Diabetes and Cognitive Impairment

Neuropathological links between T2DM and LOAD: systematic review and meta-analysis

Recent decades have described parallel neuropathological mechanisms increasing the risk for developing late-onset Alzheimer's dementia (LOAD) in type 2 diabetes mellitus (T2DM); however, still little is known of the role of diabetic encephalopathy and brain atrophy in LOAD. The aim of this systematic review is to provide a comprehensive view on diabetic encephalopathy/cerebral atrophy, taking into account neuroimaging data, neuropathology, metabolic and endocrine mechanisms, amyloid formation, brain perfusion impairments, neuroimmunology, and inflammasome activation. Key switches were identified, to further meta-analyze genomic candidate loci and epigenetic modifications. For the qualitative meta-analysis of genomic bases extracted, human linkage studies were examined; for epigenetic mechanisms, data from both human and animal studies are described. For the systematic review of pathophysiological mechanisms, 1,259 publications were evaluated and 93 gene loci extracted for candidate risk linkages. Sixty-six publications were evaluated for genomic association and descriptions of epigenomic modifications. Overall accumulated results highlight the insulin signaling system, vascular markers, inflammation and inflammasome pathways, amylin interactions, and glycosylation mechanisms. The protocol was registered with PROSPERO (ID: CRD42023440535).

Teeth, Health, and Mind: Understanding the Interplay of Social Determinants and Cognitive Decline in Older Adults

The study examines the association between social determinants of health, tooth loss, and cognitive decline. Using regression models, the 2020 Behavioral Risk Factor Surveillance data examined the study objective; it included 32,663 older adults who reported on cognitive status. Results suggested that older adults missing more than five teeth or unable to work are 1.61 times and 6.84 times more likely to report cognitive decline, respectively. Older adults with higher education and higher household incomes are less likely to report cognitive decline. Results suggested that older adults with no diabetes or who never smoked are 31% and 39% less likely to report a cognitive decline. The results suggested a significant association between tooth loss and cognitive decline among social determinants of health. A comprehensive approach to affect cognitive decline should include oral and social health strategies.

Photobiomodulation effects on cognitive function - a systematic review and meta-analysis of randomized controlled trials

Photobiomodulation can alleviate the severity or delay the development of cognitive impairment through early prevention and intervention. This systematic review summarizes the effectiveness of photobiomodulation in improving cognitive function across various populations. Clinical randomized controlled trials from the establishment of the database to October 2024 were searched in PubMed, Web of Science, EMBASE, and the Cochrane Library according to PRISMA guidelines. Trials comparing the effects of PBM treatment with placebo or sham stimulation on cognitive function in healthy adults or subjects with cognitive impairment were included. Two independent researchers conducted literature screening, data extraction, and quality assessment of the included studies. Meta-analyses were performed using random effects models with Review Manager V.5.4 software. The methodological quality of the studies was evaluated using the Cochrane Risk of Bias tool. Sensitivity analyses were performed using Stata V.15.1 software. A total of 24 randomized trials involving 820 participants met the inclusion criteria. Compared with the control group, PBM treatment showed significant benefits for subjects in terms of global cognitive function (SMD = 0.66, 95% CI: 0.23 to 1.08, P = 0.003), working memory span (SMD = 1.41, 95% CI: 0.78 to 2.04, P < 0.0001), attention (SMD = -1.15, 95% CI: -2.05 to -0.24, P = 0.01) and the reaction time of executive function (SMD = -1.10, 95% CI: -1.86 to -0.33, P = 0.005) aspects. In the subgroup analyses, with the exception of no differences in both reaction time of working memory and accuracy of executive function, cognitive impaired subjects showed some improvement in other all cognitive domains (attention test only for healthy subjects), while healthy subjects showed an insignificant improvement in reaction time of executive function. This meta-analysis found that PBM treatment positively impacts global cognitive function, working memory, and executive function in persons with cognitive impairment, and partially improved global cognitive function, working memory and attention in the healthy population. However, this finding should be treated with caution due to the heterogeneity and limitations of the studies. Registration number: CRD42024552832. Registration data: 2024/06/10.

Resveratrol Alleviates Diabetic Adipose Tissue-Derived Extracellular Vesicles-Induced Hippocampal Ferroptosis and Cognitive Dysfunction via Inhibiting miR-9-3p/SLC7A11 Axis

Visceral adipose tissue-derived extracellular vesicles (VAT-EVs) and their cargo miR-9-3p contribute to cognitive dysfunction and insulin resistance. Resveratrol (RES) prevents T2DM-induced cognitive impairment. This study investigates the interactive role of VAT-EVs and RES in diabetes-associated cognitive dysfunction (DACD) and the potential mechanisms. T2DM mice were constructed by high-fat diet (HFD)-feeding and streptozotocin (STZ) injection. Blood glucose and insulin levels evaluated the insulin resistance. Novel object recognition test (ORT) and Morris water maze (MWM) test assessed cognitive impairment. Nissl, H&E, and TUNEL stainings evaluated neuronal death. Immunofluorescence staining, immunostaining, DHE staining, Perls' staining, biochemical assays, and Western blots determined ER, oxidative stress, and ferroptosis. ELISA measured cytokines. VAT-EVs were isolated from adipose tissues of T2DM mice and characterized by transmission electron microscopy (TEM), Western blot, and dynamic light scattering detection. Treatment of resveratrol (RES) without or with miR-9-3p mimics investigated their interactive roles in DACD. Luciferase reporter assay, Western blot, and qRT-PCR validated the binding of miR-9-3p in SLC7A11. The blood glucose and insulin results and behavioral tests showed that T2DM mice exhibited insulin resistance and cognitive impairments. T2DM mice showed impaired structures, increased apoptosis, and enhanced inflammation, ER, oxidative stress, and ferroptosis in the hippocampus. RES diminished HFD-VAT-EVs-induced insulin resistance and cognitive declines through decreasing ER and oxidative stress, inflammation, and iron overload. Mechanistically, RES decreased miR-9-3p to upregulate SLC7A11 and subsequently mitigate ferroptosis. RES protected cognitive dysfunction and insulin resistance in T2DM via diminishing VAT-EVs and their cargo miR-9-3p-induced ER and oxidative stress, inflammation, and ferroptosis in the hippocampus.

Association between hemoglobin-to-red blood cell distribution width ratio and cognitive impairment in elderly Americans

This study aimed to investigate the potential association between the hemoglobin-to-red blood cell distribution width ratio (HRR) and cognitive impairment in a representative sample of elderly Americans. Data from National Health and Nutrition Examination Survey 1999 to 2002 were utilized to analyze demographic information, cognitive function assessments, and laboratory data. Binary Logistic regression was conducted to analyze the associations. Subgroup analyses and sensitivity analyses were performed simultaneously. In the univariable logistic regression analysis, the odds ratio was 0.13 (95% confidence interval [CI]: 0.06-0.25; P < .001). After adjusting for all covariates in the multivariable regression analysis, the odds ratio was 0.25 (95% CI: 0.11-0.6; P = .002). Compared to the lowest HRR group, the higher HRR groups had significantly lower odds of cognitive impairment: Q2 (OR = 0.6, 95% CI: 0.42-0.84, P = .003), Q3 (OR = 0.54, 95% CI: 0.37-0.77, P = .001), and Q4 (OR = 0.56, 95% CI: 0.38-0.82, P = .003). Subgroup and sensitivity results were stable and consistent. These results suggest that higher levels of HRR may be associated with a lower risk of cognitive impairment in elderly Americans.

Attention as the primary cognitive domain affected in post-myocardial infarction cognitive impairment: a prospective multicenter study

We analysed cognitive impairment (CI) during the peri-myocardial infarction (MI) period and after 6 months. The study included 326 patients. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Clock Drawing Test (CDT). Routine laboratory and echocardiography data were collected. We distinguished 4 groups of patients: 1 - CI present peri-infarction and after 6 months; 2 - CI present only peri-infarction; 3 - CI present only after 6 months; 4 - without CI. Groups constituted 8.9%, 16.3%, 7.7% and 67.1% of participants (as assessed by MMSE), respectively. In those who improved (group 2) or with worsened cognitive function (group 3), analogous changes in attention function occurred. There was a group of patients with CI on the MMSE who performed the CDT correctly, 12% peri-infarct and 11% at 6-month follow-up, respectively. Patients with a normal CDT score but CI found in the MMSE had impaired attention function. Cognitive function improves in some patients, and deteriorates in others after MI. The uniform type of impaired cognitive function allows us to assume a uniform etiology of CI. Performing the CDT and using the MMSE component assessing attention could prove sufficient for the initial assessment of cognitive functions in patients after MI.

Dysregulated brain dynamics in the visualmotor network in type 2 diabetes patients and their relationship with cognitive impairment

OBJECTIVE

Type 2 diabetes mellitus (T2DM) is a significant risk factor for mild cognitive impairment (MCI). Here, we identified a T2DM-specific effective connectivity (EC) network, the dynamic features of which could be used to distinguish T2DM patients with MCI from healthy controls (HC) and correlation with cognitive performance.

METHODS

Local and multicentered T2DM patients and matched HC who underwent functional magnetic resonance imaging were recruited. Their static and dynamic effective connectivity were compared. The relationships between connectome characteristics and cognitive performance were also evaluated.

RESULTS

The nodes of the T2DM-related static causality network included the anterior central gyrus, tail of the parahippocampal gyrus, posterior superior temporal sulcus, posterior central parietal lobe, posterior central gyrus and V5 region of the occipital lobe. The V5 region of the visual cortex was the core node. In the multicentered dataset, compared with the HC group, the T2DM with MCI group had significantly greater fractional window and mean dwell time. Fractional windows of the state, which was dominated by the interaction of the nodes from SomMot_Network, Limbic_Network, Default_Network, in the T2DM-specific network increased with poorer cognitive performance in T2DM with MCI patients.

