Cognitive Function Is Impaired in Patients with Recently Diagnosed Type 2 Diabetes, but Not Type 1 Diabetes

Research Progress on Lipocalin-2 in Diabetic Encephalopathy

Diabetic encephalopathy is a central nervous complication of diabetes mellitus which is characterized by cognitive impairment and structural and neurochemical abnormalities, which is easily neglected. Lipocalin-2 (LCN2) is a 25 kDa transporter in the lipocalin family that can transport small molecules, including fatty acids, iron, steroids, and lipopolysaccharides in the circulation. Recently, LCN2 has been found to be a significant regulator of insulin resistance and glucose homeostasis. Numerous studies have shown that LCN2 is connected to central nervous system abnormalities, including neuroinflammation and neurodegeneration, while the latest researches have found that LCN2 is closely related to the development of diabetic encephalopathy. Nevertheless, its precise role in the pathogenesis of diabetic encephalopathy remains to be determined. In this paper, we review recent evidence on the role of LCN2 in diabetic encephalopathy from multiple perspectives in order to decipher the impact of LCN2 in both the aetiology and treatment of diabetic encephalopathy.

Sex Differences in Metabolic and Behavioral Responses to Exercise but Not Exogenous Osteocalcin Treatment in Mice Fed a High Fat Diet

Background

Exercise helps improve glucose handling in diabetes and has been shown to improve mood and cognition in other conditions. Osteocalcin, a protein produced by bone osteoblasts, was reported to have endocrine actions to improve both metabolism and also improve age-related cognitive deficits in mice.

Methods

This study was designed to compare the effects of daily treadmill running exercise with injection of osteocalcin in high fat diet (HFD) induced diabetes in male and female C57BL/6J mice. Following established glucose intolerance and treatment for 8 weeks, mice were assessed for anxiety on an elevated plus maze, motivation by tail suspension test and cognition and memory in a puzzle box. Endogenous osteocalcin was measured by ELISA.

Results

Mice on HFD had high weight gain, glucose intolerance and increased white fat. Exercise increased circulating osteocalcin levels in female mice but decreased them in male mice. Exercise also decreased weight gain and improved glucose tolerance in female but not male mice; however, treatment with osteocalcin made no metabolic improvements in either males or females. HFD induced anxiety only in female mice and this was not improved by osteocalcin. Exercise induced anxiety only in male mice. HFD also increased depressive-like behavior in both sexes, and this was improved by either exercise or osteocalcin treatment. Cognitive deficits were seen in both male and female mice on HFD. Exercise improved cognitive performance in female but not male mice, while osteocalcin treatment improved cognitive performance in both sexes.

Conclusion

There were sex differences in the effects of exercise on endogenous osteocalcin regulation that correlated with improvements in cognitive but not metabolic outcomes. Exogenous osteocalcin did not improve metabolism but was effective in improving HFD-induced cognitive deficits. Sex is an important variable in hormonal and cognitive responses to exercise in diabetes.

Comparison of cognitive status of diabetic and non-diabetic elderly in the last ten years in primary health care in Iran

Introduction. Cognitive disorders and chronic diseases such as diabetes are common problems of aging. The aim of this study was to determine and compare the cognitive status of diabetic and non-diabetic elderly in the past ten years in primary health care in Iran. Method: This cross-sectional study was performed on people aged 60 years and older in Kerman, Iran in 2020. In total, this study was performed on 200 patients (100 diabetic and 100 non-diabetic) meeting inclusion criteria. The Short Mental Status Questionnaire (MMSE) and The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) were used to assess cognitive function. The validity and reliability of the questionnaires were confirmed in this study. Data were analyzed using Chi-square, T-test, and ANOVA analysis in SPSS 21 software. Results. The results showed that there was a statistically significant difference between diabetic and non-diabetic groups in the current cognitive status and cognitive status in the last ten years. The mean scores of cognitive function from the short mental status questionnaire in the diabetic group were lower than in the non-diabetic group (p = 0.001). The mean scores of the cognitive deficit screening questionnaire in diabetic elderly were higher than in non-diabetic elderly (p < 0.001). Conclusion. Based on the results of this study, health care providers and family physicians should focus on controlling diabetes and identifying any cognitive impairment in the early stages of comprehensive care of diabetic patients.

Sport reduziert den diabetesassoziierten Verlust kognitiver Fähigkeiten bei Typ-2-Diabetes-Patienten

Kognitive Defizite entwickeln sich bei T2D-Patienten häufig auf dem Boden metabolischer Störungen. Neben den eher mild ausfallenden, aber klinisch relevanten diabetesassoziierten kognitiven Dysfunktionen geht T2 D ebenfalls mit einem erhöhten Risiko für Demenz verschiedener Ursachen einher. Die zugrunde liegenden Mechanismen, die zu einer diabetesassoziierten kognitiven Dysfunktion führen, sind nicht vollständig geklärt. Trainingsinterventionen bieten die Möglichkeit, mögliche metabolische Risikofaktoren zu verringern und gleichzeitig dadurch die diabetesassoziierten kognitiven Verschlechterungen zu reduzieren. Unklar ist allerdings noch, welche Trainingsart und -intensität den größten gesundheitlichen Nutzen bringt, da bisherige Studienergebnisse wegen unterschiedlicher Kohorten, Interventionsmethoden und Interventionsdauern schwer zu vergleichen sind.

