Cognitive Dysfunction Among Adults With Type 2 Diabetes Mellitus in Karnataka, India

A Cross-Sectional Study on the Prevalence and Predictors of Cognitive Impairment and Depression in Elderly Patients With Type 2 Diabetes Mellitus

Background The rising prevalence of type 2 diabetes mellitus (T2DM) in the elderly is associated with mental health disorders like cognitive impairment and depression due to hyperglycemia and inflammation. The present study aims to estimate the prevalence of cognitive impairment and depression and its association with clinical, biochemical, and psychosocial factors to identify high-risk subjects. Methods A cross-sectional study was conducted at a tertiary care teaching hospital and enrolled 99 patients of T2DM, aged equal to or more than 60 years from North India. Cognitive function and depression were assessed by the Hindi Mental Scale Examination (HMSE) and the Hindi version of the Geriatric Depression Scale (GDS-H), respectively. Fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), and the lipid profile were measured. Univariate and multivariate binary logistic regression analyses were applied to identify association and independent predictors, respectively, and receiver operating characteristic (ROC) curve analysis to determine the optimal cut-off values. Results The mean age of the patients was 66.68 years, and 38.38% were females. The prevalence of impaired cognition and depression in elderly T2DM subjects was 37.37% and 43.43%, respectively. HMSE was inversely correlated while GDS-H was positively correlated with FPG and HbA1C. Cognitive impairment was independently predicted by age, HbA1C levels, and rural residence. Depression was independently associated with HbA1C levels and being unmarried or widowed. The optimal cut-off for cognitive impairment was age >63 years and HbA1C >7.7%. For depression, the cut-off for HbA1C was >6.9%. Conclusion This study revealed a higher prevalence of cognitive impairment and depression among elderly T2DM patients in North India. The age of more than 63 years, poor glycemic control, rural residents, and marital status are high-risk groups for cognitive impairment and depression. This study suggests the integration of routine mental health screening for high-risk elderly T2DM patients and the development of comprehensive diabetes management programs that address both physical and mental health aspects.

Neurocognitive impairment and its associated factors among patients with diabetes mellitus who have follow up at referral hospital in Northwest, Ethiopia

Background

Neurocognitive impairment is a condition that makes it difficult for a person to make decisions that affect memory, learning new things, concentration on daily activities, and can range from mild to severe forms. It is a major health problem, less known and less addressed complication of diabetes mellitus.

Objectives

The aim of the study is to assess prevalence of neurocognitive impairment and associated factors among diabetic mellitus patients.

Methods

We conducted an institutional-based cross-sectional study involving 512 diabetic patients under follow-up at XXX Specialized Hospital from March 1 to April 30, 2023. Data on cognition, behavior, and depression were collected using standardized tools, including the Mini Mental State Examination for cognition, the CAGE assessment tool for alcohol-related behavior, and the PHQ-9 for depression. These assessments were conducted through face-to-face interviews and chart reviews. A diagnosis of diabetes is confirmed in adults when fasting blood glucose levels exceed 126 mg/dl in three consecutive follow-up measurements. Data entry was performed using Epidata version 4.6, and analysis was conducted using SPSS version 26. Variables with a P-value < 0.25 in bivariate analysis were included in multivariable logistic regression. Statistical significance was set at P ≤ 0.05 with a 95% CI. Results were presented using tables, graphs, and descriptive text.

Results

The prevalence of neurocognitive impairment among diabetic patients at XXX Comprehensive Specialized Hospital was 28.3% [95% CI: 24.57-32.39]. Factors associated with this impairment included being female (AOR=2.29 [95% CI: 1.43-3.67]), rural residence (AOR=3.16 [95% CI: 2.01-4.95]), comorbidity (AOR=3.30 [95% CI: 2.08-5.23]), diabetes duration of 6-10 years (AOR=1.72 [95% CI: 1.01-2.94]), diabetes duration >10 years, and blood sugar level >126 mg/dl (AOR=2.25 [95% CI: 1.42-3.57]). Patients are encouraged to adhere to proper medication regimens to effectively control their blood glucose levels. This study found a high prevalence of neurocognitive impairment (NCI) among diabetic patients, affecting about one-fourth based on MMSE scores. Key risk factors identified include female gender, rural residence, comorbidities, longer duration of diabetes, and elevated blood glucose levels.