CONCLUSION

Our findings provide insights into the neurobiological mechanisms of the cognitive impairment of T2DM patients from a dynamic network perspective, which may ultimately inform more targeted and effective strategies to prevent MCI.

Type 2 diabetes and late-onset Alzheimer's disease and related dementia: A longitudinal cohort study integrating polygenic risk score

BackgroundThe inherent genetic effects were not established between type 2 diabetes (T2DM) and Alzheimer's disease and related dementia (ADRD).ObjectiveWe aimed to investigate the association between T2DM and ADRD by integrating T2DM polygenic risk score (PRS) and applying matching in every subgroup.MethodsWe utilized UK Biobank First-occurrences datasets. T2DM were 1:1 matched to non-T2DM using propensity scores generated by 8 covariates; age at diagnosis, sex, cerebrovascular disease, ischemic heart disease, hypertensive disorders, lipid disorders, obesity, and mood disorders. T2DM PRS was additionally matched in T2DM PRS matched analysis. Subgroup analyses by age at diagnosis, sex, and APOE4 genotype were performed with the same matching criteria within each subgroup. Cox proportional hazard and Fine & Gray competing risk model were utilized.ResultsIn T2DM PRS unmatched cohort, 24,583 T2DM were 1:1 matched to non-T2DM. The mean age at diagnosis was around 62 years old, with females constituting around 40%. Up to 25-year follow-up, ADRD rate/1000 person-years was 0.88 versus 1.52 (Non-T2DM versus T2DM); PRS unmatched (cHR: 1.72, 95% CI: 1.46-2.03) and matched (cHR:1.75, 95% CI: 1.47-2.09). Except for older age onset (≥75 years), the other subgroups demonstrated significantly increased ADRD risks in T2DM. T2DM PRS was higher in non-ADRD group across all subgroups. Contrarily, T2DM PRS was higher in ADRD in younger onset group (<55 years).ConclusionsT2DM is one of the strong risk factors of ADRD but genetic T2DM effect does not contribute to ADRD risk. However, a genetic link might be present in younger age onset group.

Handgrip strength and risk of cognitive impairment across different glucose metabolism statuses: insights from the CHARLS study

Background

Both low handgrip strength (HGS) and abnormal glucose metabolism have been implicated in an increased risk of cognitive impairment. However, whether HGS interacts with glucose metabolism status to influence cognitive function remains unclear. This study explores the relationship between HGS and cognitive impairment risk among middle-aged and older Chinese adults and examines the potential modulation of this association by glucose metabolism status.

Methods

Data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2011 and 2018 were analyzed, including 7,301 participants aged ≥ 45 years. Cognitive impairment was the primary outcome. Logistic regression and restricted cubic spline (RCS) analyses were applied to evaluate the association between HGS and cognitive impairment risk across different glucose metabolism statuses.

Results

The study included 7,301 participants (mean age: 58.8 ± 8.9 years; 49.3% female). Over a 7-year follow-up, the mean cognitive function score declined from 12.05 ± 3.30 to 7.75 ± 5.70. After adjusting for confounders, logistic regression analyses indicated that higher HGS was significantly associated with a lower risk of cognitive impairment. Participants in the highest HGS quartile (Q4) had a significantly reduced odds of cognitive impairment compared to those in the lowest quartile (Q1) (odds ratio [OR]: 0.59, 95% confidence interval [CI]: 0.49-0.71; P < 0.001). RCS analysis demonstrated a significant negative linear correlation between HGS and cognitive impairment across individuals with normal glucose regulation, prediabetes, and diabetes (P < 0.001). The interaction p-value was 0.277, indicating no significant differences in this association among glucose metabolism subgroups.

Conclusion

Higher HGS is significantly associated with a reduced risk of cognitive impairment among middle-aged and older individuals, irrespective of glucose metabolism status. These findings suggest that HGS assessment could be a valuable universal tool for evaluating cognitive impairment risk, regardless of metabolic conditions.

Health Literacy and Cognitive Disorders in Diabetic Patients

Background/Objectives: Diabetes is a chronic metabolic disease affecting over 500 million adults worldwide, which is over 10% of the world's population. Diabetes is associated with a high risk of complications, including cognitive impairment of varying severity. Effective treatment of diabetes requires the patients not only to follow medical recommendations, but also to have appropriate health literacy (HL). The aim of the study was to determine the level of health literacy in diabetes patients, taking into account their cognitive functions. Methods: the study design consists of an anonymous survey involving 312 patients with type 1 and 2 diabetes, treated at the Diabetology Clinic of the Institute of Rural Health in Lublin, Poland. The survey was based on two standardized research tools, the 47-item European Health Literacy Questionnaire (EU-HLS-Q47) and the Mini-Mental State Examination (MMSE), and an original questionnaire focusing on the patients' health situation, metric questions, questions about self-assessment of knowledge, and educational needs. Results: The EU-HLS-Q47 and MMSE showed that diabetic patients mostly presented a sufficient level of health literacy. A limited level of health literacy was presented by 36.86% of the examined diabetic patients. A statistically significant relationship between the length of diabetes (in years) and the General Health Literacy, Health Care, and Health Promotion Indices was reported. The MMSE test showed that every third patient with diabetes had cognitive disorders of varying intensity. Conclusions: Patients with diabetes and their family members require coordinated care and targeted therapeutic education to prepare them for self-care and self-control so as to reduce the risk of complications.

The Impact of Exercise Training on the Brain and Cognition in Type 2 Diabetes, and its Physiological Mediators: A Systematic Review

BACKGROUND

Type 2 diabetes (T2DM) affects brain structure and function, and is associated with an increased risk of dementia and mild cognitive impairment. It is known that exercise training has a beneficial effect on cognition and brain structure and function, at least in healthy people, but the impact of exercise training on these aspects remains to be fully elucidated in patients with T2DM.

OBJECTIVE

To determine the impact of exercise training on cognition and brain structure and function in T2DM, and identify the involved physiological mediators.

METHODS

This paper systematically reviews studies that evaluate the effect of exercise training on cognition in T2DM, and aims to indicate the most beneficial exercise modality for improving or preserving cognition in this patient group. In addition, the possible physiological mediators and targets involved in these improvements are narratively described in the second part of this review. Papers published up until the 14th of January 2025 were searched by means of the electronic databases PubMed, Embase, and Web of Science. Studies directly investigating the effect of any kind of exercise training on the brain or cognition in patients with T2DM, or animal models thereof, were included, with the exception of human studies assessing cognition only at one time point, and studies combining exercise training with other interventions (e.g. dietary changes, cognitive training, etc.). Study quality was assessed by means of the TESTEX tool for human studies, and the CAMARADES tool for animal studies.

RESULTS

For the systematic part of the review, 22 papers were found to be eligible. 18 out of 22 papers (81.8%) showed a significant positive effect of exercise training on cognition in T2DM, of which two studies only showed significant improvements in the minority of the cognitive tests. Four papers (18.2%) could not find a significant effect of exercise on cognition in T2DM. Resistance and endurance exercise were found to be equally effective for achieving cognitive improvement. Machine-based power training is seemingly more effective than resistance training with body weight and elastic bands to reach cognitive improvement. In addition, BDNF, lactate, leptin, adiponectin, GSK3β, GLP-1, the AMPK/SIRT1 pathway, and the PI3K/Akt pathway were identified as plausible mediators directly from studies investigating the effect of exercise training on brain structure and function in T2DM. Via these mediators, exercise training induces multiple beneficial brain changes, such as increased neuroplasticity, increased insulin sensitivity, and decreased inflammation.

CONCLUSION

Overall, exercise training beneficially affects cognition and brain structure and function in T2DM, with resistance and endurance exercise having similar effects. However, there is a need for additional studies, and more methodological consistency between different studies in order to define an exercise program optimal for improving cognition in T2DM. Furthermore, we were able to define several mediators involved in the effect of exercise training on cognition in T2DM, but further research is necessary to unravel the entire process.

Associated factors of oral frailty in older adults with long-term T2DM duration of more than 10 years

OBJECTIVE

To identify the factors that affect oral frailty in older adults with type 2 diabetes mellitus (T2DM) with long-term disease duration of more than 10 years.

METHODS

This cross-sectional study was conducted at a National Metabolic Center in China from October 2023 to March 2024. Participants with T2DM (aged ≥ 60 years and a disease duration > 10 years) underwent comprehensive dental examinations to assess functional natural teeth (FNT) counts and oral restoration behaviors. Oral frailty and cognitive function were assessed using the Oral Frailty Index-8 (OFI-8) and the Clock Drawing Test (CDT), respectively. Demographic and clinical data were extracted from the hospital information system. Univariate analysis and hierarchical multiple linear regressions were performed to identify associated factors of oral frailty.

RESULTS

Among 211 participants (mean age 71.22 ± 6.35 years, mean diabetes duration 20.95 ± 7.34 years), the mean OFI-8 score was 5.08 ± 2.29, with 74.4% scoring ≥ 4 (indicating oral frailty). The final regression model was statistically significant (F = 19.101, P < 0.001). In the regression model, a lower number of FNTs was significantly associated with higher oral frailty scores (β = -0.263, P < 0.001), whereas different oral restoration behaviors vary in the effect on oral frailty, fasting blood glucose (FBG) (β = 0.131, P = 0.014) and cognitive impairment (β = 0.255, P < 0.001) were positively associated with OFI-8 scores.

