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Diabetologia

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01.07.2003 | Article

Cognitive efficiency declines over time in adults with Type 1 diabetes: effects of micro- and macrovascular complications

verfasst von: Dr. C. M. Ryan, M. O. Geckle, T. J. Orchard

Erschienen in: Diabetologia | Ausgabe 7/2003

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Abstract

Aims/hypothesis

Mild cognitive dysfunction is not uncommon in adults with Type 1 diabetes, but its pathogenesis remains unclear. Previous cross-sectional studies had suggested that microangiopathy might affect brain integrity and lead to 'central neuropathy.' To assess the relationship between changes in cognitive performance and the incidence of new micro- and macrovascular complications, 103 young and middle-aged adults (mean age: 40 yrs) with childhood-onset Type 1 diabetes were followed over a 7-year period, and were compared to 57 demographically-similar adults without diabetes.

Methods

All subjects completed a comprehensive battery of neurocognitive tests on two occasions. Diabetic subjects also received repeated medical assessments to diagnose the onset of clinically significant complications.

Results

Relative to control subjects, diabetic adults showed significant declines on measures of psychomotor efficiency; no between-group differences were evident on learning, memory, or problem-solving tasks. The development of proliferative retinopathy and autonomic neuropathy during the follow-up period predicted decline in psychomotor speed (p<0.01), as did incident macrovascular complications (p<0.05), systolic blood pressure at follow-up (p<0.01), and duration of diabetes (p<0.01).

Conclusion/interpretation

This study shows that cognitive efficiency may decline over time in diabetic adults, and that this neurocognitive change may be linked, at least in part, to the occurrence of complications like proliferative retinopathy and elevated blood pressure. Therapeutic interventions that reduce the risk of vascular complications may have a similarly beneficial effect on the brain and reduce the risk of neurocognitive dysfunction in diabetic patients.

Biessels G-J (1999) Cerebral complications of diabetes: Clinical findings and pathogenetic mechanisms. Neth J Med 54:35–45CrossRefPubMed

Deary IJ, Langan SJ, Graham KS, Hepburn D, Frier BM (1992) Recurrent severe hypoglycemia, intelligence, and speed of information processing. Intelligence 16:337–359CrossRef

Sachon C, Grimaldi A, Digy JP, Pillon B, Dubois B, Thervet F (1992) Cognitive function, insulin-dependent diabetes and hypoglycaemia. J Intern Med 231:471–475PubMed

Wredling R, Levander S, Adamson U, Lins PE (1990) Permanent neuropsychological impairment after recurrent episodes of severe hypoglycaemia in man. Diabetologia 33:152–157PubMed

Ryan CM, Williams TM, Orchard TJ, Finegold DN (1992) Psychomotor slowing is associated with distal symmetrical polyneuropathy in adults with diabetes mellitus. Diabetes 41:107–113

Perros P, Deary IJ, Sellar RJ, Best JJK, Frier BM (1997) Brain abnormalities demonstrated by magnetic resonance imaging in adult IDDM patients with and without a history of recurrent severe hypoglycemia. Diabetes Care 20:1013–1018PubMed

Dejgaard A, Gade A, Larsson H, Balle V, Parving A, Parving H (1991) Evidence for diabetic encephalopathy. Diabet Med 8:162–167PubMed

Quirce R, Carril JM, Jiménez-Bonilla JF, Amado JA, Gutiérrez-Mendiguchía C, Banzo I, Blanco I, Uriarte I, Montero A (1997) Semi-quantitative assessment of cerebral blood flow with^99mTc-HMPAO SPET in type 1 diabetic patients with no clinical history of cerebrovascular disease. Eur J Nucl Med 24:1507–1513

Perros P, Deary IJ (1999) Long-term effects of hypoglycaemia on cognitive function and the brain in diabetes. In: Frier BM, Fisher BM (eds) Hypoglycaemia in clinical diabetes. Wiley, Chichester, pp 187–210

10.

Deary I, Crawford J, Hepburn DA, Langan SJ, Blackmore LM, Frier BM (1993) Severe hypoglycemia and intelligence in adult patients with insulin-treated diabetes. Diabetes 42:341–344PubMed

11.