Association of Hyperlipidemia and Hyperglycemia With Cognitive Function in Type 2 Diabetes: A Cross-Sectional Analysis

Introduction Cognitive impairment is increasingly recognized as a significant health concern, particularly in the early stages of diabetes. The type and severity of cognitive deficits may vary with the duration of diabetes and the effectiveness of glucose management. Complications associated with metabolic syndrome may exacerbate these cognitive declines. This study investigates the association of hyperlipidemia and hyperglycemia with cognitive function in patients with type 2 diabetes (T2D). Methods We conducted a cross-sectional study on type 2 diabetic patients aged between 30 and 40 years of age and having the disease for less than 10 years duration. We collected anthropometric measurements, tested glycated hemoglobin (HbA1c) and fasting lipid profiles, and assessed cognitive function using the Montreal Cognitive Assessment (MoCA). Results All participants exhibited elevated HbA1c levels and abnormal lipid profiles. We observed weak positive correlations between the duration of diabetes and low-density lipoprotein cholesterol (LDL; 0.448), very low-density lipoprotein cholesterol (VLDL; 0.398), total cholesterol (0.526), and HbA1c (0.360). There were moderately negative correlations between the duration of diabetes and MoCA scores (-0.522) and weak negative correlations between LDL and MoCA (-0.304), VLDL and MoCA (-0.259), and total cholesterol and MoCA (-0.409). The correlation between HbA1c and MoCA was also moderately negative (-0.779). Regression analysis revealed statistically significant associations of MoCA with the duration of diabetes, HbA1c, and lipid parameters, with HbA1c being the largest contributor to cognitive decline at 60.66%, while the contributions of various lipid parameters were considerably lower (LDL: R² = 0.092, VLDL: R² = 0.067, total cholesterol: R² = 0.167). The contribution of the duration of diabetes (R² = 0.272) to cognitive decline was less than that of HbA1c but more than the lipid parameters. Conclusions The findings suggest that hyperglycemia and the duration of diabetes are the major factors contributing to cognitive decline in patients with T2D. Patients should be advised to maintain optimal glycemic control and engage in activities that enhance cognitive function to prevent cognitive impairment. Regular cognitive screening for diabetic patients is also recommended.

Dysglycemia, gender, and cognitive performance in older persons living with mild cognitive impairment: findings from a cross-sectional, population-based study

OBJECTIVE

This study aims to examine the relationship between dysglycemia - also known as pre-diabetes or impaired glucose tolerance- and cognitive abilities in an older population living Mild Cognitive Impairment (MCI) and stratified by gender.

STUDY DESIGN

This is a retrospective study with data gathered from a large Italian clinical-based database.

MAIN OUTCOME MEASURES

The evaluation of cognitive performances by the Mini-Mental State Examination and the Addenbrooke's Cognitive Examination Revised rating scale as tests of screening and a comprehensive neuropsychological evaluation of several cognitive areas.

RESULTS

The study comprised 682 subjects (445 F/237 M) with a mean age of 76.08 ± 9.03 (range: 66-93) years. In all population, subjects with dysglycemia 193 (28.3%) had significantly poorer performance in memory (p = 0.006) and logic reasoning (p = 0.007) when compared with subjects without dysglycemia. The linear regression analyses revealed significant differences in the correlates of cognitive domains between gender groups. Independent of multiple covariates, women with dysglycemia showed worse performances in attention and short-term memory domains as compared with men. Even in the absence of dysglycemia women were more likely to show lower score in screening test of general cognition and attention.

CONCLUSIONS

Our findings suggest that dysglycemia in older individuals with MCI is associated with declines in specific cognitive domains, potentially influenced by gender. Implementing a comprehensive approach involving risk stratification and preventive strategies may be more effective in averting further cognitive decline in this high-risk population.

Study of cognitive functions and their association with depression in type II diabetes mellitus

Introduction

Individuals with diabetes have higher risk of developing depression, cognitive impairment, and dementia compared to those who do not have diabetes. The present study aims to assess the level of cognitive functions and the presence of depression in diabetes patients and healthy controls. The study also explores the level of cognition among the normal control, diabetes without depression, and diabetes with depression.

Methods

In the present study, the presence of depression and the level of cognitive functions of 59 cases of diabetes mellitus type-2 were compared with an age- and gender-matched control group of 40 individuals. Clinical and demographic details were recorded on a semi-structured performa. Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9) were applied to both diabetes patients and healthy controls to assess the level of cognitive functions and the presence of depression, respectively.

Results

On applying odds ratio (OR), it was observed in the present study that there were 93.50% more chances [OR 1.935 with 95% confidence interval (CI) being 0.481-7.789] of depression among diabetic cases as compared to the control group. Similarly, the chance of MoCA score being less than 26 was twice among the diabetic group as compared to the control group (OR 2.208 with 95% CI being 0.702-6.946). On application of the Chi-square test, the association of depression was significant with HBA1C level, level of education, and presence of complications.

