Deterioration in Motor Function Over Time in Older Adults With Type 2 Diabetes is Associated with Accelerated Cognitive Decline

Facilitators and Barriers of Health Behaviors in Patients With Type 2 Diabetes: A Qualitative Study

PURPOSE

The purpose of the study was to explore the facilitators and barriers of health behaviors in patients with type 2 diabetes (T2D), providing a reference for the development of health behavior interventions programs.

METHODS

A qualitative descriptive research design was adopted, and interviews were conducted with 25 patients with T2D. The interview guide was developed based on the health action process approach theory. The interviews were audio-recorded and transcribed verbatim. Data analysis was performed using thematic analysis.

RESULTS

Through the analysis of interview data, 2 main themes were identified: facilitators and barriers of health behaviors, comprising 18 subthemes. The facilitators included self-efficacy, outcome expectations, risk perception, intention, action planning, coping planning, emotional regulation, proactive and sustained sense of responsibility, and multidimensional social support. The barriers included insufficient disease awareness, insufficient self-control, impact of social activities, low self-efficacy, accessibility of personal conditions, lack of problem-solving skills, lack of disease management knowledge, lack of social support, and cognitive decline.

CONCLUSIONS

When designing health behavior intervention programs for patients with T2D, it is crucial to consider both facilitators and barriers to enhance the effectiveness of the interventions to encourage patients to adopt healthy lifestyles, improve their quality of life, and reduce the occurrence of complications.

Decrease in Gait Speed Over Time Is Associated With Increase in Number of Depression Symptoms in Older Adults With Type 2 Diabetes

BACKGROUND

We examined the cross-sectional and longitudinal relationships of motor functions with depression in older adults with type 2 diabetes (T2D).

METHODS

Participants (n = 984) were from the longitudinal Israel Diabetes and Cognitive Decline (IDCD) study. They were initially cognitively normal and underwent evaluations of motor functions (grip strength and gait speed) and of depression (using the 15-item version of the Geriatric Depression Scale [GDS]) approximately every 18 months. We applied Hierarchical Linear Mixed Models (HLMM) to investigate the associations between motor functions and depression adjusting for sociodemographic, cardiovascular factors, overall cognitive score, and subjective report of exhaustion.

RESULTS

Participants' baseline characteristics were 72 (±5) years of age (59.6% males), 13 (±4) years of education, Mini-Mental Status Exam (MMSE) score of 28.01 (±1.78), and a GDS score of (2 ± 2.00), consistent with normal cognitive status and lack of major affective symptomatology. Slower gait speed at baseline was associated with higher GDS scores (p = .001) and with their increase over time (p = .049). A decrease in walking speed from baseline was associated with an increase in GDS scores (p = .015). Lower grip strength at baseline was associated with higher GDS scores (p = .002), but not with trajectories in GDS scores over time. A faster decrease in grip strength from baseline was associated with a faster increase in GDS scores (p = .022).

CONCLUSIONS

Both gait speed and grip strength are cross-sectionally associated with depression. However, only gait speed and its decrease over time can potentially be used to predict incident depression symptoms, thus facilitating the introduction of depression prevention strategies.

Behavioral and Brain Correlates of Emotional Distress in Older Adults During COVID-19 Quarantine

COVID-19 led to unprecedented lockdowns and changes in older adults' lives, especially those with type 2 diabetes who have high risk of complications and mortality. We investigated the associations of cognitive and motor function and gray matter volumes (GMVs) with COVID-19 lockdown-related emotional distress of type 2 diabetes older adults, participating in the Israel Diabetes and Cognitive Decline Study. We administered a questionnaire to obtain information about anxiety, depression, general well-being, and optimism during a mandated lockdown. Lower grip strength before lockdown was associated with increased sadness, anxiety, and less optimism. Slower gait speed was associated with greater sadness. Lower GMV was related to greater anxiety during the lockdown when compared with anxiety levels before the COVID-19 outbreak. Yet, global cognition was not associated with any emotional distress measure. These results support the role of good motor function on emotional well-being during acute stress and GMV as a potential underlying mechanism.

Type 2 diabetes mellitus and cognitive function: understanding the connections

PURPOSE OF REVIEW

To review the connection between type 2 diabetes and cognitive dysfunction, including its epidemiology, potential mechanisms of pathophysiology, risk factors, possible prevention, and treatment considerations.

RECENT FINDINGS

Diabetes is a risk factor for mild cognitive decline, in addition to Alzheimer's disease and vascular dementia. Duration of diabetes, concomitant vascular or associated co-morbidities, hyper- and hypoglycemia may lead to worsening cognitive dysfunction. Unfortunately, there is a lack of evidence-based guidance on the prevention of cognitive dysfunction in the diabetes population. Studies of diabetes medications, including metformin, glucagon-like peptide-1 (GLP-1) receptor agonists, and sodium-glucose cotransporter-2 inhibitors (SGLT2) have shown some benefit with cardiovascular morbidity and may affect cognition. In the absence of clearly defined preventive tools, diabetes practice guidelines recommend annual cognitive screening as standard of care in adults with diabetes aged 65 years or older.