Austin EJ, Deary IJ (1999) Effects of repeated hypoglycemia on cognitive function. Diabetes Care 22:1273–1277PubMed

12.

Diabetes Control and Complications Trial Research Group (1996) Effects of intensive diabetes therapy on neuropsychological function in adults in the Diabetes Control and Complications Trial. Ann Intern Med 124:379–388PubMed

13.

Reichard P, Berglund B, Britz A, Levander S, Rosenqvist U (1991) Hypoglycemic episodes during intensified insulin treatment: increased frequency but no effect on cognitive function. J Intern Med 229:9–16PubMed

14.

Chabriat H, Sachon C, Levasseur M, Grimaldi A, Pappata S, Rougemont D, Masure MC, De Rocondo A, Samson Y (1994) Brain metabolism after recurrent insulin-induced hypoglycemic episodes: A PET study. J Neurol Neurosurg Psychiatry 57:1360–1365PubMed

15.

Kramer L, Fasching P, Madl C, Schneider B, Damjancic P, Waldhäusl W, Irsigler K, Grimm G (1998) Previous episodes of hypoglycemic coma are not associated with permanent cognitive brain dysfunction in IDDM patients on intensive insulin treatment. Diabetes 47:1909–1914PubMed

16.

Ryan CM, Williams TM, Finegold DN, Orchard TJ (1993) Cognitive dysfunction in adults with Type 1 (insulin-dependent) diabetes mellitus of long duration: effects of recurrent hypoglycaemia and other chronic complications. Diabetologia 36:329–334PubMed

17.

Orchard TJ, Dorman JS, Maser RE, Becker DJ, Drash AL, Ellis D, Laporte RE, Kuller LH (1990) Prevalence of complications in IDDM by sex and duration: Pittsburgh Epidemiology of Complications Study II. Diabetes 39:1116–1124PubMed

18.

Orchard TJ, Forrest KY-Z, Kuller LH, Becker DJ (2001) Lipid and blood pressure treatment goals for Type 1 diabetes: 10-year incidence data from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care 24:1053–1059PubMed

19.

American Diabetes Association (1999) Screening for Type 2 diabetes. Diabetes Care 22:S20–S23

20.

Borhani NO, Kass EH, Langford HG, Payne GH, Remington RD, Stamler J (1976) The hypertension detection and follow-up program. Prev Med 5:207–215PubMed

21.

Maser RE, Nielsen VK, Bass EB, Manjoo Q, Dorman JS, Kelsey SF, Becker DJ, Orchard TJ (1989) Measuring diabetic neuropathy: Assessment and comparison of clinical examination and quantitative sensory testing. Diabetes Care 12:270–275PubMed

22.

Diabetes Control and Complications Trial Research Group (1986) The Diabetes Control and Complications Trial (DCCT): design and methodologic considerations for the feasibility phase. Diabetes 35:530–545PubMed

23.

Early Treatment of Diabetic Retinopathy Study Coordinating Center (1980) Manual of operations. University of Maryland School of Medicine, Baltimore, MD

24.

Diabetes Control and Complications Trial Research Group (1988) Factors in development of diabetic neuropathy: Baseline analysis of neuropathy in feasibility phase of Diabetes Control and Complications Trial (DCCT). Diabetes 37:476–481PubMed

25.

Stella P, Ellis D, Maser RE, Orchard TJ (2000) Cardiac autonomic neuropathy (expiration and inspiration ratio) in type 1 diabetes: Incidence and predictors. J Diabetes Complications 14:1–6CrossRefPubMed

26.

Ryan CM (1994) Measures of cognitive function. In: Bradley C (ed.) Handbook of psychology and diabetes. Harwood, Chur, Switzerland, pp 191–219

27.

Mitrushina MN, Boone KB, D'Elia LF (1999) Handbook of normative data for neuropsychological assessment. Oxford University Press, New York

28.

Derogatis LR (1983) SCL-90-R manual: administration, scoring & procedures. Clinical Psychometric Research, Towson, MD

29.

