (Group I) and 421 (16.23%) had none of the three diseases (Group II). Group I had a higher proportion of individuals that were women, aged 70-74 years, illiterate and with lower income. Group I had a higher number of participants with low cognitive performance (28.04% vs. 17.58% in Group II). Variables associated with poor cognitive performance were: female gender (OR: 2.43, p < 0.001); and lower education (OR: 0.410, p < 0.001). The presence of the three diseases and age were not significant in the education-adjusted model. Conclusion There was an association between cognition and the presence of SH, DM and obesity. However, education seems to be decisive in determining cognitive performance in the presence of these three conditions.
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Affiliation(s)
| | - Mônica Sanches Yassuda
- Post-Graduate Program in Gerontology - Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
| | - Ivan Aprahamian
- Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, SP, Brazil.,Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Anita Liberalesso Neri
- Post-Graduate Program in Gerontology - Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil
| | - Maria Elena Guariento
- Post-Graduate Program in Gerontology - Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, SP, Brazil
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21
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Yuan XY, Wang XG. Mild cognitive impairment in type 2 diabetes mellitus and related risk factors: a review. Rev Neurosci 2017; 28:715-723. [DOI: 10.1515/revneuro-2017-0016] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/18/2017] [Indexed: 01/05/2023]
Abstract
AbstractType 2 diabetes mellitus (T2DM) is a global epidemic disease and has become a significant health problem. Many studies have raised concern about the mild cognitive impairment (MCI) with T2DM and even the Alzheimer’s disease patients with T2DM. The incidence of MCI is higher in individuals with T2DM than those without diabetes. Cognitive changes might affect everyday activities depending on the work and situation. Although the exact pathophysiology of MCI in T2DM is unclear, many studies suggest that the alterations in pathoglycemia, diabetic complications, related end products, and physical/psychological status are significant risk factors. In this article, we systematically overview the studies to illustrate the related risk factors of cognitive impairment in patients with T2DM. Further high quality studies and treatment need to be initiated and it will become incumbent on clinicians to identify and cure the earliest signs of clinical impairment.
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Affiliation(s)
- Xiao-Ying Yuan
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian 116044, P.R. China
| | - Xu-Gang Wang
- Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116027, P.R. China
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22
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Factors Associated with Mild Cognitive Impairment among Elderly Filipinos with Type 2 Diabetes Mellitus. J ASEAN Fed Endocr Soc 2017; 32:145-150. [PMID: 33442098 PMCID: PMC7784175 DOI: 10.15605/jafes.032.02.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/09/2017] [Indexed: 01/21/2023] Open
Abstract
Objectives This study aims to identify factors associated with mild cognitive impairment (MCI) among elderly Filipinos with Type 2 diabetes mellitus. Methodology This is an analytic cross-sectional study involving 133 elderly (≥60 years old) with Type 2 diabetes mellitus consecutively sampled from the General Medicine and Diabetes Clinics of the Philippine General Hospital. Eligible subjects were interviewed to gather demographic and clinical data. Body mass index, waist-hip ratio and mean blood pressure were computed. HBA1c, lipid profile, creatinine and urine proteinuria were tested or recorded if done recently. Dilated fundus examination via indirect ophthalmoscopy and 10-gram monofilament test were performed to detect retinopathy and neuropathy. The Montreal Cognitive Assessment-Philippines tool was administered to detect patients with probable MCI using a cutoff score of ≤21. Multivariate logistic regression analysis was performed to determine the associated factors. Results Using MoCA-P tool, MCI has a rate of 45% among elderly Filipino diabetics. Having more than 12 years of education is significantly associated with lower odds of MCI. (OR 0.38 CI 0.18, 0.80, p value 0.010). Conclusion The rate of MCI among Filipino elderly diabetics is high. Higher education is associated with lower odds of having MCI. Case-control or prospective cohort studies involving larger sample and non-diabetic population are recommended.