CONCLUSIONS

The study found that older adults with T2DM and a disease duration exceeding 10 years had a higher likelihood of exhibiting oral frailty. Individuals with fewer FNTs and those exhibiting cognitive impairment are the potential intervention targets to be concerned. Strict glycemic control and timely oral restoration are recommended to reduce oral frailty incidence in this population.

CLINICAL TRIAL NUMBER

Not applicable.

Insulin acts on astrocytes to shift their substrate preference to fatty acids

It is increasingly recognized that brain can β-oxidize fatty acids for use as an energy substrate. However, mechanism(s) by which neural cells switch their preference from glucose to fatty acids are not fully elucidated. Here we provide evidence that insulin acts directly on astrocytes to promote the uptake of glucose and fatty acids while modifying their substrate preference through a sequential shift in the expression of genes associated with fatty acid uptake, synthesis, transport, and metabolism. Under these conditions, fatty acids are converted into TCA cycle intermediates to satisfy astrocyte energy demands, allowing pyruvate derived from glucose to be directed toward the production of lactate; a preferred fuel for neurons. This shift in astrocyte energy substrate preference is required for insulin to enhance long-term potentiation in the Schaffer collateral. These findings establish a homeostatic mechanism where insulin promotes LTP by switching the energy substrate preference of astrocytes to fatty acids.

Transcriptomics and proteomics characterizing the antioxidant mechanisms of semaglutide in diabetic mice with cognitive impairment

The aim of the present study was to investigate the neuroprotective effects of semaglutide in diabetes‑associated cognitive decline (DACD), while also exploring the underlying mechanisms targeting anti‑oxidative effects. The present study evaluated the antioxidant properties of semaglutide using a DACD model of inflammation. To investigate the underlying mechanisms, omics technologies were employed. Comprehensive transcriptomic and proteomic analysis of the cells was conducted to identify the pathways responsible for the observed antioxidant effects. Semaglutide demonstrated the potential to enhance learning and memory functions while mitigating hippocampal pathological damage. RNA‑sequencing and data‑independent acquisition proteomics analyses identified 13,511 differentially expressed genes and 588 differentially expressed proteins between the control and type 2 diabetes mellitus (T2DM) groups. In addition, 1,378 genes and 2,394 proteins exhibited a differential expression between the T2DM and semaglutide (10 µg/kg) treatment groups. A combined transcriptomic and proteomic analysis unveiled 40 common pathways. Acyl‑CoA oxidase 1 (ACOX1) was observed to be activated during oxidative stress and subsequently suppressed by semaglutide. Of note, the antioxidant and anti‑apoptotic properties of semaglutide in high glucose (HG) conditions were partially reversed upon ACOX1 overexpression. Overall, the present data provided molecular evidence to elucidate the physiological connections between semaglutide and neuronal function, and contribute to clarifying the role of semaglutide in combating oxidative stress and HG‑induced cognitive impairment.

Risk Factors, Pathological Changes, and Potential Treatment of Diabetes-Associated Cognitive Dysfunction

BACKGROUND

Diabetes is a prevalent public health issue worldwide, and the cognitive dysfunction and subsequent dementia caused by it seriously affect the quality of life of patients.

METHODS

Recent studies were reviewed to provide a comprehensive summary of the risk factors, pathogenesis, pathological changes and potential drug treatments for diabetes-related cognitive dysfunction (DACD).

RESULTS

Several risk factors contribute to DACD, including hyperglycemia, hypoglycemia, blood sugar fluctuations, hyperinsulinemia, aging, and others. Among them, modifiable risk factors for DACD include blood glucose control, physical activity, diet, smoking, and hypertension management, while non-modifiable risk factors include age, genetic predisposition, sex, and duration of diabetes. At the present, the pathogenesis of DACD mainly includes insulin resistance, neuroinflammation, vascular disorders, oxidative stress, and neurotransmitter disorders.

CONCLUSIONS

In this review, we provide a comprehensive summary of the risk factors, pathogenesis, pathological changes and potential drug treatments for DACD, providing information from multiple perspectives for its prevention and management.

Medium-chain triglycerides tricaprin TC10 and tricaprylin TC8 attenuated HFD-induced cognitive decline in a manner dependent on or independent of GLP-1

Population aging is the most important social and medical demographic issue worldwide; therefore, healthy aging is important. The increasing prevalence of dementia and cognitive decline are major health concerns. Medium-chain triglycerides (MCTs) have been shown to improve cognitive decline. The present study investigated the effects and mechanisms of action of orally administered MCTs, including tricaprylin (TC8), tricaprin (TC10), and trilaurin (TC12), on cognitive function in mice fed a high-fat diet (HFD). The administration of TC8 and TC10 attenuated cognitive decline. A relationship has been reported between cognitive dysfunction and impaired glucose metabolism. The administration of TC8 and TC10 also reduced blood glucose levels in the glucose tolerance test. Cognitive improvements by MCTs are widely attributed to the ketogenic effect. In the present study, TC8 significantly increased blood ketone concentrations, whereas TC10 did not. On the other hand, TC10 increased the plasma concentration of glucagon-like peptide-1 (GLP-1), the hormone that promotes insulin secretion. The administration of the GLP-1 receptor antagonist, exendin(9-39), blocked the cognitive-enhancing effects of TC10. These results suggest that TC10 improved cognitive function via the GLP-1 receptor. The in vitro experiment indicated that 2-monocaprin (2-MC10), not TC10, stimulated the secretion of GLP-1 and decreased intracellular cAMP concentrations. In conclusion, we herein demonstrated that TC8 and TC10 attenuated cognitive decline through different mechanisms. This is the first study to suggest that TC10 attenuates cognitive decline via GLP-1.

Cognitive impairment in chronic kidney disease: role of brain imaging, functional imaging, electroencephalography, cerebrospinal fluid biomarkers and sensors

Chronic kidney disease is associated with cognitive impairment although the underlying mechanisms are still not fully understood. Characterization and efficient monitoring of the cognitive impact of kidney disease and ensuing therapies are critical for the accurate clinical management of patients. A vast array of imaging modalities, biomarkers, and sensors have shown relevance for the assessment of cognitive impairment. Knowing the potential and limitations of these paraclinical techniques is a necessary condition to improve the understanding of this phenomenon and to design monitoring protocols and guidelines applicable to this clinical population. The goal of this review is to provide an overview of current imaging modalities and biomarker sources available to the community, for the benefit of the research and clinical community.

Neuroprotective effects of traditional Chinese medicine Naofucong on diabetic cognitive impairment: Mechanisms involving insulin-degrading enzyme-mediated degradation of Amyloid-β and inhibition of ERK/JNK/p38 MAPK signaling pathway

The increasing prevalence of diabetes and its related cognitive impairments is a significant public health concern. With limited clinical treatment options and an incomplete understanding of the underlying mechanisms, traditional Chinese medicine (TCM) Naofucong is proposed as a potential neuroprotective agent against diabetic cognitive impairment (DCI). This study aims to investigate the therapeutic mechanisms of Naofucong in DCI. We hypothesize that Naofucong may improve cognitive function in diabetic rats by modulating the extracellular regulated protein kinases (ERK)/c-Jun N-terminal kinase (JNK)/p38 mitogen-activated protein kinases (MAPK) signaling pathway, enhancing insulin-degrading enzyme (IDE) expression, reducing amyloid-beta (Aβ) deposition, decreasing phosphorylated Tau (p-Tau) levels, and alleviating oxidative stress. Diabetes was induced in specific-pathogen-free male Sprague-Dawley rats using streptozotocin, and the rats were treated with oral Naofucong for 12 weeks. We assessed cognitive function and measured neuronal damage, oxidative stress injury, and the expression levels of IDE, Aβ, amyloid precursor protein (APP), p-Tau, and components of the ERK/JNK/p38 MAPK pathway. Diabetic rats showed significant declines in cognitive function, neuronal damage, oxidative stress, low IDE expression, Aβ accumulation, high APP expression, abnormal Tau phosphorylation, and overactivation of the ERK/JNK/p38 MAPK pathway. Naofucong treatment significantly reversed these symptoms. Our findings suggest that Naofucong improves cognitive impairment in diabetic rats by inhibiting the ERK/JNK/p38 MAPK pathway, upregulating IDE, reducing Aβ deposition, suppressing APP and p-Tau expression, and alleviating neuronal damage and oxidative stress. This research provides a reference for the clinical prevention and treatment of DCI using TCM Naofucong.

Association between depressive status and mild cognitive impairment in middle-aged and elderly Chinese adults from CHARLS study

Background

The potential association between depressive status and the risk of mild cognitive impairment (MCI) remains unclear, especially in the absence of prospective evidence. This study aims to elucidate the impact of either depression score or depression on the risk of MCI using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS).

Methods

This prospective study included 5,766 participants from CHARLS followed from 2011 to 2015. We calculated the baseline depression score using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) and the cognitive status score after 3 years of follow-up through four dimensions: orientation, memory, calculation, and draw. We collected baseline sociological characteristics and health-related factors as covariates, using multivariate-adjusted logistics regression models (odds ratios (OR) and 95% confidence intervals (CI)) and restricted cubic splines (RCS) to estimate the effect of depressive status on MCI risk.

