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Zhou X, Dai N, Yu D, Niu T, Wang S. Development and validation of Galectin-3 and CVAI-based model for predicting cognitive impairment in type 2 diabetes. J Endocrinol Invest 2025; 48:1017-1031. [PMID: 39565520 DOI: 10.1007/s40618-024-02506-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 11/14/2024] [Indexed: 11/21/2024]
Abstract
OBJECTIVE The objective of this study is to develop a predictive model combining multiple indicators to quantify the risk of mild cognitive impairment (MCI) in T2DM patients. METHODS This study included Chinese T2DM patients who were hospitalized at Zhongda Hospital between November 2021 and May 2023. Clinical data, including demographics, medical history, biochemical tests, and cognitive status, were collected. Cognitive assessment was performed using neuropsychological tests, and MCI was diagnosed based on the Montreal Cognitive Assessment (MoCA) scores. The dataset was randomly divided into a training set and a validation set in a 7:3 ratio. Logistic regression analysis was conducted to identify factors influencing MCI in the training set. A nomogram-based scoring model was then developed by integrating these findings with high-risk clinical variables, and its performance was validated in the validation set. RESULTS In this study, T2DM patients were divided into a training set and a validation set in a 7:3 ratio. There were no significant differences in MCI incidence, demographics, or clinical characteristics between the two groups, confirming the appropriateness of model construction. In the training set, Galectin-3 and CVAI were significantly negatively correlated with cognitive function (MoCA and MMSE scores), and this negative correlation remained after adjusting for confounding variables. Logistic regression analysis revealed that age, CVAI, and Galectin-3 significantly increased the risk of MCI, while years of education had a protective effect. The constructed nomogram model, which integrated age, sex, education level, hypertension, CVAI, and Galectin-3 levels, exhibited high predictive performance (C-index of 0.816), with AUCs of 0.816 in the training set and 0.858 in the validation set, outperforming single indicators. PR curve analysis further validated the superiority of the nomogram model. CONCLUSION The straightforward, highly accurate, and interactive nomogram model developed in this study facilitate the early risk prediction of MCI in individuals with T2DM by incorporating Galectin-3, CVAI, and other common clinical risk factors.
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Affiliation(s)
- Xueling Zhou
- School of Medicine, Southeast University, Nanjing, China
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Ning Dai
- Department of ENT, Maanshan People's Hospital, Maanshan, China
| | - Dandan Yu
- School of Medicine, Southeast University, Nanjing, China
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Tong Niu
- School of Medicine, Southeast University, Nanjing, China
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Shaohua Wang
- School of Medicine, Southeast University, Nanjing, China.
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
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Xiao Y, Hong X, Neelagar R, Mo H. Association between glycated hemoglobin A1c levels, control status, and cognitive function in type 2 diabetes: a prospective cohort study. Sci Rep 2025; 15:5011. [PMID: 39929979 PMCID: PMC11811129 DOI: 10.1038/s41598-025-89374-6] [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: 10/07/2024] [Accepted: 02/05/2025] [Indexed: 02/13/2025] Open
Abstract
Cognitive impairment (CI) is a common complication in patients with type 2 diabetes mellitus (T2DM), but its relationship with long-term glycemic control remains unclear. This study aimed to investigate the associations between mean hemoglobin A1c (HbA1c) levels, HbA1c control status, HbA1c fluctuations, and CI in Chinese adults aged 45 years and older with T2DM using data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 797 participants with HbA1c measurements from 2011 to 2015 and cognitive function assessments in 2018 were included. Logistic regression models and restricted cubic spline (RCS) analysis were applied, adjusting for potential confounders. Higher mean HbA1c levels (≥ 9%) were significantly associated with an increased risk of CI, particularly in global cognition and episodic memory (OR 4.03 (1.45-11.20) for global cognition; OR 2.92 (1.02-8.38) for episodic memory). RCS analysis revealed a U-shaped relationship between mean HbA1c and CI, indicating that both excessively low and high HbA1c levels elevate CI risk. Uncontrolled HbA1c levels (≥ 8%) were also linked to higher CI risk compared to stable HbA1c levels. Maintaining HbA1c levels below 8% may significantly reduce CI risk in T2DM patients, highlighting the importance of personalized glycemic management.