Conclusions

Patients with diabetes had almost double the risk of developing depression and poor cognitive functions as compared to the healthy control. High HbA1C level, level of education, and presence of complication in diabetes had a positive statistical association with depression. Thus, it is advisable to investigate patients with diabetes for the presence of depression and cognitive dysfunction by applying simple tools.

Network analysis of depression, cognitive functions, and suicidal ideation in patients with diabetes: an epidemiological study in Iran

AIMS

The main aim of this study was to assess the prevalence of suicidal ideation and previous suicide attempts among Iranian patients diagnosed with Type-1 diabetes (T1D) and Type-2 diabetes (T2D). Additionally, the study sought to estimate the network structure of depressive symptoms and cognitive functions.

METHODS

1073 patients participated in the current study. We used Patient Health Questionnaire-9 (PHQ-9), Ask Suicide-Screening Questionnaire, diabetes-related factors, and a battery of cognitive functions tasks to estimate network structures. Also, suicidal ideations and suicide attempts prevalence have been estimated. Statistical analyses were performed using R-studio software, including mixed-graphical models (MGMs) for undirected effects and Directed Acyclic Graphs (DAGs) for directed effects.

RESULTS

The prevalence of suicidal ideation was 29.97% in T1D and 26.81% in T2D (p < 0.05). The history of suicide attempts was higher in T1D (10.78%) compared to T2D (8.36%) (p < 0.01). In the MRF networks for T1D, suicidal ideation was directly linked to 'feeling guilt (PHQ.6)', 'Suicide (PHQ.9)', HbA1c, and FBS, while the Inhibition node was directly related to suicidal ideation. The DAGs suggested connections between 'depression', HbA1c, and 'inhibition' with suicidal ideation, along with a link between the current family history of suicide attempts and the patient's history of suicide attempts. For T2D, the MRF networks indicated direct links between suicidal ideation and 'anhedonia (PHQ.1)', 'suicide (PHQ.9)', age, being female, and BMI, with inhibition also being directly related to suicidal ideation. The DAGs revealed connections between 'depression', age, and 'inhibition' with suicidal ideation, as well as links between being female or single/divorced and the patient's history of suicide attempts.

CONCLUSION

The findings suggest that suicide ideation is highly prevalent in patients with diabetes, and these symptoms should be carefully monitored in these patients.

Sex comparisons in the association of prediabetes and type 2 diabetes with cognitive function, depression, and quality of life: The Maastricht study

AIMS

There are sex differences in the excess risk of diabetes-associated cardiovascular disease. However, it is not clear whether these sex differences exist with regard to other complications like mental health aspects. Therefore, we investigated sex differences in the association of prediabetes and type 2 diabetes (T2D) with cognitive function, depression, and quality of life (QoL).

MATERIALS AND METHODS

In a population-based cross-sectional cohort study (n = 7639; age 40-75 years, 50% women, 25% T2D), we estimated sex-specific associations, and differences therein, of prediabetes and T2D (reference: normal glucose metabolism) with measures of cognitive function, depression, and physical and mental QoL. Sex differences were analysed using multiple regression models with interaction terms.

RESULTS

In general, T2D, but not prediabetes, was associated with higher odds of cognitive impairment, major depressive disorder, and poorer QoL. The odds ratio (OR) of cognitive impairment associated with T2D was 1.29 (95% CI: 0.96-1.72) for women and 1.39 (1.10-1.75) for men. The OR of major depressive disorder associated with T2D was 1.19 (0.69-2.04) for women and 1.68 (1.02-2.75) for men. The mean difference of the physical QoL score (ranging from 0 to 100, with 100 indicating the best possible QoL) associated with T2D was -2.09 (-2.92 to -1.25) for women and -1.81 (-2.48 to -1.13) for men. The mean difference of the mental QoL score associated with T2D was -0.90 (-1.79 to -0.02) for women and -0.52 (-1.23 to 0.20) for men. There was no clear pattern of sex differences in the associations of either prediabetes or T2D with measures of cognitive function, depression, or QoL.

CONCLUSIONS

In general, T2D was associated with worse cognitive function, depression, and poorer QoL. The strength of these associations was similar among women and men.

