What do diabetes and dementia have in common? – Studies have shown that type 2 diabetes can be a risk factor for Alzheimer’s disease, vascular dementia and other types of dementia, This is because the same cardiovascular problems that increase the risk of type 2 diabetes also increase the risk dementia. These include:
Obesity, Heart disease or family history of heart disease, Impaired blood vessels, Circulation problems, High cholesterol, and High blood pressure.
Research has also proved that, similar to diabetes, glucose is not used properly in the brains of people with Alzheimer’s disease. This may be caused by nerve cell death, which reduces the brain’s ability to interpret messages. In the case of vascular dementia, brain cells die due to lack of oxygen, preventing brain cells from communicating with each other.
How does diabetes affect someone with dementia?
Managing diabetes in people with dementia | Nursing Times 02 March, 2015 The number of patients with both type 2 diabetes and dementia is rising, which poses new challenges in blood glucose monitoring and medicines administration Abstract Diabetes and dementia may manifest simultaneously: one is potentially life threatening, the other causes severe, progressive loss of memory and cognitive function.
Where they coexist, they present nurses with challenges such as administering life-saving interventions to patients who are unable to give informed consent. This article offers guidance on the clinical and ethical challenges involved in blood glucose monitoring and medicines administration in patients with dementia.
Citation: Brown J et al (2014) Managing diabetes in people with dementia. Nursing Times; 111: 10, 16-19. Authors: Joe Brown is lecturer in nursing; Amanda Carson is lecturer in adult nursing; Anna Waugh is lecturer in mental health nursing; Douglas Park is senior librarian; all are at the University of the West of Scotland, Dumfries. 
To continue reading this clinical article please log in or, Already have an account, to sign in : Managing diabetes in people with dementia | Nursing Times
What are the signs of dementia in diabetics?
Hyperglycemia and hypoglycemia – brain glucose metabolism – Hyperglycemia and hypoglycemia have impacts on cognitive function and activity of daily life. Interestingly, Holmes et al. demonstrated that attention and fine motor skills were slowed at altered glucose levels, assessed in diabetic patients during hypoglycemia and hyperglycemia induced by an artificial insulin/glucose infusion system ( 27 ).
- In the long term, the duration of diabetes is associated with impaired cognition in patients with higher HbA1c levels ( 54 ).
- Glucose metabolism declines with age in many brain regions ( 55 ), and glucose hypometabolism and brain atrophy are associated with concurrent cognitive dysfunction ( 56 ).
- Hypoglycemia is associated with cognitive impairment in elderly diabetic patients ( 57 ).
Because the brain uses mainly glucose as an energy source, hypoglycemia causes defects of neuronal function, though lactate can also be used in such situations ( 58, 59 ). In addition to dysfunction of individual cells, failure of neuronal networking also contributes to cognitive impairment in a hypoglycemic state ( 60 ).
In the long term, repeated episodes of severe hypoglycemia are reported to also be a risk for the development of dementia ( 61 ). Hyperglycemia affects cognitive function, and is associated with brain hypometabolism ( 62 ), impaired deactivation of the default mode network ( 22 ), poorer memory, and reduced hippocampal microstructures ( 63 ).
Behavioral and psychological symptoms, including apathy, overeating, and excessive daytime sleeping, appear to be increased in patients with HbA1c ≥7.0% ( 30 ). In an animal model, hyperglycemia induced by a high-fat diet causes chronic energy imbalance with resulting loss of neurons and reduces olfactory learning ( 64 ).
What is the connection between dementia and type 2 diabetes?
For example, a recent meta-analysis found that type 2 diabetes was associated with a 60% increase in risk for all-cause dementia (22), and a population-based longitudinal study found a 16% increased risk for dementia even among those in which type 2 diabetes onset was recent (23).
How long do people with vascular dementia and diabetes live?
What is the life expectancy with vascular dementia? – The life expectancy will vary from person to person and what other conditions you have. On average, people with vascular dementia live for around five years after symptoms begin, less than the average for Alzheimer’s disease.