Results

We observed 724 new cases of MCI at follow-up. Logistics regression analysis showed that participants with depression had a 58% higher risk of developing MCI than those without depression (OR = 1.58, 95%CI: 1.35-1.85), and the positive association persisted after adjusting for covariates such as sociological characteristics of the population and health-related factors (OR = 1.24, 95%CI: 1.04-1.48). We also observed a dose-response relationship between depression score and MCI risk, with participants with 11~20 and 21~30 scores having a progressively higher risk of MCI compared to participants with depression score of 0~10 (p for trend < 0.05), and a 3% increase in MCI risk for each 1-point increase in depression scores (OR = 1.03, 95%CI: 1.01-1.04). RCS analysis also showed a nonlinear association between depression score and MCI risk (p for non-linearity = 0.001), with MCI risk increasing with increasing depression score. In addition, stratified analyses based on sex, age, marital status, residence, BMI, nighttime sleep, smoking status, alcohol drinking status, baseline serological indicators, and comorbidities showed no interaction (p for interaction > 0.05) other than serum total cholesterol levels (p for interaction = 0.008).

Conclusions

Among middle-aged and elderly adults from CHARLS, depression is an independent risk factor for MCI, indicating that individuals with more severe depression symptoms are more likely to suffer from MCI. Early depression screening based on CESD-10 may help identify individuals at high risk of MCI, and early intervention may reduce the incidence of MCI and Alzheimer's disease, thereby reducing the social care burden of an ageing population.

Impact of type 2 diabetes mellitus on results in the animal naming test in patients with and without liver cirrhosis

INTRODUCTION AND OBJECTIVES

Diabetes mellitus is a common comorbidity in patients with cirrhosis and is associated with the development of hepatic encephalopathy (HE) and cognitive dysfunction. The simplified Animal Naming Test (S-ANT1) has been established for detecting minimal HE (MHE). It is currently unknown whether S-ANT1 results are affected by diabetes mellitus in patients with and without cirrhosis.

MATERIALS AND METHODS

This study analyzed data from 268 patients with cirrhosis without signs of HE ≥ 1. MHE was defined using the psychometric hepatic encephalopathy score (PHES). All patients were also tested with S-ANT1. 14 patients with diabetes mellitus and diabetic foot syndrome but no cirrhosis, as well as 37 healthy controls, were also tested with S-ANT1 and served as controls.

RESULTS

Type 2 diabetes mellitus was present in 79 (29.5%) patients with cirrhosis and MHE according to PHES was detected in 81 (30.2%) patients. In the total cohort, results in S-ANT1 did not differ between patients with and without diabetes mellitus (19 vs. 20 animals, p = 0.108). In multivariable logistic regression analysis, the only variables independently associated with performance in S-ANT1 were PHES-MHE, school education, sodium, and age, while diabetes mellitus was not. Patients with diabetic foot syndrome but no cirrhosis performed poorer in S-ANT1 compared to healthy controls, while patients with cirrhosis and MHE performed poorer than patients with diabetic foot syndrome.

CONCLUSION

S-ANT1 seems to be usable for screening for MHE in patients with cirrhosis and type 2 diabetes mellitus, while one might be more cautious when interpreting results in patients with diabetes-related complications.

Association between the triglyceride glucose-body mass index and memory-related diseases: A nationwide cohort study

OBJECTIVES

This study aimed to examine the longitudinal association between the triglyceride glucose-body mass index (TyG-BMI) index and memory-related diseases (MDs) among Chinese adults.

STUDY DESIGN

Nationwide cohort study.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which is an ongoing nationally representative prospective cohort study. The exposure was the participants' TyG-BMI index at baseline from 2011 to 2012. MDs were acquired by self-reporting questions in 2018. Cox proportional hazards regression models were conducted to assess the relationship between the TyG-BMI index and MDs.

RESULTS

During a median follow-up of 7.0 years, a total of 197 incident MDs events occurred. After multivariate adjustments for established MD-related risk factors, participants with the highest tertile of the TyG-BMI index had a higher risk of MDs (HR: 1.65; 95 % CI: 1.02-2.09; P-trend <0.001) relative to individuals with the lowest tertile. Furthermore, the subgroup analyses of the association remained consistent.

CONCLUSION

A high TyG-BMI index was associated with an increased risk of MDs. Our study suggests that monitoring long-term changes in the TyG-BMI index could assist with the early identification and prevention of MDs among individuals at high risk.

Association Between Oral Health Status and DMFT Index with Cognitive Dysfunction in Community-Dwelling Older Adults with Type 2 Diabetes: A Cross-Sectional Study

OBJECTIVE

Cognitive dysfunction is a significant issue in old age and can cause many problems in older adults, especially those with diabetes. This study aimed to investigate the association between oral health status and DMFT index with cognitive dysfunction in community-dwelling older adults with T2D (type 2 diabetes).

METHODS

This was a cross-sectional study that included 245 older people aged 60 years and older with T2D, visiting healthcare centers in north of Iran, using the cluster sampling method. Data collection tools included clinical-demographic questionnaire, the Geriatric Oral Health Assessment Index (GOHAI) and the Mini-Mental State Examination (MMSE) questionnaire. A P-value <.05 was considered significant.

RESULTS

The mean age of older adults in this study was 64.86 ± 3.99 years. The mean and standard deviation for the DMFT index, GOHAI index and MMSE scale were 9.39 ± 3.83, 34.29 ± 17.93 and 15.18 ± 10.04 respectively. The results showed statistically significant relationship between poor oral health status and the cognitive status of older adults with T2D (p < .001). Additionally, the relationship between oral health index domains (physical function, psychosocial function and pain) and cognitive status in older adults was significant (p < .001). Another finding indicated an inverse and significant relationship between the DMFT index and cognitive dysfunction in older adults (p < .001).

CONCLUSION

Poor oral health was associated with cognitive dysfunction among the community-dwelling older adults with T2D. Given the high prevalence of T2D in older adults and the critical importance of oral and dental health for cognition, it is necessary to develop interventions to improve oral health in older adults with T2D.

Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments

Background

Diabetes-related cognitive impairment is increasingly recognized as a significant complication, profoundly impacting patients' quality of life. This review aims to examine the pathophysiological mechanisms, clinical manifestations, risk factors, assessment and diagnosis, management strategies, and future research directions of cognitive impairment in diabetes.

Methodology

A comprehensive literature search was conducted using PubMed, Medline, and other medical databases to identify, review, and evaluate published articles on cognitive impairment in diabetes. The search focused on studies examining pathophysiology, clinical presentations, risk factors, diagnostic approaches, and management strategies.

Results

The review of current literature revealed that chronic hyperglycemia, insulin resistance, and vascular factors are major contributing factors to cognitive deficits in diabetes. Clinical manifestations include impairments in attention, memory, executive function, visuospatial abilities, and language. Risk factors encompass disease duration, glycemic control, presence of complications, age, education level, and comorbidities. Assessment tools include cognitive screening instruments, neuropsychological testing, and neuroimaging techniques. Management strategies involve glycemic control optimization, lifestyle modifications, cognitive training, and pharmacological interventions.

Conclusion

This review highlights the significant prevalence and impact of cognitive impairment in diabetes, resulting from complex metabolic and vascular disturbances. Early detection and multifaceted interventions are crucial for preserving cognitive function and improving patient outcomes. Future research should focus on neuroprotective strategies, biomarker identification, and personalized approaches. Collaborative efforts between clinicians and researchers are essential to effectively address this growing healthcare challenge and enhance the quality of life for individuals with diabetes-related cognitive impairment.

Alzheimer's disease and diabetes-associated cognitive dysfunction: the microglia link?

Alzheimer's disease (AD) is characterized by the accumulation of amyloid-β (Aβ) plaques and the aggregation of tau protein, resulting in intense memory loss and dementia. Diabetes-associated cognitive dysfunction (DACD) is a complication of diabetes mellitus, which is associated with decreased cognitive function and impaired memory. A growing body of literature emphasize the involvement of microglia in AD and DACD. Although AD and DACD share some common features related to symptomatology and pathophysiology, the characteristics and heterogeneity of microglia remain largely unknown in these two diseases. In this study, multiple bioinformatics analyses were performed to analyze the frequency, altered genes, cell-cell communication, and subtypes of microglia in AD and DACD mouse models based on two publicly single-nucleus RNA sequencing (snRNA-Seq) datasets. The results revealed that the frequency of microglia was increased in both AD and DACD mouse models when compared with control mice. After analyzing the differentially expressed genes of microglia from the two mouse models, only six common upregulated genes were found. The CellChat analysis revealed the complex cell-cell communication network (microglia clusters with other cell types) in 5XFAD vs. control mice and db/db vs. control mice. The microglia subtypes and their transcription factor activity profile in 5XFAD mice were different from that in db/db mice. In summary, this study provided some insights into the alterations of microglia in 5XFAD and db/db mice, which might open up potential avenues for the microglial-targeted therapy in AD and DACD.

[Cognitive functions assessment of elderly patients with type 2 diabetes mellitus]

OBJECTIVE

Comparative assessment of the cognitive status of persons over 60, depending on the presence or absence of type 2 diabetes mellitus (T2DM).

MATERIAL AND METHODS

The study included 193 patients, of which 93 had no T2DM and 100 had T2DM. The mean age of patients with T2DM was 73 [68; 78] years vs. 69.2 [64; 75] years in patients without T2DM. The cognitive function was assessed using the McNair and Kahn scale, with scores over 42 indicating cognitive dysfunction and Kahn scale: in the group with T2DM, the average score was 27.0±9.36; in the group without T2DM, it was 22.0±9.60 (p<0.043). The absence of T2DM was negatively correlated with the total score on the scale for assessing the risk of cognitive impairment (p=-0.264, p<0.001). In addition, it was found that age over 75 years was significantly associated with the development of cognitive impairment, regardless of the presence of concomitant T2DM (OR=1.247, CI=95%, 1.112-1.40, p<0.001).

CONCLUSION

T2DM increases the risk of developing cognitive dysfunction, which should be taken into account in older patients for the timely detection and prevention of its progression.