SUMMARY

People living with diabetes are at risk for significant decline in cognitive function. Epidemiology and risk factors are well defined. Prevention and treatment strategies are limited and require further study.

Prevalence and possible factors of cognitive frailty in the elderly with hypertension and diabetes

BACKGROUND

Cognitive frailty is the coexistence of physical frailty and mild cognitive impairment. Research shows that cognitive frailty is related to an increased risk of hospitalization, mortality, disability, and dementia. Diabetes and hypertension are common risk factors for physical frailty and cognitive impairment. However, the factors influencing cognitive frailty in the elderly with hypertension and diabetes are still unclear. This study aimed to investigate the possible factors influencing cognitive frailty in the elderly with hypertension and diabetes.

METHODS

A cross-sectional study was conducted. We evaluated people over 60 years with hypertension and diabetes who underwent physical examination in Wuxi Xin'an Community Health Service Center. Frail scale, Montreal Cognitive Assessment-Basic and clinical dementia rating were used to assess cognitive frailty. We collected demographic characteristics, hypertension and diabetes-related laboratory indicators of the participants. We also used various scales to assess the overall health status of the elderly.

RESULTS

Approximately 20.8% of the participants were determined to have cognitive frailty in elderly adults with hypertension and diabetes. These participants were older, had a lower monthly income, and included a higher proportion of peasants. They also had a higher level of depression (p = 0.037), higher risk of falls (p = 0.000), higher risk of malnutrition (p = 0.002), poorer ability to perform activities of daily living (ADL) (p = 0.000), and less social support (p = 0.030). Multivariate regression analysis was used to further assess the factors for cognitive frailty. After adjusting for possible confounders, age and ADL score emerged as risk factors, whereas high monthly income decreased the risk of cognitive frailty.

CONCLUSION

Cognitive frailty is correlated with age, income, and ability to perform daily living activities in the elderly with diabetes and hypertension. Closer attention to the elderly who have low income and poor self-care ability may play an important role in the early prevention of cognitive frailty and even dementia.

Alzheimer’s Disease Polygenic Risk Score Is Not Associated With Cognitive Decline Among Older Adults With Type 2 Diabetes

Objectives

Multiple risk loci for late-onset Alzheimer’s disease (LOAD) have been identified. Type 2 diabetes (T2D) is a risk factor for cognitive decline, dementia and Alzheimer’s disease (AD). We investigated the association of polygenic risk score (PRS) for LOAD with overall cognitive functioning and longitudinal decline, among older adults with T2D.

Methods

The study included 1046 Jewish participants from the Israel Diabetes and Cognitive Decline (IDCD) study, aged ≥ 65 years, diagnosed with T2D, and cognitively normal at baseline. The PRS included variants from 26 LOAD associated loci (at genome-wide significance level), and was calculated with and without APOE. Outcome measures, assessed in 18 months intervals, were global cognition and the specific domains of episodic memory, attention/working memory, executive functions, and language/semantic categorization. Random coefficient models were used for analysis, adjusting for demographic variables, T2D-related characteristics, and cardiovascular factors. Additionally, in a subsample of 202 individuals, we analyzed the association of PRS with the volumes of total gray matter, frontal lobe, hippocampus, amygdala, and white matter hyperintensities. Last, the association of PRS with amyloid beta (Aβ) burden was examined in 44 participants who underwent an 18F-flutemetamol PET scan.

Results

The PRS was not significantly associated with overall functioning or decline in global cognition or any of the specific cognitive domains. Similarly, following correction for multiple testing, there was no association with Aβ burden and other brain imaging phenotypes.

Conclusion

Our results suggest that the cumulative effect of LOAD susceptibility loci is not associated with a greater rate of cognitive decline in older adults with T2D, and other pathways may underlie this link.

Correlation of physical and cognitive impairment in diabetic and hypertensive frail older adults

BACKGROUND

Diabetes and hypertension are common in older adults and represent established risk factors for frailty. Frailty is a multidimensional condition due to reserve loss and susceptibility to stressors with a high risk of death, hospitalizations, functional and cognitive impairment. Comorbidities such as diabetes and hypertension play a key role in increasing the risk of mortality, hospitalization, and disability. Moreover, frail patients with diabetes and hypertension are known to have an increased risk of cognitive and physical impairment. Nevertheless, no study assessed the correlation between physical and cognitive impairment in frail older adults with diabetes and hypertension.

METHODS

We evaluated consecutive frail older patients with diabetes and hypertension who presented at ASL (local health unit of the Italian Ministry of Health) Avellino, Italy, from March 2021 to October 2021. The inclusion criteria were: a previous diagnosis of diabetes and hypertension with no evidence of secondary causes; age > 65 years; a frailty status; Montreal Cognitive Assessment (MoCA) score < 26.