Does sugar make dementia worse?
The Golden Years is a time for YOU to Live Passionately, Purposefully and Playfully! Call us for a complimentary lunch or dinner to experience our lifestyle! Skip to content Science has yet to discover the definite cause of dementia, but they certainly found out the particular factors that can increase your risk of having the disease. This includes genetics, aging, stress, and smoking. But many wonder if diet and certain foods can also expose one to dementia? Well, the chilling answer is YES.
Does high blood sugar make dementia worse?
When diabetes is not controlled, too much sugar remains in the blood. Over time, this can damage organs, including the brain. Scientists are finding more evidence that could link Type 2 diabetes with Alzheimer’s disease, the most common cause of dementia.
What are the signs of dementia getting worse?
Moderate dementia – People experiencing moderate dementia will likely need more assistance in their daily lives. It becomes harder to perform regular daily activities and self-care as dementia progresses. Common symptoms during this stage include:
- increasing confusion or poor judgment
- greater memory loss, including a loss of events in the more distant past
- needing assistance with tasks, such as getting dressed, bathing, and grooming
- significant personality and behavior changes, often caused by agitation and unfounded suspicion
- changes in sleep patterns, such as sleeping during the day and feeling restless at night
Can diabetic dementia reversed?
There is currently no cure for dementia, and current treatments cannot reverse the damage. However, if symptoms arise due to vitamin deficiencies or drug use, there may be options to prevent the condition from progressing.
Does metformin bring on dementia?
There have been numerous observational studies on metformin treatment in people with type 2 diabetes, but results have been inconsistent. In several recent meta-analyses of numerous studies enrolling people with type 2 diabetes, metformin treatment was associated with reduced risks of neurodegenerative diseases (e.g., Alzheimer’s disease, Parkinson’s disease, and others) and cognitive dysfunction compared to those not taking metformin, and risk reduction was more prominent in people taking metformin long-term (over 4 years),
A different meta-analysis enrolling people with or without diabetes reported that there was no relationship between metformin treatment and cognitive performance, or protection against Alzheimer’s disease, vascular dementia, or cognitive impairment, Three individual studies, however, reported an increased risk for impaired cognitive performance, dementia, or Alzheimer’s disease with metformin treatment compared to those taking other medications,
In a small randomized controlled trial of patients with depression and type 2 diabetes, metformin treatment for 24 weeks improved cognitive performance and symptoms of depression, Several factors could account for the varying results, such as duration and severity of diabetes, or how well diabetes is controlled,
Also, metformin is often used to treat mild diabetes, so patients taking other anti-diabetic drugs may have more severe diabetes, which may be associated with worse brain health. Additionally, long-term metformin use can decrease vitamin B12 levels, which may be a potential risk factor for Alzheimer’s disease.
One study reported that when controlling for vitamin B12 levels, metformin was no longer significantly associated with risk of Alzheimer’s disease, It is currently unknown whether metformin is protective against cognitive decline or Alzheimer’s disease in people without type 2 diabetes.
Does metformin increase dementia?
– Doctors commonly prescribe metformin to help in the management of type two diabetes. But there may be other uses for this medication as well. Metformin, taken as an oral tablet or solution, works by reducing the amount of glucose (sugar) made by the liver, decreasing the amount the body absorbs, and increasing the effect of insulin —a hormone that helps regulate the amount of blood sugar.
- It was approved by the FDA in 1994.
- Studies have shown that use of metformin for type 2 diabetes significantly reduces the risk of dementia among men in certain racial and age groups,” Dr.
- Porter noted.
- Previous research from the Garvan Institute of Medical Research found that the use of metformin in people with type 2 diabetes was linked with slower cognitive decline and lower rates of dementia.
This study and previously available data have paved the way for the current phase 3 clinical trial called the MetMemory Study, One of the major players in the MetMemory study, Professor Katherine Samaras, explained the trial’s goals and previous research: “This trial will look at metformin’s impact on cognitive decline among participants who don’t currently have diabetes.
