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Mild cognitive impairment may be linked to severity of diabetes
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Mild cognitive impairment is associated with early-onset, long duration and insulin-treated diabetes, according to recent data.
Researchers from the Mayo Clinic in Rochester, Minn. conducted a population-based, case controlled study that included 329 participants with mild cognitive impairment and 1,640 participants without impairment. Participants were aged between 70 and 89 years.
The researchers conducted a neurological examination and an interview on all patients to determine cognitive function and gain information on diabetes history, treatment and complications.
The researchers reported similarities in the frequency of diabetes among participants with mild cognitive impairment (20.1%) and those without impairment (17.7%).
However, onset of diabetes before age 65 years (OR=2.20), disease duration of 10 years or longer (OR=1.76) and treatment with insulin (OR=2.01) were associated with mild cognitive impairment, according to the researchers. Diabetes complications such as neuropathy and retinopathy increased the OR for mild cognitive impairment by two-fold and nephropathy increased the OR by 1.5-fold.
Arch Neurol. 2008;65:1066-1073.
This study suggests a relationship between mild cognitive impairment and type 2 diabetes — a finding which has been reported before. However, the more novel part of the study is that Roberts et al emphasize the key variables that raise the risk that patients with diabetes will develop clinically significant cognitive impairment. The effects of diabetes on the central nervous system are under-recognized, though members of the research community are beginning to understand that diabetes has central, as well as peripheral, effects but these relationships are not emphasized in clinical practice.
This study underscores the need for regular cognitive screening in patients diagnosed with diabetes before 65 years of age. The study also shows that patients should be educated on the importance of good glycemic control to avoid dependence on insulin therapy, as this type of treatment carries a stronger risk of developing mild cognitive impairment than other treatments.
Not only is mild cognitive impairment a serious disorder in itself, but it can seriously impede a patient's ability to carry out diabetes self-care behaviors needed to treat the disease, which in turn leads to a vicious cycle.
– Gail Musen, PhD
Assistant Investigator
Joslin Diabetes Center
Section on Behavioral and Mental Health