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Affiliation(s)
- Yanhua Xiao
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Xuezhi Hong
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Ranjana Neelagar
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Hanyou Mo
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
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Donat Ergin B, Gadsby-Davis K, Mattishent K, Dhatariya K, Garner N, Hornberger M. Continuous Glucose Monitoring in Comorbid Dementia and Diabetes: The Evidence So Far. J Diabetes Sci Technol 2024:19322968241301058. [PMID: 39691964 DOI: 10.1177/19322968241301058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and dementia are two of the leading chronic diseases in aging and are known to influence each other's disease progression. There is well-established evidence that T2DM increases the risk for cognitive decline and dementia. At the same time, people with cognitive changes or dementia can find it difficult to manage their diabetes, resulting in hyper- or hypoglycemic events which can exacerbate the dementia disease progression further. Monitoring of glucose variability is, therefore, of critical importance during aging and when people with T2DM develop dementia. The advent of continuous glucose monitoring (CGM) has allowed the monitoring of glucose variability in T2DM more closely. The CGM seems to be highly feasible and acceptable to use in older people with T2DM and has been shown to significantly reduce their hypoglycemic events, often resulting in falls. Less is known as to whether CGM can have a similar beneficial effect on people with T2DM who have cognitive impairment or dementia in community or hospital settings. AIMS The current perspective will explore how CGM has made an impact on T2DM management in older people and those with comorbid cognitive impairment or dementia. We will further explore opportunities and challenges of using CGM in comorbid T2DM and dementia in community and hospital settings.
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Affiliation(s)
| | | | - Katharina Mattishent
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk & Norwich University Hospital, Norwich, UK
| | - Ketan Dhatariya
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk & Norwich University Hospital, Norwich, UK
| | - Nikki Garner
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk & Norwich University Hospital, Norwich, UK
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Sola T, Sola FM, Jehkonen M. The Effects of Type 2 Diabetes on Cognitive Performance: A Review of Reviews. Int J Behav Med 2024; 31:944-958. [PMID: 38467963 PMCID: PMC11588889 DOI: 10.1007/s12529-024-10274-6] [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] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Multiple systematic reviews have found that type 2 diabetes is associated with cognitive decrements. However, these reviews are heterogeneous in terms of methodology, quality and results, making it difficult for researchers and clinicians to build an informed overall picture. We therefore conducted a review of systematic reviews on the association between type 2 diabetes and cognitive decrements in relation to healthy controls. METHODS Following a pre-registered research protocol, we searched four major databases. Nine systematic reviews met our inclusion criteria: seven were meta-analyses and two were narrative syntheses. We assessed the risk of bias in each review and reported all effect sizes and confidence intervals obtained. RESULTS Type 2 diabetes was associated with cognitive decrements in all reviews, with small or negligible effect sizes obtained in the largest meta-analyses. The most studied cognitive domains were attention, executive functions, memory, processing speed and working memory. All reviews had methodological issues and were rated as having a high or an unclear risk of bias. CONCLUSIONS Type 2 diabetes appears to be associated with lower cognitive performance in several cognitive domains and in different age groups. However, high-quality meta-analyses on the subject are still needed. Future reviews must follow the PRISMA guidelines and take into account the risk of bias of the original studies through sensitivity analyses and the heterogeneity of the studies by conducting subgroup analyses for example according to age group and disease duration. The meta-analyses that aim to study the entire type 2 diabetes population without excluding severe comorbidities, should assess concept formation and reasoning, construction and motor performance, perception, and verbal functions and language skills in addition to the cognitive domains that have been most frequently analysed in the reviews conducted so far.
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Affiliation(s)
- Teppo Sola
- Psychology, Tampere University, Tampere, Finland.
- Tampere University Hospital, Tampere, Finland.