RESULTS

179 patients successfully completed the study. We found a strong and significant correlation between MoCA score and 5-m gait speed test (r: 0.877; p < 0.001). To further verify our results, we performed a linear multivariate analysis adjusting for potential confounding factors, with MoCA score as dependent variable, which confirmed the significant association with glycemia (p < 0.001).

CONCLUSIONS

This is the first study showing a significant correlation between 5-m gait speed test and MoCA score in frail diabetic and hypertensive older adults.

Diverse Motor Performances Are Related to Incident Cognitive Impairment in Community-Dwelling Older Adults

Objective: Late-life cognitive impairment is heterogeneous. This study examined to what extent varied motor performances are differentially associated with incident Alzheimer's dementia (AD) and incident mild cognitive impairment (MCI) in older adults. Design: Nested substudy. Setting: Communities across metropolitan Chicago. Participants: African American (N = 580) and European American (N = 580) adults without dementia, propensity-balanced by age (mean = 73.2; SD = 6.0), sex (78.4% women), education (mean = 15.6; SD = 3.3) and number of follow ups. Measurements: Cognitive status was assessed annually and based in part on a composite measure of global cognition including 17 cognitive tests. A global motor score was based on 10 motor performances from which 4 motor domains were computed including hand dexterity, hand strength, gait function, and leg strength. Results: During 7 years of follow-up, 166 of 1,160 (14.3%) developed AD. In a proportional hazards model controlling for age, sex, education, and race, each 1-SD higher baseline global motor score was associated with about a 20% reduction in the risk of AD (hazard ratio: 0.81; 95% CI: 0.68, 0.97). Higher baseline motor function was also associated with decreased risk of incident MCI (hazard ratio: 0.79; 95% CI: 0.68, 0.92). Hand dexterity, hand strength and gait function but not leg strength were associated with incident AD and MCI. When including all four motor domains in the same model, results remained the same for incident MCI, while for incident AD, the association with hand strength remained significant. Conclusion: Diverse motor performances are associated with late-life cognitive impairment. Further work is needed to identify specific motor performances that may differentiate adults at risk for future MCI or AD dementia.

What can hand grip strength tell us about type 2 diabetes?: mortality, morbidities and risk of diabetes

INTRODUCTION

Hand grip strength (HGS) has been determined as a simple and cost effective method for evaluating overall skeletal muscle strength and quality. It has been used in numerous clinical studies to examine the association between skeletal muscle and type 2 diabetes (T2D). Previous studies have shown that HGS is significantly associated with mortality and cardiovascular disease (CVD) in patients with T2D. As the prevalence of T2D has seen a steady increase globally, HGS measurement can be useful and essential in managing T2D.

AREAS COVERED

This narrative review summarizes the current evidence regarding the association between HGS and T2D. HGS has been considered a useful tool for identifying risks for T2D, CVD, and mortality and evaluating skeletal muscle strength and quality.

OPINION

HGS should be measured in all patients with T2D together with height, weight, and waist circumference. However, there is yet no standard method used in measuring for HGS. T2D patients with a low HGS can engage in resistance training more effectively with appropriate advice based on HGS. Future studies clarifying the genetic association between skeletal muscle and T2D are needed to provide individualized exercise therapy.

Sarcopenia is associated with incident Alzheimer's dementia, mild cognitive impairment, and cognitive decline

OBJECTIVE

We examined whether sarcopenia is associated with the occurrence of late-life cognitive impairment.

METHODS

Nondemented older adults (N = 1175) underwent annual testing with 17 cognitive tests summarized as a global cognitive score. A composite sarcopenia score was constructed based on muscle mass measured with bioelectrical impedance and muscle function based on grip strength. Cox proportional hazard models were employed to examine associations of sarcopenia with incident Alzheimer's dementia (AD) and incident mild cognitive impairment (MCI). Linear mixed-effect models determined the association of sarcopenia with cognitive decline. All models controlled for age, sex, education, race, and height squared.

RESULTS

Average follow-up was 5.6 years. More severe sarcopenia at baseline was associated with a higher risk of incident AD (hazard ratio [HR], 1.50 [95% confidence interval 1.20-1.86]; p < 0.001) and of MCI (1.21 [1.01-1.45]; 0.04) and a faster rate of cognitive decline (estimate = -0.013; p = 0.01). Analyses of the individual components of sarcopenia showed that muscle function was associated with incident AD, incident MCI, and cognitive decline with and without a term for lean muscle mass in the model. In contrast, lean muscle mass was not associated with incident cognitive impairment or cognitive decline when a term for muscle function was included in the model.

CONCLUSIONS

Poor muscle function, but not reduced lean muscle mass, drives the association of sarcopenia with late-life cognitive impairment. Further work is needed to identify features of muscle structure, which may increase the specificity of sarcopenia for identifying older adults at risk for late-life cognitive impairment.