Does diabetes damage the brain?
The Connection Between Diabetes and the Brain – Your brain is your body’s command center. It’s made up of nerve cells that keep your body functioning—even while you sleep. It also controls how you feel, learn, and remember. And in order to do all this work, your brain uses sugar in your blood for energy.
The brain is the most energy-demanding organ—needing half of all the sugar energy in the body to function properly. If your blood sugar levels fall outside of your normal range, it can throw your command center off balance. In the same way that diabetes can cause nerve damage to your eyes, feet, and hands, it can also affect your brain by damaging nerves and blood vessels.
This can lead to problems with memory and learning, mood shifts, weight gain, hormonal changes, and over time, other serious problems like Alzheimer’s disease, Since both high and low blood sugar levels can cause these harms, it’s especially important for people with diabetes to keep their blood sugar at target levels.
What should you not say to someone with vascular dementia?
Editor’s note: This blog post originally appeared on Huffington Post Yesterday afternoon, I walked into the spacious room belonging to Mary, a woman with dementia who has few visitors and with whom I’ve volunteered to spend a little time every week. I greeted her, complimented her on her beautiful turquoise sweater, and shook her hand.
Then I sat down at her little table that was overflowing with books, photographs, the newspaper and other items she wants to keep close at hand. I started off by picking up a small framed photo of Mary with her husband and three children – two sons and a daughter. “Tell me about your daughter,” I said, using an open-ended question because they have no right or wrong answers.
That’s a tip I picked up from The Best Friends Approach to Alzheimer’s Care by Virginia Bell and David Troxell. “Oh, her name is Connie,” she told me. “She has four children – two boys and two girls.” She continued, giving me several details about Connie and her family.
- I then picked up a photograph of Mary and her twin sister, Bernice, and she told me about how they took piano lessons together when they were children.
- After a few minutes, I asked her if her daughter ever played a musical instrument.
- I don’t have a daughter,” she said matter of factly.
- Oh,” I countered, picking up the family photo again and holding it out for her to see.
“You just told me you have a daughter. Here she is.” Mary’s face fell and she said very quietly, “I guess I do have a daughter.” I immediately felt sorry for her embarrassment and was disgusted with myself for having pointed out her mistake. I realized I’d just broken one of the cardinal rules for interacting with a person who has dementia.
- I’d just read it in The Best Friend’s Approach that very morning: “Let the person save face.” When relating to a person with Alzheimer’s, there are many guidelines to follow.
- I’m going to discuss five of the most basic ones here: 1) Don’t tell them they are wrong about something, 2) Don’t argue with them, 3) Don’t ask if they remember something, 4) Don’t remind them that their spouse, parent or other loved one is dead, and 5) Don’t bring up topics that may upset them.
Don’t Tell Them They’re Wrong About Something : To let the person save face, it’s best not to contradict or correct them if they say something wrong. There’s no good reason to do that. If they’re alert enough, they’ll realize they made a mistake and feel bad about it.
- Even if they don’t understand their error, correcting them may embarrass or be otherwise unpleasant for them.
- Don’t Argue With the Person: It’s never a good idea to argue with a person who has dementia.
- First of all, you can’t win.
- And second, it will probably upset them or even make them angry.
- I learned a long time ago, when caring for my beloved Romanian soul mate, Ed, the best thing to do is simply change the subject – preferably to something pleasant that will immediately catch their attention.
That way, they’ll likely forget all about the disagreement. Don’t Ask if They Remember Something: When talking with a person who has Alzheimer’s, it’s so tempting to ask them if they remember some person or event. “What did you have for lunch?” “What did you do this morning?” “Do you remember that we had candy bars when I visited last week?” “This is David.
- Do you remember him?” Of course they don’t remember.
- Otherwise, they wouldn’t have a diagnosis of dementia.
- It could embarrass or frustrate them if they don’t remember.
- It’s better to say, “I remember that we had candy the last time I was here.
- It was delicious.” Don’t Remind the Person that a Loved One Is Dead : It’s not uncommon for people with dementia to believe their deceased spouse, parent or other loved one is still alive.