| | | | - Mervi Jehkonen
- Psychology, Tampere University, Tampere, Finland
- Tampere University Hospital, Tampere, Finland
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Yang Y, Wang Y, Wang Y, Ke T, Zhao L. PCSK9 inhibitor effectively alleviated cognitive dysfunction in a type 2 diabetes mellitus rat model. PeerJ 2024; 12:e17676. [PMID: 39157774 PMCID: PMC11330219 DOI: 10.7717/peerj.17676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 06/12/2024] [Indexed: 08/20/2024] Open
Abstract
Background The incidence of diabetes-associated cognitive dysfunction (DACD) is increasing; however, few clinical intervention measures are available for the prevention and treatment of this disease. Research has shown that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, particularly SBC-115076, have a protective effect against various neurodegenerative diseases. However, their role in DACD remains unknown. In this study, we aimed to explore the impact of PCSK9 inhibitors on DACD. Methods Male Sprague-Dawley (SD) rats were used to establish an animal model of type 2 diabetes mellitus (T2DM). The rats were randomly divided into three groups: the Control group (Control, healthy rats, n = 8), the Model group (Model, rats with T2DM, n = 8), and the PCSK9 inhibitor-treated group (Treat, T2DM rats treated with PCSK9 inhibitors, n = 8). To assess the spatial learning and memory of the rats in each group, the Morris water maze (MWM) test was conducted. Hematoxylin-eosin staining and Nissl staining procedures were performed to assess the structural characteristics and functional status of the neurons of rats from each group. Transmission electron microscopy was used to examine the morphology and structure of the hippocampal neurons. Determine serum PCSK9 and lipid metabolism indicators in each group of rats. Use qRT-PCR to detect the expression levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha (TNF-α) in the hippocampal tissues of each group of rats. Western blot was used to detect the expression of PCSK9 and low-density lipoprotein receptor (LDLR) in the hippocampal tissues of rats. In addition, a 4D label-free quantitative proteomics approach was used to analyse protein expression in rat hippocampal tissues. The expression of selected proteins in hippocampal tissues was verified by parallel reaction monitoring (PRM) and immunohistochemistry (IHC). Results The results showed that the PCSK9 inhibitor alleviated cognitive dysfunction in T2DM rats. PCSK9 inhibitors can reduce PCSK9, total cholesterol (TC), and low-density lipoprotein (LDL) levels in the serum of T2DM rats. Meanwhile, it was found that PCSK9 inhibitors can reduce the expression of PCSK9, IL-1β, IL-6, and TNF-α in the hippocampal tissues of T2DM rats, while increasing the expression of LDLR. Thirteen potential target proteins for the action of PCSK9 inhibitors on DACD rats were identified. PRM and IHC revealed that PCSK9 inhibitors effectively counteracted the downregulation of transthyretin in DACD rats. Conclusion This study uncovered the target proteins and specific mechanisms of PCSK9 inhibitors in DACD, providing an experimental basis for the clinical application of PCSK9 inhibitors for the potential treatment of DACD.
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Affiliation(s)
- Yang Yang
- Department of Endocrinology, the Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Yeying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yuwen Wang
- Department of Endocrinology, the Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Tingyu Ke
- Department of Endocrinology, the Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Ling Zhao
- Department of Endocrinology, the Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
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Gupta A, Goyal A, Rajan R, Vishnu VY, Kalaivani M, Tandon N, Srivastava MVP, Gupta Y. Validity of Montreal Cognitive Assessment to Detect Cognitive Impairment in Individuals with Type 2 Diabetes. Diabetes Ther 2024; 15:1155-1168. [PMID: 38520603 PMCID: PMC11043253 DOI: 10.1007/s13300-024-01549-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/06/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Guidelines recommend screening older people (> 60-65 years) with type 2 diabetes (T2D) for cognitive impairment, as it has implications in the management of diabetes. The Montreal Cognitive Assessment (MoCA) is a sensitive test for the detection of mild cognitive impairment (MCI) in the general population, but its validity in T2D has not been established. METHODS We administered MoCA to patients with T2D (age ≥ 60 years) and controls (no T2D), along with a culturally validated neuropsychological battery and functional activity questionnaire. MCI was defined as performance in one or more cognitive domains ≥ 1.0 SD below the control group (on two tests representing a cognitive domain), with preserved functional activities. The discriminant validity of MoCA for the diagnosis of MCI at different cut-offs was ascertained. RESULTS We enrolled 267 patients with T2D and 120 controls; 39% of the participants with T2D met the diagnostic criteria for MCI on detailed neuropsychological testing. At the recommended cut-off on MoCA (< 26), the sensitivity (94.2%) was high, but the specificity was quite low (29.5%). The cut-off score of < 23 showed an optimal trade-off between sensitivity (69.2%), specificity (71.8%), and diagnostic accuracy (70.8%). The cut-off of < 21 exhibited the highest diagnostic accuracy (74.9%) with an excellent specificity (91.4%), a good positive and negative predictive value (78.5% and 73.7%, respectively). CONCLUSIONS The recommended screening cut-off point on MoCA of < 26 has a suboptimal specificity and may increase the referral burden in memory clinics. A lower cut-off of < 21 on MoCA maximizes the diagnostic accuracy. Interactive Visual Abstract available for this article.