McNair DM, Lorr M, Droppleman LF (1981) EDITS manual for the profile of mood states. Educational and Industrial Service, San Diego, CA

30.

Ryan C, Vega A, Longstreet C, Drash L (1984) Neuropsychological changes in adolescents with insulin-dependent diabetes mellitus. J Consult Clin Psychol 52:335–342CrossRefPubMed

31.

Ryan CM, Geckle MO (2000) Circumscribed cognitive dysfunction in middle-aged adults with type 2 diabetes. Diabetes Care 23:1486–1493PubMed

32.

Stewart RJ, Liolitsa D (1999) Type 2 diabetes mellitus, cognitive impairment and dementia. Diabet Med 16:93–112CrossRefPubMed

33.

Strachan MWJ, Deary IJ, Ewing FME, Frier BM (1997) Is Type 2 (non-insulin dependent) diabetes mellitus associated with an increased risk of cognitive dysfunction? Diabetes Care 20:438–445

34.

Miller CD, Phillips LS, Ziemer DC, Gallina DL, Cook CB, El-Kebbi IM (2001) Hypoglycemia in patients with Type 2 diabetes mellitus. Arch Intern Med 161:1653–1659CrossRefPubMed

35.

Fontbonne A, Ducimetiere P, Berr C, Alperovitch A (2001) Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 24:366–370PubMed

36.

Gregg EW, Yaffe K, Cauley JA, Rolka DB, Blackwell TL, Narayan KM, Cummings SR (2000) Is diabetes associated with cognitive impairment and cognitive decline among older women? Arch Intern Med 160:174–180

37.

Knopman DS, Boland LL, Mosley T, Howard G, Liao D, Szklo M, McGovern PG, Folsom AR, ARIC Study Investigators (2001) Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology 56:42–48PubMed

38.

Haan MN, Shemanski L, Jagust WJ, Manolio TA, Kuller L (1999) The role of APOE ε4 in modulating effects of other risk factors for cognitive decline in elderly persons. JAMA 282:40–46CrossRefPubMed

39.

Ferguson SC, Blane A, Perros P, McCrimmon RJ, Best JJK, Wardlaw JM, Deary IJ, Frier BM (2003) Cognitive ability and brain structure in type 1 diabetes: Relation to microangiopathy and preceding severe hypoglycemia. Diabetes 52:149–156PubMed

40.

Wong TY, Klein R, Sharrett AR, Nieto FJ, Boland LL, Couper DJ, Mosley TH, Klein BEK, Hubbard LD, Szklo M (2002) Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the Atherosclerosis Risk in Communities Study. Stroke 33:1487–1492CrossRefPubMed

41.

Wong TY, Klein R, Sharrett AR, Couper DJ, Klein BEK, Liao D-P, Hubbard LD, Mosley TH, ARIC Investigators (2002) Cerebral white matter lesions, retinopathy, and incident clinical stroke. JAMA 288:67–74CrossRefPubMed

42.

Cameron NE, Eaton SEM, Cotter MA, Tesfaye S (2001) Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. Diabetologia 44:1973–1988CrossRefPubMed

43.

Price JC, Kelley DE, Ryan CM, Meltzer CC, Drevets WC, Mathis CA, Mazumdar S, Reynolds CF (2002) Evidence of increased serotonin-1A receptor binding in type 2 diabetes: a positron emission tomography study. Brain Res 927:97–103CrossRefPubMed

44.

Friedman EA (1999) Advanced glycosylated end products and hyperglycemia in the pathogenesis of diabetic complications. Diabetes Care 22:B65–B71PubMed

45.

Swan GE, DeCarli C, Miller BL, Reed T, Wolf PA, Jack LM, Carmelli D (1998) Association of midlife blood pressure to late-life cognitive decline and brain morphology. Neurology 51:986–993PubMed

46.

Strassburger TL, Lee H-C, Daly EM, Szczepanik J, Krausuki JS, Mentis MJ, Salerno JA, DeCarli C, Schapiro MB, Alexander GE (1997) Interactive effects of age and hypertension on volumes of brain structures. Stroke 28:1410–1417PubMed

47.