They may be confused or feel hurt that the person doesn’t come to visit. If you inform them that the person is dead, they might not believe it and become angry with you. If they do believe you they’ll probably be very upset by the news. What’s more, they’re likely to soon forget what you said and go back to believing their loved one is still alive.
- An exception to this guideline is if they ask you if the person is gone.
- Then it’s wise to give them an honest answer, even if they will soon forget it, and then go on to some other topic.
- Don’t Bring up Other Topics That May Upset Them: There’s no reason to bring up topics you know may upset your loved one.
If you don’t see eye-to eye on politics, for example, don’t even bring it up. It may just kindle an argument, which goes again the second guideline above. You won’t prevail and it’s just likely to cause them anger and/or frustration. So there you go. A few guidelines for visiting.
What stage of dementia is sleeping all the time?
Sleeping more and more is a common feature of later-stage dementia. As the disease progresses, the damage to a person’s brain becomes more extensive and they gradually become weaker and frailer over time.
When dementia suddenly gets worse?
Dementia is a progressive, unpredictable group of diseases. Symptoms generally progress steadily. However, a person may experience a sudden worsening of dementia symptoms. This can be part of the disease progressing or a sign of a serious medical problem.
- A sudden change in thinking or behavior can be the result of delirium, stroke, or other health conditions.
- In other cases, worsening symptoms may be a temporary result of stress or a change in routine.
- Because people with dementia may not be able to clearly communicate their symptoms, it is important to treat their behavior as communication and as a sign that something may be wrong.
Read on to learn more about sudden worsening of dementia symptoms.
Why does ice cream help with dementia?
Ice cream has the power to immediately elicit soothing feelings at the very first taste of a single spoon-full. It erases all the negative feel- ings related to the frustration and continues to stimulate pleasure receptors in the brain with every new scoop. And dementia (here is the best part!)
Should dementia patients watch TV?
TV Shows and Movies for People with Dementia | VGF Who knew watching a favorite movie or TV show could be good for you? For men and women with Alzheimer’s disease or other forms of dementia, it can be especially beneficial. Watching movies and TV shows can help keep their brain active, which can stimulate positive memories, improve mood, and even increase socialization.However, the choice of program is important.
Why do diabetics get dementia?
How diabetes can lead to dementia – There are multiple reasons why years of type 2 diabetes may lead to dementia. One reason is related to the effects that diabetes has on the heart, as heart health is related to brain health, Heart disease and elevated blood pressure are both associated with strokes that, in turn, can lead to dementia.
However, strokes do not appear to be the complete answer, as some studies found that diabetes led to an increased risk of dementia even when strokes were controlled for, Another factor relates to the episodes of hypoglycemia that commonly occur in diabetes. Although tight control of blood sugars has been proven to reduce the long-term risks of heart disease and strokes, tight control can also lead to hypoglycemia, memory loss, and dementia,
Here, the reason is likely because low blood sugars are known to damage the hippocampus — the memory center of the brain, One of the more intriguing hypotheses is that diabetes directly causes Alzheimer’s disease, Indeed, Alzheimer’s disease has even been called “type 3 diabetes” because of shared molecular and cellular features among diabetes and Alzheimer’s.
Can diabetes cause temporary dementia?
Learn about cognitive impairment risk in people with diabetes and how to adapt treatments for patients with cognitive problems. José A. Luchsinger, MD, is a professor of medicine and epidemiology at Columbia University Irving Medical Center, New York. As an expert in aging and cognition, he shares his insights on the relationship between diabetes and cognitive impairment, and how health care professionals can adapt treatment for patients with cognitive problems.
- Q: What is cognitive impairment, and why does it matter for people with diabetes? A: Cognitive impairment is a decline from usual cognitive abilities.
- There are different types.
- The one most people are concerned about is forgetfulness, which is the inability to remember events or learn material.
- Other types of cognitive impairment are not related to memory or can co-occur with memory problems.