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Affiliation(s)
- Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Alpesh Goyal
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Yashdeep Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Wang G, Zhao Z, Ren B, Yu W, Zhang X, Liu J, Wang L, Si D, Yang M. Exenatide exerts a neuroprotective effect against diabetic cognitive impairment in rats by inhibiting apoptosis: Role of the JNK/c‑JUN signaling pathway. Mol Med Rep 2022; 25:111. [PMID: 35119079 PMCID: PMC8845025 DOI: 10.3892/mmr.2022.12627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022] Open
Abstract
Exenatide could reduce blood glucose and alleviate cognitive dysfunction induced by diabetes mellitus (DM). In the present study, a diabetic model was established in Sprague‑Dawley rats to further explore the mechanism of exenatide on diabetes‑induced cognitive impairment. Notably, the model rats performed poorly in the Morris water maze test and had more apoptotic neurons compared with the control rats. By contrast, exenatide attenuated cognitive impairment and inhibited neuronal apoptosis in the DM rat model. To explore the neuroprotective mechanisms of exenatide, western blotting was performed to detect the expression levels of markers of endoplasmic reticulum stress, including cytochrome c (Cyt‑c), Caspase‑3, JNK and c‑JUN, in hippocampal tissue. Reverse transcription‑quantitative PCR was also performed to measure the mRNA expression levels of Cyt‑c and Caspase‑3. After 16 weeks of treatment, exenatide treatment downregulated Cyt‑c, Caspase‑3, phosphorylated (p)‑JNK and p‑c‑JUN expression in the hippocampal tissue of diabetic rats. Moreover, Cyt‑c, Caspase‑3, JNK and JUN expression levels were detected following treatment with a specific inhibitor of JNK (SP600125). The results revealed that SP600125 had similar inhibitory effects on the JNK pathway and ERS‑related protein expression (Cyt‑t, Caspase‑3, p‑JNK and p‑c‑JUN). These results suggested that exenatide improved cognitive dysfunction in DM rats and that the underlying mechanism may be associated with inhibiting apoptosis by suppressing the activation of JNK/c‑JUN.
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Affiliation(s)
- Gengyin Wang
- Department of Human Anatomy, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei 063210, P.R. China
| | - Zongquan Zhao
- General Practice, Pingjiang Xincheng Community Health Service Center, Suzhou, Jiangsu 215101, P.R. China
| | - Bo Ren
- Medical Experimental Center, Jitang College of North China University of Science and Technology, Tangshan, Hebei 063210, P.R. China
| | - Wu Yu
- School Hospital, Hengshui University, Hengshui, Hebei 053010, P.R. China
| | - Xudong Zhang
- Department of Human Anatomy, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei 063210, P.R. China
| | - Jiang Liu
- Department of Human Anatomy, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei 063210, P.R. China
| | - Liping Wang
- Department of Human Anatomy, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei 063210, P.R. China
| | - Daowen Si
- Department of Human Anatomy, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei 063210, P.R. China
| | - Meiliu Yang
- Department of Life Sciences, Hengshui University, Hengshui, Hebei 053010, P.R. China
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Thompson F, Harriss LR, Russell S, Taylor S, Cysique LA, Strivens E, Maruff P, McDermott R. Using health check data to investigate cognitive function in Aboriginal and Torres Strait Islanders living with diabetes in the Torres Strait, Australia. Endocrinol Diabetes Metab 2022; 5:e00297. [PMID: 34559471 PMCID: PMC8754245 DOI: 10.1002/edm2.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Type 2 Diabetes (T2DM) has a subtle deleterious effect on cognition and imposes a higher lifetime risk of cognitive impairment and dementia. In populations where both T2DM and dementia are highly prevalent, understanding more about the early effects of T2DM on cognition may provide insights into the lifetime risks of this disease. METHODS In 2016, 186 Australian Aboriginal and/or Torres Strait Islander residents of the Torres Strait (54% female, mean age =38.9 years, SD =15.9, range =15-74) participated in a community health check. The effect of diabetes (Type 1 or Type 2) on speed of thinking and working memory was assessed with the Cogstate Brief Battery (CBB) during the health check. RESULTS One third of participants had diabetes (n = 56, 30.1%). After adjusting for age, education and previous iPad/Tablet experience, participants with diabetes had a small, yet significant reduction in accuracy on the One Back working memory task (β = -.076, p = .010, r2 = .042). The effect was most pronounced among participants with diabetes aged 20-49 years (n = 20), who also had evidence of poorer diabetes control (eg HbA1c% ≥6.5, 76.6%), relative to participants with diabetes aged 50 years and over (n = 31) (HbA1c% ≥6.5, 32.0%, p = .005). CONCLUSIONS Early and subtle decrements in working memory may be a potential complication of diabetes among Aboriginal and Torres Strait Islander residents of the Torres Strait. Several potentially influential variables were not captured in this study (eg medication and diabetes duration). Greater preventative health resources are required for this population, particularly given the emerging elevated dementia rates linked to chronic disease.