Type 2 diabetes mellitus in older adults: clinical considerations and management

The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.

Cognitive Function in Adolescents and Young Adults With Youth-Onset Type 1 Versus Type 2 Diabetes: The SEARCH for Diabetes in Youth Study

OBJECTIVE

Poor cognition has been observed in children and adolescents with youth-onset type 1 (T1D) and type 2 diabetes (T2D) compared with control subjects without diabetes. Differences in cognition between youth-onset T1D and T2D, however, are not known. Thus, using data from SEARCH for Diabetes in Youth, a multicenter, observational cohort study, we tested the association between diabetes type and cognitive function in adolescents and young adults with T1D (n = 1,095) or T2D (n = 285).

RESEARCH DESIGN AND METHODS

Cognition was assessed via the National Institutes of Health Toolbox Cognition Battery, and age-corrected composite Fluid Cognition scores were used as the primary outcome. Confounder-adjusted linear regression models were run. Model 1 included diabetes type and clinical site. Model 2 additionally included sex, race/ethnicity, waist-to-height ratio, diabetes duration, depressive symptoms, glycemic control, any hypoglycemic episode in the past year, parental education, and household income. Model 3 additionally included the Picture Vocabulary score, a measure of receptive language and crystallized cognition.

RESULTS

Having T2D was significantly associated with lower fluid cognitive scores before adjustment for confounders (model 1; P < 0.001). This association was attenuated to nonsignificance with the addition of a priori confounders (model 2; P = 0.06) and Picture Vocabulary scores (model 3; P = 0.49). Receptive language, waist-to-height ratio, and depressive symptoms remained significant in the final model (P < 0.01 for all, respectively).

CONCLUSIONS

These data suggest that while youth with T2D have worse fluid cognition than youth with T1D, these differences are accounted for by differences in crystallized cognition (receptive language), central adiposity, and mental health. These potentially modifiable factors are also independently associated with fluid cognitive health, regardless of diabetes type. Future studies of cognitive health in people with youth-onset diabetes should focus on investigating these significant factors.

The Association between Hepatic Encephalopathy and Diabetic Encephalopathy: The Brain-Liver Axis

Hepatic encephalopathy (HE) is one of the main consequences of liver disease and is observed in severe liver failure and cirrhosis. Recent studies have provided significant evidence that HE shows several neurological symptoms including depressive mood, cognitive dysfunction, impaired circadian rhythm, and attention deficits as well as motor disturbance. Liver disease is also a risk factor for the development of diabetes mellitus. Diabetic encephalopathy (DE) is characterized by cognitive dysfunction and motor impairment. Recent research investigated the relationship between metabolic changes and the pathogenesis of neurological disease, indicating the importance between metabolic organs and the brain. Given that a diverse number of metabolites and changes in the brain contribute to neurologic dysfunction, HE and DE are emerging types of neurologic disease. Here, we review significant evidence of the association between HE and DE, and summarise the common risk factors. This review may provide promising therapeutic information and help to design a future metabolic organ-related study in relation to HE and DE.

The Relation of Diabetes to Memory Function

PURPOSE OF REVIEW

Research has consistently shown that type 2 diabetes (T2D) is associated with increased risk of all-cause dementia. Because one of the most common clinical presentations of early stage dementia is memory impairment, we examined the relationship of T2D with memory function, using the recently published scientific literature.

RECENT FINDINGS

We conducted a structured review to identify studies of "T2D and memory" published since 2015. After review of the 129 articles retrieved, we identified 14 studies meeting the inclusion and exclusion criteria. Among the eight studies with a single assessment of memory function in time (mostly cross-sectional), six found an association of T2D with lower memory function, but mostly in select subgroups of persons. Separately, six studies included repeated measures of memory (longitudinal design). Four out of six longitudinal studies found that T2D was related with a faster decline in memory, while two did not. Among the four studies showing a relation with memory decline, two had sample sizes of 9000-10,000 persons. Further, three longitudinal studies controlled for hypertension and stroke as covariates, and results suggested that common vascular risk factors and diseases do not account for the relation. While mechanistic studies clearly support a role for cerebrovascular disease in the relation of T2D with cognition, emerging data suggest that insulin resistance in the brain itself may also play a role. Most, but not all, recently published studies suggest that T2D is associated with a lower level and faster decline in memory function. This association does not appear to be fully accounted for by common vascular processes. More research will clarify the mechanisms linking T2D to memory and dementia.