Skoog I, Lernfelt B, Landahl S, Palmertz B, Andreasson L-A, Nilsson L, Persson G, Odén A, Svanborg A (1996) 15-year longitudinal study of blood pressure and dementia. Lancet 347:1141–1145PubMed

48.

Elias MF, Robbins MA, Elias PK, Streeten DHP (1998) A longitudinal study of blood pressure in relation to performance on the Wechsler Adult Intelligence Scale. Health Psychol 17:486–493CrossRefPubMed

49.

Elias PK, Elias MF, D'Agostino RB, Cupples LA, Wilson PW, Silbershatz H, Wolf PA (1997) NIDDM and blood pressure as risk factors for poor cognitive performance. Diabetes Care 20:1388–1395PubMed

50.

Kilander L, Nyman H, Boberg M, Hansson L, Lithell H (1998) Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension 31:780–786PubMed

51.

Jennings JR, Muldoon MF, Ryan CM, Mintun MA, Meltzer CC, Townsend DW, Sutton-Tyrrell K, Shapiro AP, Manuck SB (1998) Cerebral blood flow in hypertensive patients: an initial report of reduced and compensatory blood flow responses during performance of two cognitive tasks. Hypertension 31:1216–1222PubMed

52.

Longstreth WT, Manolio TAAA, Burke GL, Bryan N, Jungreis CA, Enright PL, O'Leary D, Fried L (1996) Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people: the Cardiovascular Health Study. Stroke 27:1274–1282PubMed

53.

Sierra C, Sierra A de la, Mercader JM, Gómez-Angelats E, Urbano-Márquez A, Coca A (2002) Silent cerebral white matter lesions in middle-aged essential hypertensive patients. J Hypertens 20:519–524CrossRefPubMed

54.

Leaper SA, Murray AD, Lemmon HA, Staff RT, Deary IJ, Crawford JR, Whalley LJ (2001) Neuropsychologic correlates of brain white matter lesions depicted on MR images: 1921 Aberdeen birth cohort. Radiology 221:51–55PubMed

55.

Groot JC de, Leeuw F-E de, Oudkerk M, Gijn J van, Hofman A, Jolles J, Breteler MMB (2000) Cerebral white matter lesions and cognitive function: the Rotterdam Scan Study. Ann Neurol 47:145–151CrossRefPubMed

56.

Miller EM (1994) Intelligence and brain myelination: a hypothesis. Pers Individ Diff 17:803–832CrossRef

57.

Marstrand JR, Garde E, Rostrup E, Ring P, Rosenbaum S, Mortensen EL, Larsson HBW (2002) Cerebral perfusion and cerebrovascular reactivity are reduced in white matter hyperintensities. Stroke 33:972–976CrossRefPubMed

58.

Filley CM (2001) The behavioral neurology of white matter. Oxford University Press, Oxford, UK

59.

Virtaniemi J, Laakso M, Kärjä J, Nuutinen J, Karjalainen S (1993) Auditory brainstem latencies in type 1 (insulin-dependent) diabetic patients. Am J Otolaryngol 14:413–418PubMed

60.

Kurita A, Katayama K, Mochio S (1996) Neurophysiological evidence for altered higher brain functions in NIDDM. Diabetes Care 19:361–364

61.

Pfefferbaum A, Sullivan EV, Hedehus M, Lim KO, Adalsteinsson E, Moseley M (2000) Age-related decline in brain white matter anisotropy measured with spatially corrected echo-planar diffusion tensor imaging. Magn Reson Med 44:259–266CrossRefPubMed

Titel: Cognitive efficiency declines over time in adults with Type 1 diabetes: effects of micro- and macrovascular complications
verfasst von: Dr. C. M. Ryan
M. O. Geckle
T. J. Orchard
Publikationsdatum: 01.07.2003
Verlag: Springer-Verlag
Erschienen in: Diabetologia / Ausgabe 7/2003
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-003-1128-2

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Cognitive efficiency declines over time in adults with Type 1 diabetes: effects of micro- and macrovascular complications

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