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and MedicineCollege of Public Health, Medical and Veterinary SciencesJames Cook UniversityCairnsQldAustralia
| | - Linton R. Harriss
- Australian Institute of Tropical Health and MedicineCollege of Public Health, Medical and Veterinary SciencesJames Cook UniversityCairnsQldAustralia
- College of Medicine and DentistryJames Cook UniversityCairnsQldAustralia
| | - Sarah Russell
- College of Medicine and DentistryJames Cook UniversityCairnsQldAustralia
- Queensland Health, Cairns and Hinterland Hospital and Health ServiceCairnsQldAustralia
| | - Sean Taylor
- Top End Health ServiceNorthern Territory GovernmentDarwinNTAustralia
| | | | - Edward Strivens
- College of Medicine and DentistryJames Cook UniversityCairnsQldAustralia
- Queensland Health, Cairns and Hinterland Hospital and Health ServiceCairnsQldAustralia
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Tsatali M, Poptsi E, Moraitou D, Agogiatou C, Bakoglidou E, Gialaouzidis M, Papasozomenou C, Soumpourou A, Tsolaki M. Discriminant Validity of the WAIS-R Digit Symbol Substitution Test in Subjective Cognitive Decline, Mild Cognitive Impairment (Amnestic Subtype) and Alzheimer's Disease Dementia (ADD) in Greece. Brain Sci 2021; 11:brainsci11070881. [PMID: 34209189 PMCID: PMC8301784 DOI: 10.3390/brainsci11070881] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: The aim of the current study was to estimate the discriminant potential and validity of the Digit Symbol Substitution Test (DSST) of the WAIS-R in the Greek elderly population meeting criteria for subjective cognitive decline (SCD), mild cognitive impairment (aMCI; amnestic subtype), or Alzheimer’s disease dementia (ADD). Method: Four hundred eighty-eight community-dwelling older adults, visitors of the Day Center of Alzheimer Hellas, participated in the study. Two hundred forty-three of them met the criteria for ADD, one hundred eighty-two for aMCI and sixty-three for SCD. Results: Path analysis indicated that the DSST score is affected by age group, educational level, and diagnostic category, but is not affected by gender. The ROC curve analysis showed that the DSST sum score could perfectly differentiate SCD from ADD patients, whereas test’s discriminant potential between aMCI and dementia ADD’s subtype was satisfactory. However, DSST was unable to separate the SCD from the aMCI group. Conclusion: It appears that the DSST is unable to separate the SCD from aMCI population. Therefore, the test in question may be insensitive to incipient cognitive decline. On the contrary, the discriminant potential of the DSST as regards SCD and ADD is excellent, while discrimination between aMCI and ADD is good.
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Affiliation(s)
- Marianna Tsatali
- Department of Psychology, Greek Association of Alzheimer Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece; (E.P.); (D.M.); (C.A.); (E.B.); (M.G.); (C.P.); (A.S.); (M.T.)
- Correspondence:
| | - Eleni Poptsi
- Department of Psychology, Greek Association of Alzheimer Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece; (E.P.); (D.M.); (C.A.); (E.B.); (M.G.); (C.P.); (A.S.); (M.T.)
- Laboratory of Psychology, Section of Cognitive and Experimental Psychology, School of Psychology, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece
| | - Despina Moraitou
- Department of Psychology, Greek Association of Alzheimer Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece; (E.P.); (D.M.); (C.A.); (E.B.); (M.G.); (C.P.); (A.S.); (M.T.)
- Laboratory of Psychology, Section of Cognitive and Experimental Psychology, School of Psychology, Aristotle University of Thessaloniki (AUTh), 54124 Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases, Aristotle University of Thessaloniki (CIRI-AUTh), 57001 Thessaloniki, Greece
| | - Christina Agogiatou
- Department of Psychology, Greek Association of Alzheimer Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece; (E.P.); (D.M.); (C.A.); (E.B.); (M.G.); (C.P.); (A.S.); (M.T.)
| | - Evaggelia Bakoglidou
- Department of Psychology, Greek Association of Alzheimer Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece; (E.P.); (D.M.); (C.A.); (E.B.); (M.G.); (C.P.); (A.S.); (M.T.)
| | - Moses Gialaouzidis
- Department of Psychology, Greek Association of Alzheimer Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece; (E.P.); (D.M.); (C.A.); (E.B.); (M.G.); (C.P.); (A.S.); (M.T.)
| | - Chrysa Papasozomenou
- Department of Psychology, Greek Association of Alzheimer Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece; (E.P.); (D.M.); (C.A.); (E.B.); (M.G.); (C.P.); (A.S.); (M.T.)
| | - Aikaterini Soumpourou
- Department of Psychology, Greek Association of Alzheimer Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece; (E.P.); (D.M.); (C.A.); (E.B.); (M.G.); (C.P.); (A.S.); (M.T.)
| | - Magdalini Tsolaki
- Department of Psychology, Greek Association of Alzheimer Disease and Related Disorders (GAADRD), 54643 Thessaloniki, Greece; (E.P.); (D.M.); (C.A.); (E.B.); (M.G.); (C.P.); (A.S.); (M.T.)