Amelioration of cognition by hesperidin-conjugated cobalt oxide nanoparticles

Diabetes mellitus is one of the metabolic syndromes that is associated with cognitive deficit, dementia, and Alzheimer's disease (AD) like pathology due to impaired insulin-signalling in the brain, oxidative stress and mitochondrial dysfunction. Nanotechnology is one of the most promising techniques for targeting the brain. However, the toxicity of metal nanoparticles is one of the biggest challenges to be studied. In this study, cobalt oxide nanoparticles are conjugated to a bioflavonoid, hesperidin, a natural antioxidant. The study is designed to assess the efficacy and safety of the cobalt oxide conjugated hesperidin in the diabetes-induced cognitive deficit rat model. The neuropharmacological behaviour, in-vivo antioxidant status and level of acetylcholinesterase, nitrite, amyloid β, and pro-inflammatory cytokines were determined for cobalt oxide conjugated hesperidin and compared with bare cobalt oxide nanoparticles and hesperidin. The cobalt oxide conjugated hesperidin significantly improved learning and memory in the streptozotocin rat model. However, further studies are required to establish a cellular and molecular mechanism involved in the neuroprotective activity of cobalt oxide-conjugated hesperidin.

Zi Shen Wan Fang repaired blood-brain barrier integrity in diabetic cognitive impairment mice via preventing cerebrovascular cells senescence

BACKGROUND

Blood-brain barrier (BBB) integrity disruption is a key pathological link of diabetes-induced cognitive impairment (DCI), but the detailed mechanism of how the diabetic environment induces BBB integrity disruption is not fully understood. Our previous study found that Zi Shen Wan Fang (ZSWF), an optimized prescription consisting of Anemarrhenae Rhizoma (Anemarrhena asphodeloides Bge.), Phellodendri Chinensis Cortex (Phellodendron chinense Schneid.) and Cistanches Herba (Cistanche deserticola Y.C.Ma) has excellent efficacy in alleviating DCI, however, whether its mechanism is related to repairing BBB integrity remains unclear. This study aims to reveal the mechanism of BBB integrity destruction in DCI mice, and to elucidate the mechanism by which ZSWF repairs BBB integrity and improves cognitive function in DCI mice.

METHODS

Diabetic mouse model was established by feeding a 60% high-fat diet combined with a single intraperitoneal injection of 120 mg/kg streptozotocin (STZ). DCI mice were screened with morris water maze (MWM) after 8 weeks of sustained hyperglycemic stimulation. ZSWF was administered daily at doses of 9.36 and 18.72 g/kg for 8 weeks. Cognitive function was evaluated using MWM, blood-brain-barrier (BBB) integrity was tested using immunostaining and western blot, the underlying mechanisms were explored using single-cell RNA sequencing (scRNA-seq), validation experiments were performed with immunofluorescence analysis, and the potential active ingredients of ZSWF against cerebrovascular senescence were predicted using molecular docking. Moreover, cerebral microvascular endothelial cells were cultured, and the effects of mangiferin on the expression of p21 and Vcam1 were investigated by immunofluorescence staining and RT-qPCR.

RESULTS

ZSWF treatment significantly ameliorated cognitive function and repaired BBB integrity in DCI mice. Using scRNA-seq, we identified 14 brain cell types. In BBB constituent cells (endothelial cells and pericytes), we found that Cdkn1a and senescence-associated secretory phenotype (SASP) genes were significantly overexpressed in DCI mice, while ZSWF intervention significantly inhibited the expression of Cdkn1a and SASP genes in cerebrovascular cells of DCI mice. Moreover, we also found that the communication between brain endothelial cells and pericytes was decreased in DCI mice, while ZSWF significantly increased the communication between them, especially the expression of PDGFRβ in pericytes. Molecular docking results showed that mangiferin, the blood component of ZSWF, had a stronger affinity with the upstream proteins of p21. In vitro experiments showed that high glucose significantly increased the expression of p21 and Vcam1 in bEnd.3 cells, while mangiferin significantly inhibited the expression of p21 and Vcam1 induced by high glucose.

CONCLUSION

Our study reveals that ZSWF can ameliorate cognitive function in DCI mice by repairing BBB integrity, and the specific mechanism of which may be related to preventing cerebrovascular cells senescence, and mangiferin is its key active ingredient.

Investigating the molecular mechanisms between type 1 diabetes and mild cognitive impairment using bioinformatics analysis, with a focus on immune response

The immune system is involved in the development and progression of several diseases. Type 1 diabetes mellitus (T1DM), an autoimmune disorder, influences the progression of several other conditions; however, the link between T1DM and mild cognitive impairment (MCI) remains unclear. This study investigated the underlying immune response mechanisms that contribute to the development and progression of T1DM and MCI. Microarray datasets for MCI (GSE63060) and T1DM (GSE30208) were retrieved from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified using the limma package. To explore the functional implications of these DEGs, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were conducted using ClusterProfiler. Protein-protein interaction networks for the DEGs were constructed using the STRING database and visualized using Cytoscape. The Molecular Complex Detection algorithm was used to analyze DEGs. Immune cell infiltration in patients with T1DM and MCI was analyzed using the xCell method. Gene set enrichment analysis was used to gain in-depth insights into the functional characteristics of T1DM and MCI. Immune-related genes were obtained from the GeneCards and ImmPort databases. Machine learning algorithms were used to identify potential hub genes associated with immunity for T1DM and MCI diagnosis, and the diagnostic value was assessed using the receiver operating characteristic curve. The identified genes were validated using quantitative polymerase chain reaction. In the T1DM and MCI datasets, 610 DEGs showed consistent trends, of which 232 and 378 were upregulated and downregulated, respectively. Immune response analysis revealed significant changes in the immune cells associated with MCI and T1DM. Using immune-related genes, DEGs, and machine learning techniques, we identified CD3D in the MCI and T1DM groups. We observed a gradual decline in the cognitive function of mice with T1DM as the disease progressed. CD3D expression increased with increasing disease severity; CD3D primarily affected CD4+ T cells. This study revealed a complex interaction between T1DM and MCI, providing novel insights into the intricate relationship between immune dysregulation and cognitive impairment and expanding our understanding of these two interconnected disorders. These findings will facilitate the development of therapeutic interventions and identification of potential therapeutic targets.

Comorbid Conditions Are Associated With Cognitive Impairment in Native Hawaiians and Pacific Islanders

We examined the association between comorbid conditions and mild cognitive impairment (MCI) in Native Hawaiians and Pacific Islanders (NHPI) (n = 54). Cross-sectional, self-reported questionnaires were utilized to collect demographic, comorbid conditions, and MCI (via the AD8 index) data. Separate logistic regression models were conducted to investigate the relationship between comorbid conditions and MCI, adjusting for other covariates. We found significantly increased odds of MCI in those reporting high blood pressure (OR = 5.27; 95% CI: [1.36, 20.46]; p = 0.016), high cholesterol (OR = 7.30; 95% CI: [1.90, 28.14], p = 0.004), and prediabetes or borderline diabetes (OR = 4.53; 95% CI: [1.27, 16.16], p = 0.02) compared with those not reporting these respective conditions. These data show that hypertension, hypercholesterolemia, and prediabetes are associated with MCI in the NHPI community, suggesting that preventive strategies to reduce chronic conditions may also potentially slow cognitive decline in underrepresented/understudied NHPI.

Experimental Periodontitis Increases Anxious Behavior and Worsens Cognitive Aspects and Systemic Oxidative Stress in Wistar Rats

OBJECTIVES

Periodontitis (PD) has the potential to induce systemic changes that affect both physical and behavioral aspects. These alterations may be associated with changes in both the inflammatory profile and the oxidative stress status of individuals with PD. Therefore, we aimed to evaluate the effects of PD on oxidative stress, as well as on behavioral parameters and cognitive impairment, in a preclinical model.

MATERIAL AND METHODS

Twenty-four male Wistar rats were randomly assigned to PD and sham groups. PD was induced by the ligature protocol for 14 days. Behavioral tests were initiated on the 9th day of the experiment to evaluate anxious behavior and cognition (learning and memory). After euthanasia, oxidative stress was evaluated in the gums, blood, hippocampus, and amygdala. Alveolar bone loss, bone microstructure, and elemental compositions of the mandibular bone were also assessed.

RESULTS

PD increased alveolar bone loss, reduced the calcium and phosphorus content in the mandibular bone, and increased anxiety-like behavior and cognitive decline (p < 0.05). Furthermore, PD significantly affected the redox balance, as evidenced by increased total antioxidant capacity (TAC) in the gingiva and hippocampus (p < 0.05). It also led to increased lipid peroxidation in the gingiva and erythrocytes (p < 0.05), decreased antioxidant defenses in erythrocytes (superoxide dismutase) and the hippocampus (catalase), and increased antioxidant activity (catalase) in the amygdala (p < 0.05).

CONCLUSION

PD resulted in cognitive alterations, including impairments in spatial learning and memory, as well as increased anxious behavior, likely due to redox imbalance in rats.

Beneficial effect of Caesalpinia pulcherrima linn., on diabetic neuropathy, cognitive dysfunction and cardiac complications in streptozotocin-induced diabetic rats

Pharmacological relevance

Caesalpinia pulcherrima L. is used in Indian Traditional Medicinal system to treat Diabetes.

Aim

This study was carried out to evaluate the standardized alcoholic extract of Caesalpinia pulcherrima seed (CPS) in Streptozotocin (STZ)-induced diabetic neuropathic and cardiac complications in rodents.