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23
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West RK, Ravona-Springer R, Heymann A, Schmeidler J, Leroith D, Koifman K, D'Arcy RCN, Song X, Guerrero-Berroa E, Preiss R, Hoffman H, Sano M, Silverman JM, Schnaider-Beeri M. Waist circumference is correlated with poorer cognition in elderly type 2 diabetes women. Alzheimers Dement 2016; 12:925-9. [PMID: 27149905 DOI: 10.1016/j.jalz.2016.03.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/17/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Waist circumference is associated with type 2 diabetes (T2D) and cognition, yet the relationship between waist circumference and cognition in individuals with T2D is not well understood. METHODS We studied the relationship of waist circumference with five cognitive outcomes (executive functioning, language/semantic categorization, attention/working memory, episodic memory, and an overall cognition measure) in 845 cognitively normal elderly with type 2 diabetes (T2D). RESULTS In women, waist circumference was correlated with significantly lower language and/or semantic categorization performance (P < .0001), executive functioning (P = .026), and overall cognition (P = .003) after controlling for age, education, BMI, and cardiovascular, diabetes-related, APOE ε4, and inflammatory potential confounders. Attention/working memory (P = .532) and episodic memory (P = .144) were not associated with waist circumference. These correlations were not found in men. DISCUSSION These results suggest that central adiposity in elderly women with T2D may increase their risk for dementia.
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Affiliation(s)
- Rebecca K West
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Anthony Heymann
- Maccabi Healthcare Services, Tel-Aviv, Israel; Department of Family Medicine, The Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - James Schmeidler
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Derek Leroith
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keren Koifman
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Ryan C N D'Arcy
- Simon Fraser University, Metro Vancouver, British Columbia, Canada; Surrey Memorial Hospital, Fraser Health, Metro Vancouver, British Columbia, Canada
| | - Xiaowei Song
- Simon Fraser University, Metro Vancouver, British Columbia, Canada; Surrey Memorial Hospital, Fraser Health, Metro Vancouver, British Columbia, Canada
| | - Elizabeth Guerrero-Berroa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Rachel Preiss
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Hadas Hoffman
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Jeremy M Silverman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Michal Schnaider-Beeri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
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Deckers K, van Boxtel MPJ, Schiepers OJG, de Vugt M, Muñoz Sánchez JL, Anstey KJ, Brayne C, Dartigues JF, Engedal K, Kivipelto M, Ritchie K, Starr JM, Yaffe K, Irving K, Verhey FRJ, Köhler S. Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies. Int J Geriatr Psychiatry 2015; 30:234-46. [PMID: 25504093 DOI: 10.1002/gps.4245] [Citation(s) in RCA: 333] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/17/2014] [Accepted: 11/05/2014] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Dementia has a multifactorial etiology, but the importance of individual health and lifestyle related risk factors is often uncertain or based on few studies. The goal of this paper is to identify the major modifiable risk factors for dementia as a first step in developing an effective preventive strategy and promoting healthy late life cognitive functioning. METHODS A mixed-method approach combined findings from a systematic literature review and a Delphi consensus study. The literature search was conducted in PubMed and updated an earlier review by the United States National Institutes of Health from 2010. We reviewed the available evidence from observational epidemiological studies. The online Delphi study asked eight international experts to rank and weigh each risk factor for its importance for dementia prevention. RESULTS Out of 3127 abstracts, 291 were included in the review. There was good agreement between modifiable risk factors identified in the literature review and risk factors named spontaneously by experts. After triangulation of both methods and re-weighting by experts, strongest support was found for depression, (midlife) hypertension, physical inactivity, diabetes, (midlife) obesity, hyperlipidemia, and smoking, while more research is needed for coronary heart disease, renal dysfunction, diet, and cognitive activity. CONCLUSIONS Findings provide good support for several somatic and lifestyle factors and will be used to inform the design of a new multicenter trial into dementia prevention.
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Affiliation(s)
- Kay Deckers
- Maastricht University, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht, The Netherlands
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Monette MCE, Baird A, Jackson DL. A meta-analysis of cognitive functioning in nondemented adults with type 2 diabetes mellitus. Can J Diabetes 2014; 38:401-8. [PMID: 24933107 DOI: 10.1016/j.jcjd.2014.01.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/28/2013] [Accepted: 01/27/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The current investigation sought to determine the pattern and magnitude of cognitive functioning deficits in persons with type 2 diabetes mellitus without dementia using meta-analysis to consolidate findings in the literature. METHODS MedLine and PsychInfo databases were searched to identify studies of cognitive functioning in persons with type 2 diabetes. Effect sizes (Cohen's d) were calculated for the differences in cognitive functioning between subjects with type 2 diabetes and controls without diabetes on classified cognitive abilities. Average d values were calculated for all cognitive abilities across studies. RESULTS Twenty-five studies meeting the inclusion criteria were identified. Persons with type 2 diabetes performed significantly lower than controls without diabetes (p<0.05) on all cognitive abilities evaluated, with effect sizes ranging from -0.14 to -0.37. The largest effect sizes were processing speed (with motor task demands), M -0.37 (95% CI, -0.41 to -0.32), and divided attention/shifting, M -0.36 (95% CI, -0.42 to -0.31). CONCLUSIONS Type 2 diabetes leads to mild to moderate deficits in all measured cognitive abilities. There was a lack of published studies investigating type 2 diabetes-associated variables; therefore, additional meta-analyses investigating the impact of these variables on cognitive functioning in type 2 diabetes could not be performed. As such, data from individual studies must be reported consistently to allow for investigation of variables that may affect the relationship between type 2 diabetes and cognitive functioning. Given the present findings, clinicians working with patients with type 2 diabetes should be alerted to the possibility of cognitive changes that could impact type 2 diabetes treatment management or require referral for neuropsychological assessment.