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases, Aristotle University of Thessaloniki (CIRI-AUTh), 57001 Thessaloniki, Greece
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Teong XT, Hutchison AT, Liu B, Wittert GA, Lange K, Banks S, Heilbronn LK. Eight weeks of intermittent fasting versus calorie restriction does not alter eating behaviors, mood, sleep quality, quality of life and cognitive performance in women with overweight. Nutr Res 2021; 92:32-39. [PMID: 34274552 DOI: 10.1016/j.nutres.2021.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/09/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
Human trials that compare intermittent fasting (IF) to calorie restriction (CR) with psychological, behavioral and cognition outcomes are limited. We hypothesized that there would be no difference between CR and IF on perceived eating behaviors, mood, sleep quality, quality of life (QOL) and cognition in women with overweight and obesity. In this prespecified secondary analysis of an open-label, single center, parallel assignment, randomized controlled trial, healthy women with overweight or obesity (N = 46, mean [SD] age 50 [9] years, BMI 32.9 [4.4] kg/m2), without a diagnosed eating disorder and who were randomized into 2 weight loss groups (prescribed 70% of calculated energy requirements as IF or CR) were included. Measurements were assessed in both IF and CR groups following a 12-hour overnight fast during baseline and week 8 and additionally following a 24-hour fast in the IF group only at week 8. We observed that IF produced greater weight and body fat loss than CR (P < .001). We did not detect any statistical difference between groups for the change in dietary restraint, disinhibition, hunger, mood, sleep quality, and QOL. An increase in cognitive performance was found in both IF (P = .036) and CR (P = .006) groups in one of the cognitive tasks, but there was no statistical difference between groups. Perceived eating behaviors, mood, sleep quality and cognitive performance were not changed by an acute 24-hour fast within the IF group (all P > .05). IF may be a viable alternative to CR for weight loss, in the short-term, without adversely impacting eating behaviors, mood, sleep quality, QOL or cognition in healthy women with overweight or obesity. However, larger and long term trials are required.
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Affiliation(s)
- Xiao Tong Teong
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Amy T Hutchison
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Bo Liu
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Gary A Wittert
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Kylie Lange
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Siobhan Banks
- Behavior-Brain-Body Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Leonie K Heilbronn
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
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11
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Yuan T, Ying J, Li C, Jin L, Kang J, Shi Y, Gui S, Liu C, Wang R, Zuo Z, Zhang Y. In Vivo Characterization of Cortical and White Matter Microstructural Pathology in Growth Hormone-Secreting Pituitary Adenoma. Front Oncol 2021; 11:641359. [PMID: 33912457 PMCID: PMC8072046 DOI: 10.3389/fonc.2021.641359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background The growth hormone (GH) and insulin-like-growth factor 1 (IGF-1) axis has long been recognized for its critical role in brain growth, development. This study was designed to investigate microstructural pathology in the cortex and white matter in growth hormone-secreting pituitary adenoma, which characterized by excessive secretion of GH and IGF-1. Methods 29 patients with growth hormone-secreting pituitary adenoma (acromegaly) and 31 patients with non-functional pituitary adenoma as controls were recruited and assessed using neuropsychological test, surface-based morphometry, T1/T2-weighted myelin-sensitive magnetic resonance imaging, neurite orientation dispersion and density imaging, and diffusion tensor imaging. Results Compared to controls, we found 1) acromegaly had significantly increased cortical thickness throughout the bilateral cortex (pFDR < 0.05). 2) T1/T2-weighted ratio in the cortex were decreased in the bilateral occipital cortex and pre/postcentral central gyri but increased in the bilateral fusiform, insular, and superior temporal gyri in acromegaly (pFDR < 0.05). 3) T1/T2-weighted ratio were decreased in most bundles, and only a few areas showed increases in acromegaly (pFDR < 0.05). 4) Neurite density index (NDI) was significantly lower throughout the cortex and bundles in acromegaly (pTFCE < 0.05). 5) lower fractional anisotropy (FA) and higher mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) in extensive bundles in acromegaly (pTFCE < 0.05). 6) microstructural pathology in the cortex and white matter were associated with neuropsychological dysfunction in acromegaly. Conclusions Our findings suggested that long-term persistent and excess serum GH/IGF-1 levels alter the microstructure in the cortex and white matter in acromegaly, which may be responsible for neuropsychological dysfunction.