Prevalence of Cognitive Decline in Type 2 Diabetes Mellitus Patients: A Real-World Cross-Sectional Study in Mysuru, India

The goal of this research is to study the prevalence of cognitive impairment in diabetes mellitus (DM) patients and establish the necessity of detecting and treating it early in these patients. A cross-sectional study was conducted at a tertiary care hospital in Mysuru for 4 months examined diabetic patients (test) and nondiabetic subjects (control) for cognitive decline using the Montreal Cognitive Assessment (MoCA) tool. Cognitive functions such as visuospatial/executive function, naming, attention, language, abstraction, delayed recall, and orientation were assessed in both groups. The diabetic group showed a significantly lower total MoCA score than the non-diabetic group (18.99 ± 0.48 and 26.21 ± 0.46, respectively; p < 0.001). Assessment of scores in diabetic patients demonstrated the significant influence of age demographics on cognitive impairment (p-value < 0.001). Furthermore, a higher proportion of diabetic patients displayed cognitive impairment despite a higher score in a single subdomain, making it evident that diabetes is diverse and multifactorial in origin, where oxidative stress and inflammatory responses play a predominant role. This study suggested that the local T2DM population residing in Mysuru (India) has a high prevalence of cognitive impairment, evident from poor performance in almost all cognitive domains assessed by MoCA. Future studies could examine the generalizability of cognitive function findings in diabetic patients across diverse geographic regions and ethnic groups, as well as investigate interventions such as lifestyle modifications and medication to prevent or delay cognitive decline in those with diabetes.

Impact of lifestyle modification on glycemic control and cognitive function among Type II diabetes mellitus patients

AIM

Assessing impact of lifestyle modification on Type 2 diabetes mellitus (T2DM) glycemic control and cognitive function.

SUBJECTS & METHODS

Prospective study was conducted on T2DM patients (92 patients as interventional group and 92 patients conventional therapy).

RESULTS

After 6 months, significant improvements of HbA1c, oxidant and antioxidant, lipid profile, and cognitive function among only the interventional group (p < 0.05). Using logistic analysis, conventional therapy, DM duration >10 years, lower education, HbA1c baseline >7 were significant predictive risks for uncontrolled DM (AOR 4.2, 2.9, 2.7 and 2.2, respectively). While, conventional therapy, baseline mild cognitive impairment (MCI) and females were significant risks for MCI (AOR 11.5, 10.8 and 4.8, respectively).

CONCLUSION

Lifestyle modification is a very important for glycemic control and cognitive function.Clinical Trial Registration: NCT04891887 (ClinicalTrials.gov).

Omarigliptin alleviates cognitive dysfunction in Streptozotocin-induced diabetic mouse

Increasing epidemiological evidence supports the strong association between diabetes mellitus (DM) and cognitive dysfunction. Omarigliptin is a long-acting dipeptidyl peptidase 4 (DPP-4) inhibitor for the treatment of diabetes. However, the effect of Omarigliptin in diabetes-associated cognitive dysfunction has not been reported. In this study, we established an in vivo diabetic mice model through streptozotocin (STZ) treatment and investigated the therapeutic effect of Omarigliptin in diabetic mice. The results show that administration with Omarigliptin reduced the food and water intake of STZ-induced diabetic mice, accompanied by decreased blood glucose levels and increased serum insulin levels. The Y-Maze test demonstrated that Omarigliptin ameliorated cognitive dysfunction in STZ-induced diabetic mice. Omarigliptin presented a protective role in the brain, as shown by the decreased reactive oxygen species (ROS) level, increased NAD+/NADH ratio, adenosine triphosphate (ATP) level, and ATP synthase activity in the hippocampus. Omarigliptin induced the increased expression level of mitochondrial inner membrane protein sirtuin 3 (SIRT3) and regulated its substrates, including forkhead box O3a (FOXO3a) and superoxide dismutase 2 (SOD2). Furthermore, knockdown of SIRT3 abolished the protective effects of Omarigliptin on mitochondrial dysfunction and cognitive dysfunction in STZ-induced diabetic mice. Taken together, these findings suggest that Omarigliptin improved insulin sensitivity and cognitive function in STZ-induced diabetic mice. Mechanistically, SIRT3 expression is required for the effect of Omarigliptin. This study provided preclinical evidence that Omarigliptin has the neuroprotective effect to improve diabetes-associated cognitive dysfunction.

