Update on cognitive decline and dementia in elderly patients with diabetes

Diabetes Metab. 2014 Nov;40(5):331-7. doi: 10.1016/j.diabet.2014.02.002. Epub 2014 Apr 2.

Abstract

Aim: This article is an update of the relationship between type 2 diabetes (T2D), cognitive dysfunction and dementia in older people.

Methods and results: The number of older patients consulting for diabetes who also exhibit cognitive difficulties is consistently growing because of the increased longevity of the population as a whole and, according to a number of studies, the increased risk of cognitive impairment and dementia in older diabetic patients. Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabetic patients. A history of severe hypoglycaemic episodes has also been associated with a greater risk of late-in-life cognitive deficits and dementia in patients with T2D. Several processes are thought to promote cognitive decline and dementia in diabetics. Based on both clinical and non-clinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycaemia. Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression-related symptoms, greater incidence of recurrent hypoglycaemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies.

Conclusion: Clinical guidelines have recently been devised for older diabetic patients, particularly those with cognitive deficits and a reduced capacity to self-manage. In the most vulnerable patients, specific treatment strategies have been proposed for glycaemic control to limit metabolic decompensation and avoid the risk of hypoglycaemia. Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients' cognitive and functional status.

Keywords: Cognitive impairment; Dementia; Diabetes; Elderly patient; Hypoglycaemia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism
  • Cerebrovascular Disorders / complications
  • Cerebrovascular Disorders / etiology
  • Cerebrovascular Disorders / prevention & control
  • Cognition Disorders / chemically induced
  • Cognition Disorders / etiology*
  • Dementia / chemically induced
  • Dementia / etiology*
  • Depression / complications*
  • Depression / etiology
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetic Angiopathies / complications*
  • Diabetic Angiopathies / prevention & control
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / complications*
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects*
  • Insulin / administration & dosage
  • Insulin / adverse effects
  • Longitudinal Studies
  • Medication Adherence / psychology
  • Patient Education as Topic
  • Prevalence
  • Risk Factors
  • Self Care* / psychology

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • hemoglobin A1c protein, human