These include problems with attention and executive function—the ability to start, conduct, and finish a complex task. When these problems are mild and do not impact a person’s ability to function by themselves, they’re called mild cognitive impairment.
- When cognitive impairment is so severe that it affects people’s ability to live independently—meaning they need help to remember things, keep track of things, or conduct activities of daily living—then we call that dementia.
- People with diabetes are at risk of developing cognitive impairment, which presents challenges for following treatment.
Q: Are people with diabetes more likely to develop cognitive impairment than people without diabetes? A: Yes. Studies have demonstrated that people who have diabetes, compared with people without diabetes, are more likely to develop cognitive problems.
Older adults with diabetes have higher incidences of dementia, Alzheimer’s disease, and vascular dementia than those with normal glucose tolerance. All cognitive domains may be affected. But the nonmemory domains, like attention, executive function, and psychomotor speed (how fast a task is done), are affected more strongly or are affected first, studies show.
People with diabetes need to follow a relatively complex treatment regimen. Anything that affects their ability to remember or organize themselves to begin and carry out an action related to their treatment is important. Why people with diabetes are more likely to develop cognitive impairment is not well understood.
One explanation is that people with diabetes age just like people without diabetes. Cognitive problems increase with age, so people with diabetes are bound to have the same problems as the general population. We also know that certain comorbid conditions, such as high blood pressure, can contribute to cognitive decline.
We know that diabetes causes cerebrovascular disease—that is, vascular disease in the brain—just as it causes vascular disease in the heart or in the legs in peripheral arterial disease, for example. This damage in the brain can lead to different cognitive problems.
There are studies showing that diabetes can affect memory, but whether this is caused by vascular problems or other mechanisms is unclear. Investigators are interested in figuring this out. Q: Which groups are most at risk of cognitive impairment? A: Some studies suggest that the more severe the diabetes or the longer the duration of diabetes, the higher the risk of developing cognitive impairment.
But not all studies show this. In general, older adults are at higher risk of developing diabetes or cognitive impairment, or both, than younger adults. Risk does vary among racial and ethnic groups. Non-Hispanic Black and Hispanic people have a greater risk of cognitive impairment than non-Hispanic white people.
That’s true for diabetes, too. My colleagues and I looked at whether these disparities in diabetes could account for disparities in cognitive impairment. Our study of 941 adults age 65 and older in northern Manhattan, New York, suggested that at least part of the disparity in cognitive impairment between racial and ethnic groups could be accounted for by the disparities in diabetes prevalence.
Q: What signs of cognitive impairment should health care professionals look for in patients with diabetes? Should they screen for cognitive impairment? A: Anyone on the diabetes care team, family members, and patients themselves who notice problems keeping up with treatment—for example, forgetting appointments, forgetting to take medication, or trouble following a complex treatment regimen—should recognize there’s a possible cognitive issue underlying those behaviors.
- Another sign is that diabetes control worsens despite good treatment.
- We have to be careful not to judge the patient, to think they’re being irresponsible.
- It’s important to go the extra mile to make sure that prescriptions are being filled.
- If they’re being filled, is medication actually being taken? For that, it’s necessary to do pill counts, to communicate with nurses, and to have patients bring in their medications.
As for screening, the U.S. Preventive Services Task Force does not recommend screening older adults for cognitive impairment because there is no evidence it improves patient or caregiver outcomes. However, the American Diabetes Association (ADA) 2021 practice guidelines do call for screening adults age 65 and older with diabetes for cognitive impairment.
That is covered by Medicare and can be done at the initial visit and annually as appropriate. Now, if somebody has signs of concern, then we’re talking about detection, not screening. There are various tools, such as the Mini-Mental State Examination (PDF, 29 KB), the Montreal Cognitive Assessment, the Mini-Cog, or the Memory Impairment Screen (PDF, 104 KB),
The use of one or the other depends on availability and time. When you have a patient with complex issues, taking 5 or 10 minutes to do this is easier said than done. Depending on the results, the patient might need further testing and referral to a neurocognitive specialist.