Materials and methods

HPLC finger printing profile of CPS was performed to identify the bioactive molecules. Two doses of CPS (100 & 200 mg/kg b.w.) was orally administered daily once for six weeks to streptozotocin (50 mg/kg, i.v.)-induced diabetic rats. Every week intervals hot & cold immersion tests were carried to know the effect of CPS on peripheral neuropathy. In addition, blood glucose, body weight, food and water intake were also monitored. At the end of the study, sciatic nerve conduction velocity, diabetic cardiomyopathy and diabetic cognitive parameters were evaluated. Furthermore, histopathological studies of sciatic nerve and aortic strip were also carried out.

Results

HPLC finger print experiment showed the presence of gallic acid and protocatechuic acid. Administration of CPS for six weeks significantly prevented the development of diabetic peripheral neuropathy (DPN), cardiomyopathy and cognitive dysfunction in diabetic rats. The CPS treated rats displayed prominent (P < 0.001) improvement in motor coordination, muscle grip, locomotor activity and memory in diabetic rats. CPS treatment restored elevated systolic, diastolic, mean arterial blood pressure (MABP), and heart rate to near normal in diabetic condition. These observed beneficial effects were well correlated and justified with histopathological studies. In addition, CPS treatment also exhibited significant (P < 0.001) reduction of loss in body weight, and reduce the water and feed intake throughout the study.

Conclusion

Taken together, the present study provided a good insight in the therapeutic efficacy of Caesalpinia pulcherrima seed extract in dealing with diabetic complications. The study also scientifically justifies the ethnomedicinal/traditional claims of the title plant.

Association between elevated glycosylated hemoglobin and cognitive impairment in older Korean adults: 2009-2010 Ansan cohort of the Korean genome and epidemiology study

Objective

Cohort studies on the risk of cognitive impairment in the older population of S. Korea based on glycosylated hemoglobin (HbA1c) levels are exceedingly rare. This study aimed to analyze the association between HbA1c levels and cognitive impairment in older Korean adults without dementia.

Methods

We conducted a cross-sectional study using data from a community-based Ansan cohort (2009-2010), which was part of the Korea Genome Epidemiology Study. The study included 853 cohort participants aged ≥59 years living in Ansan city. Cognitive function was evaluated using the Korean version of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). The MMSE and MoCA scores were categorized into normal cognition (≥24 and ≥ 23, respectively) and cognitive impairment (≤23 and ≤ 22, respectively). Multiple logistic regression analysis was used to estimate the association between HbA1c levels and cognitive impairment, with adjustments for covariates.

Results

The mean age of the participants was 66 years, and 433 (50.8%) were female. Cognitive impairment was observed in 12.5 and 44.3% of participants, based on the MMSE and MoCA, respectively. Regarding the MMSE scores, HbA1c level was a risk factor for cognitive impairment in women. Compared to normal HbA1c (≤5.6%) levels, adjusted odds ratios of MMSE decline for HbA1c 5.7-6.4% and HbA1c ≥6.5% were high: 2.16 (95% confidence interval [CI] 1.04-4.49) and 2.96 (95% CI, 1.04-8.39), respectively.

Conclusion

By improving glycemic control, the risk of cognitive impairment in the older population can be reduced. Further research on the role of sex differences in cognitive impairment is needed.

Factors associated with cognitive reserve according to education level

INTRODUCTION

We investigated distinctive factors associated with cognitive reserve (CR) based on education level.

METHODS

Among 1247 participants who underwent neuropsychological assessment, amyloid positron emission tomography, and brain magnetic resonance imaging, 336 participants with low education (≤6 years) and 697 with high education (≥12 years) were selected. CR was measured as the difference between the predicted and observed value of cognitive function based on cortical thickness. Multiple linear regression was conducted in each group after controlling for age and sex.

RESULTS

In the low-education group, low literacy, long sleep duration(>8 h/day), and diabetes were negatively associated with CR, whereas cognitive and physical activity were positively associated with CR. In the high-education group, cognitive activity was positively related to CR, whereas low literacy, long sleep duration (> 8 h/day), and depression were negatively related to CR.

DISCUSSION

This study provides insights into different strategies for enhancing CR based on educational background.

HIGHLIGHTS

Factors associated with cognitive reserve (CR) varied according to the education level. Diabetes and physical activity were associated with CR in the low-education group. Depression was related to CR in the high-education group. Low literacy, sleep duration, and cognitive activity were associated with CR in both groups. Dementia-prevention strategies should be tailored according to educational level.

Hippocampal warburg effect mediates hydrogen sulfide-ameliorated diabetes-associated cognitive dysfunction: Involving promotion of hippocampal synaptic plasticity

Our previous studies have reported that hydrogen sulfide (H2S) has ability to improve diabetes-associated cognitive dysfunction (DACD), but the exact mechanisms remain unknown. Recent research reveals that Warburg effect is associated with synaptic plasticity which plays a key role in cognition promotion. Herein, the present study was aimed to demonstrate whether hippocampal Warburg effect contributes to H2S-ameliorated DACD and further explore its potential mechanism. We found that H2S promoted the hippocampal Warburg effect and inhibited the OxPhos in the hippocampus of STZ-induced diabetic rats. It also improved the hippocampal synaptic plasticity in STZ-induced diabetic rats, as evidenced by the change of microstructures and the expression of different key-enzymes. Furthermore, inhibited hippocampal Warburg effect induced by DCA markedly abolished the improvement of H2S on synaptic plasticity in the hippocampus of STZ-induced diabetic rats. DCA blocked H2S-attenuated the cognitive dysfunction in STZ-induced diabetic rats, according to the Y-maze, Novel Objective Recognition, and Morris Water Maze tests. Collectively, these findings indicated that the hippocampal Warburg effect mediates H2S-ameliorated DACD by improving hippocampal synaptic plasticity.

Harmful Effects on the Hippocampal Morpho-Histology and on Learning and Memory in the Offspring of Rats with Streptozotocin-Induced Diabetes

Learning alterations in the child population may be linked to gestational diabetes as a causal factor, though this remains an open and highly controversial question. In that sense, it has been reported that maternal hyperglycemia generates a threatening condition that affects hippocampal development in offspring. The pyramidal cells of the CA3 subfield, a key structure in learning and memory processes, are particularly important in cognitive deficiencies. We evaluate the effect of the hyperglycemic intrauterine environment on hippocampal histomorphometry in offspring, correlating it with spatial learning and memory, as well as the morphology of dendrites and spines in 30-day-old pups (P30). The maternal hyperglycemia affected the body weight, height, and brain size of fetuses at 21 days of gestation (F21), newborn pups (P0) and P30 pups from diabetic rats, which were smaller compared to the control group. Consequently, this resulted in a decrease in hippocampal size, lower neuronal density and cytoarchitectural disorganization in the CA3 region of the hippocampus in the offspring at the three ages studied. The behavioral tests performed showed a direct relationship between morpho-histological alterations and deficiencies in learning and memory, as well as alterations in the morphology of the dendrites and spines. Therefore, knowing the harmful effects caused by gestational diabetes can be of great help to establish therapeutic and educational strategies that can help to improve learning and memory in children.

The impact of early-life exercise on CREB-signaling pathway and hippocampus neuroplasticity in diabetic adult male rats; the study of developmental model

BACKGROUND

Childhood exercise enhances brain structure, while diabetes detrimentally affects it. This study examines early-life exercise's influence on adult diabetic rats' memory and neuroplasticity.

METHODS

Male Wistar pups were divided into Control, Diabetes, Exercise Training, and Diabetes exercise groups. Diabetes was induced on day 23 with Alloxan (200 mg/kg). A 3-week regimen included aerobic and resistance training thrice weekly. The aerobic intensity was 70%, and resistance varied from 50% to 100% of the maximal carrying capacity (MCC). Following the last training sessions, spatial memory and retrieval tests were performed in infancy, childhood, and emerging adulthood using the Morris Water Maze test (MWM). The hippocampus was excised to measure protein and gene expression of brain-derived neurotrophic factor (BDNF), calmodulin-dependent protein kinase (CAMKII), N-methyl-D-aspartate receptors (NMDAR), and cAMP-response element-binding protein (CREB) by western blotting and reverse transcription-polymerase-chain reaction (RT-PCR) methods. Blood samples were collected during each developmental stage to measure glucose levels, at the study's conclusion, to assess Interleukin-1β levels using the ELISA method. The Nissel staining assessed dead hippocampal cells in CA1.

RESULTS

Post-natal exercise improved spatial memory (p < 0.05) and glucose levels (p < 0.05) in diabetic rats during adolescence and emerging adulthood. Despite reduced mRNA expression (NMDAR 40%, BDNF 62%, CREB 43%, CAMKII 66%), diabetic rats, by study end, showed increased BDNF, NMDARR, CAMKII, CREB protein/gene expression (p < 0.05) in emerging adulthood for both training groups.

CONCLUSION

Early-life exercise influenced hippocampal BDNF/NMDAR-CAMKII/CREB pathways in a diabetic rat model, highlighting post-natal exercise's role in neuroplasticity memory enhancement and improved glucose level.

Evaluation of Event-Related Potentials in Somatic Diseases - Systematic Review

Many somatic illnesses (e.g. hypertension, diabetes, pulmonary and cardiac diseases, hepatitis C, kidney and heart failure, HIV infection, Sjogren's disease) may impact central nervous system functions resulting in emotional, sensory, cognitive or even personality impairments. Event-related potential (ERP) methodology allows for monitoring neurocognitive processes and thus can provide a valuable window into these cognitive processes that are influenced, or brought about, by somatic disorders. The current review aims to present published studies on the relationships between somatic illness and brain function as assessed with ERP methodology, with the goal to discuss where this field of study is right now and suggest future directions.

