L Bordier1, J Doucet2, J Boudet3, B Bauduceau4. 1. Endocrinology Department, hôpital Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France. Electronic address: lbordier@club-internet.fr. 2. Geriatric Therapy and Internal Medicine Department, hôpital Saint-Julien, CHU de Rouen, 76031 Rouen cedex, France. 3. Medical Endocrinology Department, Lilly France, boulevard Vital-Bouhot, 92521 Neuilly-sur-Seine cedex, France. 4. Endocrinology Department, hôpital Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
Abstract
AIM: This article is an update of the relationship between type 2 diabetes (T2D), cognitive dysfunction and dementia in older people. METHODS AND RESULTS: The number of older patients consulting for diabetes who also exhibit cognitive difficulties is consistently growing because of the increased longevity of the population as a whole and, according to a number of studies, the increased risk of cognitive impairment and dementia in older diabetic patients. Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabetic patients. A history of severe hypoglycaemic episodes has also been associated with a greater risk of late-in-life cognitive deficits and dementia in patients with T2D. Several processes are thought to promote cognitive decline and dementia in diabetics. Based on both clinical and non-clinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycaemia. Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression-related symptoms, greater incidence of recurrent hypoglycaemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies. CONCLUSION: Clinical guidelines have recently been devised for older diabetic patients, particularly those with cognitive deficits and a reduced capacity to self-manage. In the most vulnerable patients, specific treatment strategies have been proposed for glycaemic control to limit metabolic decompensation and avoid the risk of hypoglycaemia. Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients' cognitive and functional status.
AIM: This article is an update of the relationship between type 2 diabetes (T2D), cognitive dysfunction and dementia in older people. METHODS AND RESULTS: The number of older patients consulting for diabetes who also exhibit cognitive difficulties is consistently growing because of the increased longevity of the population as a whole and, according to a number of studies, the increased risk of cognitive impairment and dementia in older diabeticpatients. Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabeticpatients. A history of severe hypoglycaemic episodes has also been associated with a greater risk of late-in-life cognitive deficits and dementia in patients with T2D. Several processes are thought to promote cognitive decline and dementia in diabetics. Based on both clinical and non-clinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycaemia. Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression-related symptoms, greater incidence of recurrent hypoglycaemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies. CONCLUSION: Clinical guidelines have recently been devised for older diabeticpatients, particularly those with cognitive deficits and a reduced capacity to self-manage. In the most vulnerable patients, specific treatment strategies have been proposed for glycaemic control to limit metabolic decompensation and avoid the risk of hypoglycaemia. Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients' cognitive and functional status.
Authors: Andrew R Zullo; Matthew S Duprey; Robert J Smith; Roee Gutman; Sarah D Berry; Medha N Munshi; David D Dore Journal: Diabetes Obes Metab Date: 2021-10-27 Impact factor: 6.577