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Affiliation(s)
| | - Anne Baird
- Department of Psychology, University of Windsor, Windsor, Ontario
| | - Dennis L Jackson
- Department of Psychology, University of Windsor, Windsor, Ontario
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Biessels GJ, Strachan MWJ, Visseren FLJ, Kappelle LJ, Whitmer RA. Dementia and cognitive decline in type 2 diabetes and prediabetic stages: towards targeted interventions. Lancet Diabetes Endocrinol 2014; 2:246-55. [PMID: 24622755 DOI: 10.1016/s2213-8587(13)70088-3] [Citation(s) in RCA: 408] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Type 2 diabetes is associated with dementia, and also with more slight cognitive decrements. In this Review we discuss trajectories from normal cognition to dementia in people with type 2 diabetes, and explore opportunities for treatment. Slight diabetes-associated cognitive decrements and dementia affect different age groups and show a different evolution. These cognitive entities should therefore not be regarded as a continuum, although their effects might be additive. Vascular damage is a key underlying process in both entities. Glucose-mediated processes and other metabolic disturbances might also have a role. No treatment has been established, but management of vascular risk factors and optimisation of glycaemic control could have therapeutic benefit. We identify possible opportunities for intervention to improve cognitive outcomes in people with type 2 diabetes, and suggest how treatment can be tailored to individual risk profiles and comorbidities.
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Affiliation(s)
- Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
| | | | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
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Bloemer J, Bhattacharya S, Amin R, Suppiramaniam V. Impaired insulin signaling and mechanisms of memory loss. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2014; 121:413-49. [PMID: 24373245 DOI: 10.1016/b978-0-12-800101-1.00013-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Insulin is secreted from the β-cells of the pancreas and helps maintain glucose homeostasis. Although secreted peripherally, insulin also plays a profound role in cognitive function. Increasing evidence suggests that insulin signaling in the brain is necessary to maintain health of neuronal cells, promote learning and memory, decrease oxidative stress, and ultimately increase neuronal survival. This chapter summarizes the different facets of insulin signaling necessary for learning and memory and additionally explores the association between cognitive impairment and central insulin resistance. The role of impaired insulin signaling in the advancement of cognitive dysfunction is relevant to the current debate of whether the shared pathophysiological mechanisms between diabetes and cognitive impairment implicate a direct relationship. Here, we summarize a vast amount of literature that suggests a strong association between impaired brain insulin signaling and cognitive impairment.
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Affiliation(s)
- Jenna Bloemer
- Department of Pharmacal Sciences, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Subhrajit Bhattacharya
- Department of Pharmacal Sciences, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Rajesh Amin
- Department of Pharmacal Sciences, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Vishnu Suppiramaniam
- Department of Pharmacal Sciences, Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA
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Wolinsky FD, Bentler SE, Hockenberry J, Jones MP, Weigel PA, Kaskie B, Wallace RB. A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries. BMC Public Health 2011; 11:710. [PMID: 21933430 PMCID: PMC3190354 DOI: 10.1186/1471-2458-11-710] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 09/20/2011] [Indexed: 11/16/2022] Open
Abstract
Background Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function. Methods We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests. Results Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status. Conclusions In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.
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Affiliation(s)
- Fredric D Wolinsky
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa 52242, USA.
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Handelsman Y, Mechanick JI, Blonde L, Grunberger G, Bloomgarden ZT, Bray GA, Dagogo-Jack S, Davidson JA, Einhorn D, Ganda O, Garber AJ, Hirsch IB, Horton ES, Ismail-Beigi F, Jellinger PS, Jones KL, Jovanovič L, Lebovitz H, Levy P, Moghissi ES, Orzeck EA, Vinik AI, Wyne KL, Hurley DL, Zangeneh F. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract 2011; 17 Suppl 2:1-53. [PMID: 21474420 DOI: 10.4158/ep.17.s2.1] [Citation(s) in RCA: 288] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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