Plasma Biomarkers of Brain Injury and Their Association With Brain MRI and Cognition in Type 1 Diabetes

OBJECTIVE

To evaluate associations between plasma biomarkers of brain injury and MRI and cognitive measures in participants with type 1 diabetes (T1D) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study.

RESEARCH DESIGN AND METHODS

Plasma amyloid-β-40, amyloid-β-42, neurofilament light chain (NfL), phosphorylated Tau-181 (pTau-181), and glial fibrillary acidic protein (GFAP) were measured in 373 adults who participated in the DCCT/EDIC study. MRI assessments included total brain and white matter hyperintensity volumes, white matter mean fractional anisotropy, and indices of Alzheimer disease (AD)-like atrophy and predicted brain age. Cognitive measures included memory and psychomotor and mental efficiency tests and assessments of cognitive impairment.

RESULTS

Participants were 60 (range 44-74) years old with 38 (30-51) years' T1D duration. Higher NfL was associated with an increase in predicted brain age (0.51 years per 20% increase in NfL; P < 0.001) and a 19.5% increase in the odds of impaired cognition (P < 0.01). Higher NfL and pTau-181 were associated with lower psychomotor and mental efficiency (P < 0.001) but not poorer memory. Amyloid-β measures were not associated with study measures. A 1% increase in mean HbA1c was associated with a 14.6% higher NfL and 12.8% higher pTau-181 (P < 0.0001).

CONCLUSIONS

In this aging T1D cohort, biomarkers of brain injury did not demonstrate an AD-like profile. NfL emerged as a biomarker of interest in T1D because of its association with higher HbA1c, accelerated brain aging on MRI, and cognitive dysfunction. Our study suggests that early neurodegeneration in adults with T1D is likely due to non-AD/nonamyloid mechanisms.

Risk of Dementia and Alzheimer's Disease Associated With Antidiabetics: A Bayesian Network Meta-Analysis

INTRODUCTION

Dementia risk is substantially elevated in patients with diabetes. However, evidence on dementia risk associated with various antidiabetic regimens is still limited. This study aims to comprehensively investigate the risk of dementia and Alzheimer's disease (AD) associated with various antidiabetic classes.

METHODS

Cochrane Central Register of Controlled Trials, Embase, MEDLINE (PubMed), and Scopus were searched from inception to March 2024 (PROSPERO CRD 42022365927). Observational studies investigating dementia and AD incidences after antidiabetic initiation were identified. Bayesian network meta-analysis was performed to determine dementia and AD risks associated with antidiabetics. Preferred Reporting Items for Systematic Reviews-Network Meta-Analyses (PRISMA-NMA) guidelines were followed. Statistical analysis was performed and updated in November 2023 and March 2024, respectively.

RESULTS

A total of 1,565,245 patients from 16 studies were included. Dementia and AD risks were significantly lower with metformin and sodium glucose co-transporter-2 inhibitors (SGLT2i). Metformin displayed the lowest risk of dementia across diverse antidiabetics, whereas α-glucosidase inhibitors demonstrated the highest risk. SGLT2i exhibited the lowest dementia risk across second-line antidiabetics. Dementia risk was significantly higher with dipeptidyl peptidase-4 inhibitor (DPP4i), metformin, sulfonylureas, and thiazolidinediones (TZD) compared to SGLT2i in the elderly (≥75 years). Dementia risk associated with metformin was substantially lower, regardless of diabetic complication status or baseline A1C.

DISCUSSION

Metformin and SGLT2i demonstrated lower dementia risk than other antidiabetic classes. Patient-specific factors may affect this relationship and cautious interpretation is warranted as metformin is typically initiated at an earlier stage with fewer complications. Hence, further large-scaled clinical trials are required.

SGLT2 inhibitors for the treatment of diabetes: a patent review (2019-23)

INTRODUCTION

The sodium-glucose co-transporter 2 (SGLT2) inhibitors are FDA-approved class of drugs for diabetes management. They improve glycemic control by inducing glucosuria. Notwithstanding with potent anti-hyperglycemic activity, SGLT2 inhibitors are emerging as drugs with multifaceted therapeutic potential, evidenced for cardioprotective, renoprotective, antihypertensive, and neuroprotective activities. Continuous attempts are being accomplished through structural modification, development of new formulation, or combination with other drugs, to enhance the bioactivity spectrum of SGLT2 inhibitors for better management of diabetes and related complications.

AREAS COVERED

This review comprises a summary of patent applications, acquired using the Espacenet Patent Search database, concerning SGLT2 inhibitors from 2019 to 2023, with focus on improving therapeutic potentials in management of diabetes and metabolic complications.

EXPERT OPINION

SGLT2 inhibitors have provided an exciting treatment option for diabetes. Originally developed as anti-hyperglycemic agents, SGLT2 inhibitors exert pleiotropic metabolic responses and have emerged as promising antidiabetic agents with cardio-protective and reno-protective activities. Given their distinct therapeutic profile, SGLT2 inhibitors have revolutionized the management of diabetes and associated complications. Emerging evidences on their therapeutic potential against cancer, male reproductive dysfunctions, and neurodegenerative diseases indicate that further research in this field may unfold novel prospective on their plausible use in the management of other chronic conditions.

Establishment, Prediction, and Validation of a Nomogram for Cognitive Impairment in Elderly Patients With Diabetes

Objective: The purpose of this study is to establish a predictive model of cognitive impairment in elderly people with diabetes. Methods: We analyzed a total of 878 elderly patients with diabetes who were part of the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. The data were randomly divided into training and validation cohorts at a ratio of 6:4. The least absolute shrinkage and selection operator (LASSO) logistic regression analysis to identify independent risk factors and construct a prediction nomogram for cognitive impairment. The performance of the nomogram was assessed using receiver operating characteristic (ROC) curve and calibration curve. Decision curve analysis (DCA) was performed to evaluate the clinical utility of the nomogram. Results: LASSO logistic regression was used to screen eight variables, age, race, education, poverty income ratio (PIR), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum uric acid (SUA), and heart failure (HF). A nomogram model was built based on these predictors. The ROC analysis of our training set yielded an area under the curve (AUC) of 0.786, while the validation set showed an AUC of 0.777. The calibration curve demonstrated a good fit between the two groups. Furthermore, the DCA indicated that the model has a favorable net benefit when the risk threshold exceeds 0.2. Conclusion: The newly developed nomogram has proved to be an important tool for accurately predicting cognitive impairment in elderly patients with diabetes, providing important information for targeted prevention and intervention measures.

Predictors of Cognitive Impairment among Filipino Patients with Type 2 Diabetes Mellitus in a Tertiary Government Hospital

Background

Type 2 Diabetes Mellitus (T2DM) patients are predisposed to cognitive decline and dementia. The co-occurrence of the two diseases translate to a higher medical cost. Identification of factors contributing to cognitive impairment is warranted.

Objective

To determine the predictors of cognitive impairment among Filipino patients with Type 2 Diabetes Mellitus.

Methods

This is a cross-sectional analytical study involving Filipino patients diagnosed with T2DM in the outpatient clinic. A total of 171 patients were included and were screened using AD8-P tool.

Results

A total of 171 adult patients were included and screened for cognitive impairment.19.3% were cognitively impaired, with mean age of 59.6 years old (vs. 55.5 years old, p < 0.029), and two-thirds were female. The mean duration of the patient's diabetes was 11.2 years. After adjusting for confounders and multi-collinearity, the duration of diabetes was significantly associated with cognitive impairment with odds of developing cognitive impairment increasing as the duration reach 10 years above. Those with T2DM for at least ten years were 2.5 times more likely to develop cognitive impairment, holding the age constant. (OR = 2.5, 95% CI - 1.0 to 5.8, p < 0.043).

Conclusion

19.3% of Filipino patients with Type 2 Diabetes Mellitus in a tertiary government hospital are cognitively impaired and this can occur even in less than 65 years old. The ten years or longer duration of T2DM increases the risk of developing cognitive impairment by 2.5%.

SGLT2 inhibitors: a novel therapy for cognitive impairment via multifaceted effects on the nervous system

The rising prevalence of diabetes mellitus has casted a spotlight on one of its significant sequelae: cognitive impairment. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, originally developed for diabetes management, are increasingly studied for their cognitive benefits. These benefits may include reduction of oxidative stress and neuroinflammation, decrease of amyloid burdens, enhancement of neuronal plasticity, and improved cerebral glucose utilization. The multifaceted effects and the relatively favorable side-effect profile of SGLT2 inhibitors render them a promising therapeutic candidate for cognitive disorders. Nonetheless, the application of SGLT2 inhibitors for cognitive impairment is not without its limitations, necessitating more comprehensive research to fully determine their therapeutic potential for cognitive treatment. In this review, we discuss the role of SGLT2 in neural function, elucidate the diabetes-cognition nexus, and synthesize current knowledge on the cognitive effects of SGLT2 inhibitors based on animal studies and clinical evidence. Research gaps are proposed to spur further investigation.

Inhibition of ANGPTL8 protects against diabetes-associated cognitive dysfunction by reducing synaptic loss via the PirB signaling pathway

BACKGROUND

Type 2 diabetes mellitus (T2D) is associated with an increased risk of cognitive dysfunction. Angiopoietin-like protein 8 (ANGPTL8) is an important regulator in T2D, but the role of ANGPTL8 in diabetes-associated cognitive dysfunction remains unknown. Here, we explored the role of ANGPTL8 in diabetes-associated cognitive dysfunction through its interaction with paired immunoglobulin-like receptor B (PirB) in the central nervous system.