- Q: How can health care professionals work successfully with patients who have both diabetes and cognitive impairment? A: Successful management of diabetes requires a high degree of patient involvement.
- Patients with cognitive impairment may have trouble adhering to treatment, including monitoring blood glucose, taking medications as directed, timing meals, and recognizing and managing hypoglycemia.
Patients who live alone are at particular risk, as are those with complex treatment regimens. Health care professionals can simplify treatment regimens, if possible; make sure patients have the support they need to comply with treatment; and avoid complications such as hypoglycemia.
- This could involve setting appropriate but not overly ambitious glycemic targets.
- The current ADA recommendation in elderly people with diabetes and cognitive impairment is a hemoglobin A1C level between 7% and 8%.
- Depending on the stage of cognitive decline, patients may be able to perform some tasks independently and need help with others.
Caregivers should be educated to help with blood glucose monitoring and to recognize signs of hyper- and hypoglycemia. Health care professionals can help arrange professional services for the patient—a visiting nurse service or other type of support system to make sure the patient can comply with treatment.
More research is needed to determine the best approaches to assess cognition and address cognitive decline in the health care setting. At what stage do you assess cognition? Do you do it when people are asymptomatic or already symptomatic? What do you do if cognitive impairment is detected? What are the best strategies to support patients? It seems that a team approach, such as a medical home, would be the ideal solution, with more support given to people who have cognitive impairment.
Q: Can improved glucose control or diabetes treatments help prevent cognitive impairment? A: There are studies suggesting that better glucose control—through medications or other interventions—can prevent cognitive impairment, but it has not been established with certainty.
- For example, metformin has been tested to treat or prevent Alzheimer’s dementia, often in mildly impaired subjects.
- Negative and conflicting results point to the need for larger clinical trials.
- ACCORD is a landmark study of tight glycemic control versus regular control in people with type 2 diabetes.
A sub-study called MIND compared cognitive outcomes; no differences were found between the two groups. That is, tight glycemic control did not help prevent cognitive impairment or improve cognition. In addition, the Diabetes Control and Complications Trial (DCCT) compared the effects of intensive insulin therapy and standard therapy in people with type 1 diabetes. José A. Luchsinger, MD, is a co-author of the “Diabetes and Cognitive Impairment” chapter in the NIDDK publication Diabetes in America, 3rd Edition, His research focuses on the relationship among vascular, metabolic, and dietary factors on aging outcomes and primary cognition in diverse populations.
What does it mean when you keep forgetting words?
Memory loss and dementia – The word “dementia” is an umbrella term used to describe a set of symptoms, including impairment in memory, reasoning, judgment, language and other thinking skills. Dementia usually begins gradually, worsens over time and impairs a person’s abilities in work, social interactions and relationships.
- Asking the same questions repeatedly
- Forgetting common words when speaking
- Mixing words up — saying “bed” instead of “table,” for example
- Taking longer to complete familiar tasks, such as following a recipe
- Misplacing items in inappropriate places, such as putting a wallet in a kitchen drawer
- Getting lost while walking or driving in a familiar area
- Having changes in mood or behavior for no apparent reason
Diseases that cause progressive damage to the brain — and consequently result in dementia — include:
- Alzheimer’s disease, the most common cause of dementia
- Vascular dementia
- Frontotemporal dementia
- Lewy body dementia
- limbic-predominant age-related TDP-43 encephalopathy (LATE)
- A combination of several of these types of dementia (mixed dementia)
The disease process (pathology) of each of these conditions is different. Memory loss isn’t always the first sign, and the type of memory problems varies.
What effects does diabetes have on the brain?
The Connection Between Diabetes and the Brain – Your brain is your body’s command center. It’s made up of nerve cells that keep your body functioning—even while you sleep. It also controls how you feel, learn, and remember. And in order to do all this work, your brain uses sugar in your blood for energy.