Correlation between Body Mass Index (BMI) and Performance on the Montreal Cognitive Assessment (MoCA) in a Cohort of Adult Women in South Africa

Objective. Recent evidence suggests that obesity is increasing worldwide and may negatively impact neurocognition. Local studies on the association of weight status with neurocognitive function are sparse. This study is aimed at examining the association between body mass index (BMI) and neurocognitive functioning scores in a cohort of adult women. Methods. A convenience sample of 175 women aged 18 to 59 years ( $28.03\pm 8.87$ ) recruited in a community-based quantitative study completed the Montreal Cognitive Assessment (MoCA). The BMI metric was used to measure body fat based on weight and height and was stratified as high BMI (overweight or obese) or low BMI (normal weight). The Beck Depression Inventory (BDI) was used to assess depression. Pearson’s correlation analysis and the student’s $t$ -test analysis were performed. Results. We observed a significant inverse association between BMI and performance on MoCA ( $r\left(173\right)=-0.32$ , $p<0.001$ ). Performance on subtest of attention, memory, constructive abstraction, and executive functions significantly and inversely correlated with BMI. Significantly lower scores on the MoCA were found in women with a high BMI compared to women with a low BMI ( $23\pm 4$ vs. $26\pm 3$ ), $t\left(173\right)=4.12$ , $p<0.0001$ ). Conclusions. BMI and MoCA were inversely associated on both global and domain-specific neurocognitive test of attention, memory, and executive function; key neurocognitive control; and regulatory functions underlying behavior and decision-making. The findings provide a rationale for further research into the long-term effects of BMI on neurocognition.

Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review

Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.

Cognitive impairment among patients with diabetes in Saudi Arabia: a cross-sectional study

Background

The incidence of cognitive impairment (CI) is higher in patients with diabetes mellitus (DM). The association between DM and CI and the risk factors for CI need to be addressed to estimate the prevalence of cognitive impairment in patients with DM and to identify the potential risk factors. The study is a cross-sectional study using a convenient sample of 269 subjects. Sociodemographic diabetes-related variables including biochemical markers were collected. CI and diabetes-related distress (DRD) were assessed using the Arabic version of Montreal Cognitive Assessment scale (MoCA) and the Diabetes Distress Screening Scale respectively.

Results

Overall, 80.3% had cognitive impairment while 33.8% had severe impairment. Older age, female gender, low level of education, and low income were associated with CI; duration of diabetes and DRD were associated with CI while ophthalmic complications were associated with severe CI. Duration of diabetes was inversely associated with CI. Level of HbA1c was significantly higher in patients with severe CI, and the probability of CI increased as the level of HbA1c increased. Low level of education was associated with severe CI, and CI was two times more likely among patients with DRD.

Conclusion

CI was higher than worldwide figures. Elderly females with low educational level, long duration of DM, and low socioeconomic status are at more risk. The probability of severe CI increased with increased level of HbA1c. Screening for CI in patients with diabetes along with intervention programs while considering the DRD and the level of HbA1c is crucial.

Association of diabetes status with cognitive impairment in two Chinese rural communities

BACKGROUND AND PURPOSE

Diabetes may be one of the risk factors of cognitive impairment. In this study, we aimed to investigate the relationship between diabetes status and cognitive impairment among the middle-aged and elderly population (≥40 years) in Chinese rural communities.

METHODS

A sample of 3392 participants aged 40 years or older from the China National Stroke Prevention Project (CSPP) between 2015 and 2017 were enrolled in this study. Cognitive function was assessed by the Beijing edition of the Montreal cognitive assessment (MoCA) scale. Cognitive impairment was diagnosed as a MoCA score < 26. Diabetes status was divided into three groups------Normal: fasting plasma glucose (FPG) ≤ 5.5 mmol/L, Prediabetes: 5.6 ≤ FPG ≤ 6.9 mmol/L, Diabetes: FPG ≥ 7.0 mmol/L or with a history of diabetes. Multivariate logistic regression was used to analyze the association between diabetes status and cognitive impairment.

RESULTS

Out of the 3392 enrolled participants, 2023(59.6%) had cognitive impairment, 1586(46.8%) had abnormal fasting plasma glucose including 867(25.6%) prediabetes and 719(21.2%) diabetes. After adjusting for potential risk factors, we found prediabetes (OR: 1.22, 95%CI: 1.03-1.45) and diabetes (OR: 1.28, 95%CI: 1.06-1.55) are all associated with cognitive impairment, especially in the domains of language (prediabetes: OR: 1.14, 95%CI: 1.05-1.25; diabetes: OR:1.13, 95%CI: 1.03-1.24), visuospatial/executive functions (diabetes: OR: 1.50, 95%CI: 1.22-1.84) and attention (diabetes: OR: 1.15, 95%CI: 1.02-1.31).

CONCLUSIONS

In this large community-based study, we found diabetes status may be an independent risk factor for cognitive impairment, particularly in domains of language, visuospatial/executive functions, and attention.