METHODS

The levels of ANGPTL8 in type 2 diabetic patients with cognitive dysfunction and control individuals were measured. Mouse models of diabetes-associated cognitive dysfunction were constructed to investigate the role of ANGPTL8 in cognitive function. The cognitive function of the mice was assessed by the Barnes Maze test and the novel object recognition test, and levels of ANGPTL8, synaptic and axonal markers, and pro-inflammatory cytokines were measured. Primary neurons and microglia were treated with recombinant ANGPTL8 protein (rA8), and subsequent changes were examined. In addition, the changes induced by ANGPTL8 were validated after blocking PirB and its downstream pathways. Finally, mice with central nervous system-specific knockout of Angptl8 and PirB-/- mice were generated, and relevant in vivo experiments were performed.

RESULTS

Here, we demonstrated that in the diabetic brain, ANGPTL8 was secreted by neurons into the hippocampus, resulting in neuroinflammation and impairment of synaptic plasticity. Moreover, neuron-specific Angptl8 knockout prevented diabetes-associated cognitive dysfunction and neuroinflammation. Mechanistically, ANGPTL8 acted in parallel to neurons and microglia via its receptor PirB, manifesting as downregulation of synaptic and axonal markers in neurons and upregulation of proinflammatory cytokine expression in microglia. In vivo, PirB-/- mice exhibited resistance to ANGPTL8-induced neuroinflammation and synaptic damage.

CONCLUSION

Taken together, our findings reveal the role of ANGPTL8 in the pathogenesis of diabetes-associated cognitive dysfunction and identify the ANGPTL8-PirB signaling pathway as a potential target for the management of this condition.

HECTD3 promotes NLRP3 inflammasome and pyroptosis to exacerbate diabetes-related cognitive impairment by stabilising MALT1 to regulate JNK pathway

BACKGROUND

HECTD3 (HECT domain E3 ubiquitin protein ligase 3) exerts biological activities in neuroinflammation of distinct diseases, such as autoimmune encephalomyelitis and donations after heart death. However, the effect of HECTD3 on diabetes-associated cognitive decline (DACD) remains unclear.

METHODS

Wild-type or HECTD3-knockout rats were administered with streptozotocin to establish diabetic model. Pathological changes in the hippocampus were assessed by NISSL and haematoxylin and eosin staining. Morris water maze test was used to assess cognitive function. Neuronal survival and inflammation were investigated by immunofluorescence staining and ELISA assay. NLRP3 inflammasome and pyroptosis were assessed by western blot, immunofluorescence and flow cytometry assays.

RESULTS

HECTD3 was up-regulated in hippocampus of streptozotocin-induced diabetic rats and high glucose-induced PC12 cells. Knockout of HECTD3 increased the number of neurons and improved the learning and memory function. Moreover, knockout of HECTD3 promoted in vivo neuronal survival, and reduced levels of IL-1β, TNF-α, and IL-6 in the hippocampus. Silencing of HECTD3 increased cell viability, and reduced IL-1β, TNF-α, and IL-6 in high glucose-induced PC12 cells. Fluorescence intensities of NLRP3, GSDMD-N and caspase-1 were reduced in HECTD3-knockout diabetic rats, and knockdown of HECTD3 down-regulated protein expression of NLRP3, GSDMD-N, caspase-1, IL-1β, and IL-18 in high glucose-induced PC12 cells to suppress the pyroptosis. HECTD3 promoted the stability of mucosa-associated lymphoid tissue 1 (MALT1) through up-regulation of c-JUN and phospho (p)-JNK in high glucose-induced PC12 cells. Over-expression of MALT1 attenuated neuroprotective effects of HECTD3 silencing on high glucose-induced PC12 cells.

CONCLUSION

HECTD3 silencing exerted neuroprotective effect against DACD through MALT1-mediated JNK signalling.HighlightsHECTD3 was up-regulated in hippocampus of streptozotocin-induced diabetic rats and high glucose-induced PC12.Knockout of HECTD3 promoted in vivo neuronal survival, reduced inflammation and pyroptosis, and improved the learning and memory function in diabetic rats.Knockout of HECTD3 suppressed the activation of NLRP3 inflammasome in diabetic rats.Silencing of HECTD3 exerted neuroprotective effects through MALT1-mediated JNK signalling.

Neuroprotective Effects of Bexarotene and Icariin in a Diabetic Rat Model

Objective Type 2 diabetes mellitus (T2DM), a chronic metabolic disorder affecting over 400 million people globally, is increasingly recognized for its detrimental impact on the central nervous system. T2DM is linked to neurodegenerative diseases like Alzheimer's and vascular dementia. This study investigates the neuroprotective effects of bexarotene and icariin in a T2DM rat model, focusing on brain-derived neurotrophic factor (BDNF), glial fibrillary acidic protein (GFAP), and neurofilament-light chain (NfL) levels. Methods Before the study, rats underwent fasting blood glucose tests, lipid profile assessments, and general health evaluations, followed by a high-fat diet for two weeks and a single streptozotocin dose (35 mg/kg). Rats with fasting blood glucose levels ≥250 mg/dl were classified as diabetes mellitus (DM) and continued on the high-fat diet throughout the experiment. Forty-seven male Wistar Albino rats were divided into six groups: a healthy control group, a DM control group, a DM group treated with bexarotene, a DM group treated with icariin, and two DM groups treated with combinations of low and high doses of bexarotene and icariin. After the 45-day treatment, blood samples were collected under thiopental sodium anesthesia, with HbA1c (glycosylated hemoglobin) and hematological parameters analyzed within eight hours, and serum stored at -80°C for further analysis. The animals were then euthanized, and brain tissues were harvested, frozen, and stored at -80°C until further examination. Brain tissues were analyzed for BDNF, GFAP, and NfL levels using ELISA (enzyme-linked immunosorbent assay). For comparing multiple groups, the Kruskal-Wallis test was applied to nonparametric data, and one-way ANOVA was used for parametric data, followed by Bonferroni's post hoc test for pairwise comparisons. Statistical significance was determined with two-tailed tests at p < 0.05. Results Significant changes in GFAP levels were observed across groups (p < 0.001). The DM control group showed the highest GFAP levels, while treatment groups exhibited reductions. The DM control group also showed the highest BDNF levels, while treatment groups exhibited reductions. The DM control group showed the lowest NfL levels, while treatment groups exhibited increments. Conclusion This study highlights the neuroprotective potential of bexarotene and icariin in a diabetic rat model, evidenced by significant changes in GFAP levels. The lack of significant changes in BDNF and NfL suggests that longer study durations may be necessary to observe these effects. Future research should include extended study periods, larger sample sizes, varied dosages, and comprehensive behavioral assessments to better understand the therapeutic potential of these agents.

DNA Methylation Mediates the Association Between Cardiometabolic Risk Factors and Cognition: Findings From the Health and Retirement Study

The association between cardiometabolic risk factors and cognitive function has been well documented, but the underlying mechanisms are not fully understood. This longitudinal study aimed to investigate the potential mediating role of DNA methylation in this association. We conducted the analyses in 3 708 participants (mean [standard deviation {SD}] age: 67.3 [9.5], women: 57.9%) from the Health and Retirement Study who were assessed in the 2014-2020 waves, had Infinium Methylation EPIC BeadChip methylation assays from the 2016 Venous Blood Study, and had cognitive assessment between 2016 and 2020. Causal mediation analyses were used to test the mediation role of DNA methylation in the associations between cardiometabolic risk factors and cognition, adjusting for demographic, socioeconomic, and lifestyle factors. Hypertension (-0.061 in composite cognitive z-score; 95% confidence interval [CI: -0.119, -0.004]) and diabetes (-0.134; 95% CI: [-0.198, -0.071]) were significantly associated with worse cognitive function while abnormal body weight and hypercholesterolemia were not. An increased number of cardiometabolic risk factors was associated with worse cognitive function (p = .002). DNA methylation significantly mediated the association of hypertension (mediated effect on composite cognitive z-score: -0.023; 95% CI: -0.033, -0.014), diabetes (-0.022; 95% CI: -0.032, -0.014), and obesity (-0.021; 95% CI: -0.033, -0.011) with cognitive function, whereas the mediation effect was not observed for having hypercholesterolemia. The estimated proportions mediated were 37.4% for hypertension and 16.7% for diabetes. DNA methylation may be an important mediator linking cardiometabolic risk factors to worse cognition and might even provide a potential target for dementia prevention.

Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology

Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.

Highly purified hypochlorous acid water facilitates glucose metabolism and memory formation in type 2 diabetic mice associated with altered-gut microbiota

Hypochlorous acid (HOCl) is an endogenous oxidant and chlorinating agent in mammals that is effective against a broad range of microorganisms. However, the effects of exogenous HOCl on biological processes have not been reported. In this study, the effects of highly purified slightly acidic hypochlorous acid water (HP-HAW) were investigated. After the safety of oral administration of HP-HAW was confirmed, the effects of HP-HAW on glucose homeostasis were assessed in mice. HP-HAW treatment significantly improved blood glucose levels in hyperglycemic condition. Based on the 16S rRNA sequencing, HP-HAW treatment significantly increased the diversity and changed the composition of gut microbiota by decreasing the abundance of genus Romboutsia in mice fed normal chow. In obese mice, HP-HAW administration tended to improve glucose tolerance. HP-HAW also attenuated memory impairments and changes N-methyl-d-aspartate (NMDA) receptor mRNA expression in obese mice. HP-HAW treatment suppressed Il-6 mRNA expression in the hippocampus in type 2 diabetic mice. Overall, these results support HP-HAW as a potential therapeutic agent to improve or prevent glucose tolerance and memory decline via gut microbiota alteration.