The brain is the most energy-demanding organ—needing half of all the sugar energy in the body to function properly. If your blood sugar levels fall outside of your normal range, it can throw your command center off balance. In the same way that diabetes can cause nerve damage to your eyes, feet, and hands, it can also affect your brain by damaging nerves and blood vessels.
This can lead to problems with memory and learning, mood shifts, weight gain, hormonal changes, and over time, other serious problems like Alzheimer’s disease, Since both high and low blood sugar levels can cause these harms, it’s especially important for people with diabetes to keep their blood sugar at target levels.
How does diabetes affect Alzheimer’s?
Blocked Nerve Communication – High blood sugar has been linked to higher levels of protein pieces called beta amyloid. When these clump together, they get stuck between the nerve cells in your brain and block signals. Nerve cells that can’t talk to each other is a main trait of Alzheimer’s,
Can diabetes cause mental confusion?
Learn about cognitive impairment risk in people with diabetes and how to adapt treatments for patients with cognitive problems. José A. Luchsinger, MD, is a professor of medicine and epidemiology at Columbia University Irving Medical Center, New York. As an expert in aging and cognition, he shares his insights on the relationship between diabetes and cognitive impairment, and how health care professionals can adapt treatment for patients with cognitive problems.
Q: What is cognitive impairment, and why does it matter for people with diabetes? A: Cognitive impairment is a decline from usual cognitive abilities. There are different types. The one most people are concerned about is forgetfulness, which is the inability to remember events or learn material. Other types of cognitive impairment are not related to memory or can co-occur with memory problems.
These include problems with attention and executive function—the ability to start, conduct, and finish a complex task. When these problems are mild and do not impact a person’s ability to function by themselves, they’re called mild cognitive impairment.
- When cognitive impairment is so severe that it affects people’s ability to live independently—meaning they need help to remember things, keep track of things, or conduct activities of daily living—then we call that dementia.
- People with diabetes are at risk of developing cognitive impairment, which presents challenges for following treatment.
Q: Are people with diabetes more likely to develop cognitive impairment than people without diabetes? A: Yes. Studies have demonstrated that people who have diabetes, compared with people without diabetes, are more likely to develop cognitive problems.
- Older adults with diabetes have higher incidences of dementia, Alzheimer’s disease, and vascular dementia than those with normal glucose tolerance.
- All cognitive domains may be affected.
- But the nonmemory domains, like attention, executive function, and psychomotor speed (how fast a task is done), are affected more strongly or are affected first, studies show.
People with diabetes need to follow a relatively complex treatment regimen. Anything that affects their ability to remember or organize themselves to begin and carry out an action related to their treatment is important. Why people with diabetes are more likely to develop cognitive impairment is not well understood.
One explanation is that people with diabetes age just like people without diabetes. Cognitive problems increase with age, so people with diabetes are bound to have the same problems as the general population. We also know that certain comorbid conditions, such as high blood pressure, can contribute to cognitive decline.
We know that diabetes causes cerebrovascular disease—that is, vascular disease in the brain—just as it causes vascular disease in the heart or in the legs in peripheral arterial disease, for example. This damage in the brain can lead to different cognitive problems.
There are studies showing that diabetes can affect memory, but whether this is caused by vascular problems or other mechanisms is unclear. Investigators are interested in figuring this out. Q: Which groups are most at risk of cognitive impairment? A: Some studies suggest that the more severe the diabetes or the longer the duration of diabetes, the higher the risk of developing cognitive impairment.
But not all studies show this. In general, older adults are at higher risk of developing diabetes or cognitive impairment, or both, than younger adults. Risk does vary among racial and ethnic groups. Non-Hispanic Black and Hispanic people have a greater risk of cognitive impairment than non-Hispanic white people.
- That’s true for diabetes, too.
- My colleagues and I looked at whether these disparities in diabetes could account for disparities in cognitive impairment.
- Our study of 941 adults age 65 and older in northern Manhattan, New York, suggested that at least part of the disparity in cognitive impairment between racial and ethnic groups could be accounted for by the disparities in diabetes prevalence.