Healthy brain, healthy life: a review of diet and exercise interventions to promote brain health and reduce Alzheimer's disease risk

With the world's population aging at a rapid rate, the prevalence of Alzheimer's disease (AD) has significantly increased. These statistics are alarming given recent evidence that a third of dementia cases may be preventable. The role of lifestyle factors, such as diet and exercise, can directly alter the risk of disease development. However, an understanding of the effectiveness of dietary patterns and exercise strategies to reduce AD risk or improve brain function is not fully understood. The aim of this review is to discuss the effects of diet and exercise on AD risk. Key components of the Western and Mediterranean diets are discussed in relation to AD progression, as well as how physical activity promotes brain health. Components of the Western diet (saturated fatty acids and simple carbohydrates) are detrimental to the brain, impair cognition, and increase AD pathologies. While components of the Mediterranean diet (polyunsaturated fatty acids, polyphenols, and antioxidants) are considered to be neuroprotective. Exercise can significantly reduce the risk of AD; however, specific exercise recommendations for older adults are limited and optimal intensity, duration, and type remains unknown. This review highlights important modifiable risk factors for AD and points out potential avenues for future research. Novelty Diet and exercise are modifiable factors that can improve brain health and reduce the risk of AD. Polyunsaturated fatty acids, polyphenols, and antioxidants are neuroprotective. Exercise reduces neuroinflammation, improves brain insulin sensitivity, and increases brain derived neurotrophic factor.

Diabetic encephalopathy causes the imbalance of neural activities between hippocampal glutamatergic neurons and GABAergic neurons in mice

Diabetic encephalopathy is a severe diabetes-related complication in the central nervous system (CNS) that is characterized by the impairment of neurochemical and structural changes leading to cognitive dysfunction. Its cellular and molecular mechanisms are still unclear and clinical approaches are still lacking of promising therapies. In this study, we have investigated the changes of different hippocampal neurons during diabetic encephalopathy in mouse models of diabetes by simultaneously analyzing the activities and synaptic transmission of glutamatergic neurons and GABAergic neurons in brain slices. Compared with the data from a group of control, diabetic encephalopathy permanently impairs the excitability of GABAergic neurons and synaptic transmission mediated by γ-aminobutyric acid (GABA). However, glutamatergic neurons appear to be more excited. Our findings highlight the critical role of the dysfunction of GABAergic neurons and glutamatergic neurons during diabetic encephalopathy in hippocampus to neural impairment as well as a strategy to prevent the function of progress of diabetic encephalopathy by protecting central neurons.

Associations between cognitive performance and Mediterranean dietary pattern in patients with type 1 or type 2 diabetes mellitus

Diabetes mellitus has been associated with impaired cognitive performance, particularly in verbal memory. Mediterranean diets (MedD) may lead to improvements in overall and single cognitive functions. We hypothesised that adherence to MedD associates with better performance in verbal memory in patients with type 1 or type 2 diabetes. Thus, we performed a cross-sectional analysis including patients with recently diagnosed type 1 (n = 75) or type 2 diabetes (n = 118), metabolically healthy individuals (n = 41) and individuals with type 1 (n = 44) or type 2 diabetes (n = 62) of at least five years after diagnosis. Participants underwent comprehensive metabolic phenotyping and cognitive testing. Adherence to the Modified Mediterranean diet scale (MMDS) was computed from a food frequency questionnaire. Among patients with type 2 diabetes with a known diabetes duration ≥5 years, closer adherence to the MMDS was associated with higher score in verbal memory after adjustment for potential confounders (P = 0.043). Adherence to the MMDS did not relate to verbal memory in recently diagnosed type 2 diabetes (P = 0.275), recently diagnosed or longer-standing type 1 diabetes (P = 0.215 and P = 0.626, respectively) or metabolically healthy individuals (P = 0.666). In conclusion, closer adherence to MedD may exert beneficial effects on cognitive performance in the course of type 2 diabetes.

Role of Hippocampal Lipocalin-2 in Experimental Diabetic Encephalopathy

Diabetic encephalopathy is a severe diabetes-related complication in the central nervous system (CNS) that is characterized by degenerative neurochemical and structural changes leading to impaired cognitive function. While the exact pathophysiology of diabetic encephalopathy is not well-understood, it is likely that neuroinflammation is one of the key pathogenic mechanisms that cause this complication. Lipocalin-2 (LCN2) is an acute phase protein known to promote neuroinflammation via the recruitment and activation of immune cells and glia, particularly microglia and astrocytes, thereby inducing proinflammatory mediators in a range of neurological disorders. In this study, we investigated the role of LCN2 in multiple aspects of diabetic encephalopathy in mouse models of diabetes. Here, we show that induction of diabetes increased the expression of both Lcn2 mRNA and protein in the hippocampus. Genetic deficiency of Lcn2 significantly reduced gliosis, recruitment of macrophages, and production of inflammatory cytokines in the diabetic mice. Further, diabetes-induced hippocampal toxicity and cognitive decline were both lower in Lcn2 knockout mice than in the wild-type animals. Taken together, our findings highlight the critical role of LCN2 in the pathogenesis of diabetic encephalopathy.