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Affiliation(s)
- Taoyang Yuan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jianyou Ying
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lu Jin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Kang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanyu Shi
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Chinese Academy of Sciences, Beijing, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunhui Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Chinese Academy of Sciences, Beijing, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders Brain Tumour Center, China National Clinical Research Center for Neurological Diseases, Key Laboratory of Central Nervous System Injury Research, Beijing, China
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12
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Mordenfeld N, Gayus N, Azmon M, Guri-Twito O, Yahalom Peri T, Natovich R, Cukierman-Yaffe T. Determining the Optimal Cognitive Screening Tool in Older People With Diabetes. Front Endocrinol (Lausanne) 2020; 11:322. [PMID: 32528414 PMCID: PMC7258911 DOI: 10.3389/fendo.2020.00322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Self-care is an important perspective to aging and transitional states in diabetes management. Population studies have shown that lower cognitive function is associated with worse self-care abilities. Several guidelines have emphasized the importance of assessing cognitive function in older people with diabetes and tailoring treatment plan accordingly. Those guidelines do not specify which tools are the most appropriate for this population. One approach to delineate which tools should be used is to assess which tools best correlate with self-care capacity. Objective: To assess which cognitive assessment tools best correlate with self-care capacity in older people with type 2 diabetes. Methods: Cross-sectional study, conducted amongst individuals with diabetes over the age of 60. The association between self-care capacity indices and different cognitive assessment tools was examined. Principal Component self-care constructs were determined and the association between these and the different cognitive assessment tools was examined. Results: A significant association was found between the Principal Component self-care construct and the Montreal Cognitive Assessment and MindstreamsTM scores. In a stepwise regression model including only the Montreal Cognitive Assessment score, a significant association was found between this score and the Principal Component self-care construct. The same was not found in a model that included only the MindstreamsTM scores. Conclusions: The Montreal Cognitive Assessment, previously validated as a brief cognitive screening tool, may be useful as an adjunct to assess the self-care capacity of older individuals with diabetes. Future studies in the clinic are needed to evaluate if using this tool may improve treatment plans.
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Affiliation(s)
- Nadia Mordenfeld
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
- The Epidemiology Department, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Noa Gayus
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
| | - Michal Azmon
- The Physiotherapy Department, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Omri Guri-Twito
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
| | - Tal Yahalom Peri
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
| | - Rachel Natovich
- The Rehabilitation Hospital, Sheba Medical Center, Rama Gan, Israel
| | - Tali Cukierman-Yaffe
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
- The Epidemiology Department, Sackler School of Medicine, Herczeg Institute on Aging, Tel-Aviv University, Tel Aviv-Yafo, Israel
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13
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Rivan NFM, Shahar S, Rajab NF, Singh DKA, Che Din N, Mahadzir H, Mohamed Sakian NI, Ishak WS, Abd. Rahman MH, Mohammed Z, You YX. Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1547. [PMID: 32121194 PMCID: PMC7084438 DOI: 10.3390/ijerph17051547] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 01/01/2023]
Abstract
(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.
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Affiliation(s)
- Nurul Fatin Malek Rivan
- Nutritional Sciences Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Suzana Shahar
- Dietetics Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Nor Fadilah Rajab
- Biomedical Science Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme & Centre for Healthy Ageing and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Normah Che Din
- Health Psychology Programme and Centre of Rehabilitation Science, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Hazlina Mahadzir
- Internal Medicine & Geriatric Department, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Batu 9 Cheras, Kuala Lumpur 50300, Malaysia;
| | - Noor Ibrahim Mohamed Sakian
- Occupational Therapy Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Wan Syafira Ishak
- Audiology Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Mohd Harimi Abd. Rahman
- Optometry and Vision Sciences Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (M.H.A.R.); (Z.M.)
| | - Zainora Mohammed
- Optometry and Vision Sciences Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (M.H.A.R.); (Z.M.)
| | - Yee Xing You
- Dietetics Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
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14
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LeRoith D, Biessels GJ, Braithwaite SS, Casanueva FF, Draznin B, Halter JB, Hirsch IB, McDonnell ME, Molitch ME, Murad MH, Sinclair AJ. Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104:1520-1574. [PMID: 30903688 PMCID: PMC7271968 DOI: 10.1210/jc.2019-00198] [Citation(s) in RCA: 309] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults. CONCLUSIONS Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging effects interact with diabetes to accelerate the progression of many common diabetes complications. Each section in this guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.
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Affiliation(s)
- Derek LeRoith
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Susan S Braithwaite
- Presence Saint Francis Hospital, Evanston, Illinois
- Presence Saint Joseph Hospital, Chicago, Illinois
| | - Felipe F Casanueva
- Complejo Hospitalario Universitario de Santiago, CIBER de Fisiopatologia Obesidad y Nutricion, Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - Boris Draznin
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Jeffrey B Halter
- University of Michigan, Ann Arbor, Michigan
- National University of Singapore, Singapore, Singapore
| | - Irl B Hirsch
- University of Washington Medical Center–Roosevelt, Seattle, Washington
| | - Marie E McDonnell
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark E Molitch
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
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15
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Usefulness of Eye Fixation Assessment for Identifying Type 2 Diabetic Subjects at Risk of Dementia. J Clin Med 2019; 8:jcm8010059. [PMID: 30626106 PMCID: PMC6352169 DOI: 10.3390/jcm8010059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/22/2018] [Accepted: 01/01/2019] [Indexed: 01/13/2023] Open
Abstract
Type 2 diabetic (T2D) subjects have a significantly higher risk of developing mild cognitive impairment (MCI) and dementia than age-matched non-diabetic individuals. However, the accurate evaluation of cognitive status is based on complex neuropsychological tests, which makes their incorporation into the current standard of care for the T2D population infeasible. Given that the ability to maintain visual gaze on a single location (fixation) is hampered in Alzheimer’s disease (AD), the aim of the present study was: (1) To assess whether the evaluation of gaze fixation during fundus-driven microperimetry correlated with cognitive status in T2D subjects; (2) to examine whether the addition of fixational parameters to the assessment of retinal sensitivity increased the predictive value of retinal microperimetry in identifying T2D subjects with MCI. For this purpose, fixation parameters and retinal sensitivity were compared in three age-matched groups of T2D subjects: normocognitive (n = 34), MCI (n = 33), and AD (n = 33). Our results showed that fixation is significantly more unstable in MCI subjects than normocognitive subjects, and even more altered in those affected by AD (ANOVA; p < 0.01). Moreover, adding fixation parameters to retinal sensitivity significantly increases the predictive value in identifying those subjects with MCI: ROC (Receiver Operating Characteristic) Area 0.68 with retinal sensitivity alone vs. ROC Area 0.86 when parameters of fixation are added to retinal sensitivity (p < 0.01). In conclusion, our results suggest that fixational eye movement parameters assessed by fundus-microperimetry represent a new tool for identifying T2D subjects at risk of dementia.
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16
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Abstract
PURPOSE/BACKGROUND Development of the Digit Symbol Substitution Test (DSST) was initiated over a century ago as an experimental tool to understand human associative learning. Its clinical utility, owing to its brevity and high discriminant validity, was first recognized in the 1940s, and now the DSST is among the most commonly used tests in clinical neuropsychology. METHODS Specific studies and articles were reviewed to illustrate what the test measures, to evaluate its sensitivity to change, and to discuss its use in clinical practice. RESULTS The DSST is a valid and sensitive measure of cognitive dysfunction impacted by many domains. Performance on the DSST correlates with real-world functional outcomes (eg, the ability to accomplish everyday tasks) and recovery from functional disability in a range of psychiatric conditions including schizophrenia and major depressive disorder. Importantly, the DSST has been demonstrated to be sensitive to changes in cognitive functioning in patients with major depressive disorder and offers promise as a clinical decision-making tool for monitoring treatment effects in this and other disorders affecting cognition. IMPLICATIONS/CONCLUSIONS The DSST is sensitive to the presence of cognitive dysfunction as well as to change in cognitive function across a wide range of clinical populations but has low specificity to determine exactly which cognitive domain has been affected. However, the DSST offers a practical and effective method to monitor cognitive functions over time in clinical practice.
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Affiliation(s)
- Judith Jaeger
- From CognitionMetrics, LLC, Wilmington, DE; and Albert Einstein College of Medicine, Bronx, NY
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17
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Morley JE. A Decade of JAMDA. J Am Med Dir Assoc 2017; 18:993-997. [PMID: 29169742 DOI: 10.1016/j.jamda.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO.
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18
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19
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Morley JE. The Complexities of Diabetes in Older Persons. J Am Med Dir Assoc 2016; 17:872-4. [PMID: 27590405 DOI: 10.1016/j.jamda.2016.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
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