Q: What signs of cognitive impairment should health care professionals look for in patients with diabetes? Should they screen for cognitive impairment? A: Anyone on the diabetes care team, family members, and patients themselves who notice problems keeping up with treatment—for example, forgetting appointments, forgetting to take medication, or trouble following a complex treatment regimen—should recognize there’s a possible cognitive issue underlying those behaviors.
Another sign is that diabetes control worsens despite good treatment. We have to be careful not to judge the patient, to think they’re being irresponsible. It’s important to go the extra mile to make sure that prescriptions are being filled. If they’re being filled, is medication actually being taken? For that, it’s necessary to do pill counts, to communicate with nurses, and to have patients bring in their medications.
As for screening, the U.S. Preventive Services Task Force does not recommend screening older adults for cognitive impairment because there is no evidence it improves patient or caregiver outcomes. However, the American Diabetes Association (ADA) 2021 practice guidelines do call for screening adults age 65 and older with diabetes for cognitive impairment.
That is covered by Medicare and can be done at the initial visit and annually as appropriate. Now, if somebody has signs of concern, then we’re talking about detection, not screening. There are various tools, such as the Mini-Mental State Examination (PDF, 29 KB), the Montreal Cognitive Assessment, the Mini-Cog, or the Memory Impairment Screen (PDF, 104 KB),
The use of one or the other depends on availability and time. When you have a patient with complex issues, taking 5 or 10 minutes to do this is easier said than done. Depending on the results, the patient might need further testing and referral to a neurocognitive specialist.
Q: How can health care professionals work successfully with patients who have both diabetes and cognitive impairment? A: Successful management of diabetes requires a high degree of patient involvement. Patients with cognitive impairment may have trouble adhering to treatment, including monitoring blood glucose, taking medications as directed, timing meals, and recognizing and managing hypoglycemia.
Patients who live alone are at particular risk, as are those with complex treatment regimens. Health care professionals can simplify treatment regimens, if possible; make sure patients have the support they need to comply with treatment; and avoid complications such as hypoglycemia.
This could involve setting appropriate but not overly ambitious glycemic targets. The current ADA recommendation in elderly people with diabetes and cognitive impairment is a hemoglobin A1C level between 7% and 8%. Depending on the stage of cognitive decline, patients may be able to perform some tasks independently and need help with others.
Caregivers should be educated to help with blood glucose monitoring and to recognize signs of hyper- and hypoglycemia. Health care professionals can help arrange professional services for the patient—a visiting nurse service or other type of support system to make sure the patient can comply with treatment.
- More research is needed to determine the best approaches to assess cognition and address cognitive decline in the health care setting.
- At what stage do you assess cognition? Do you do it when people are asymptomatic or already symptomatic? What do you do if cognitive impairment is detected? What are the best strategies to support patients? It seems that a team approach, such as a medical home, would be the ideal solution, with more support given to people who have cognitive impairment.
Q: Can improved glucose control or diabetes treatments help prevent cognitive impairment? A: There are studies suggesting that better glucose control—through medications or other interventions—can prevent cognitive impairment, but it has not been established with certainty.
For example, metformin has been tested to treat or prevent Alzheimer’s dementia, often in mildly impaired subjects. Negative and conflicting results point to the need for larger clinical trials. ACCORD is a landmark study of tight glycemic control versus regular control in people with type 2 diabetes.
A sub-study called MIND compared cognitive outcomes; no differences were found between the two groups. That is, tight glycemic control did not help prevent cognitive impairment or improve cognition. In addition, the Diabetes Control and Complications Trial (DCCT) compared the effects of intensive insulin therapy and standard therapy in people with type 1 diabetes. José A. Luchsinger, MD, is a co-author of the “Diabetes and Cognitive Impairment” chapter in the NIDDK publication Diabetes in America, 3rd Edition, His research focuses on the relationship among vascular, metabolic, and dietary factors on aging outcomes and primary cognition in diverse populations.
What happens to the brain when you have high blood sugar?
Sugar and the Brain “The brain is dependent on sugar as its main fuel,” says Vera Novak, MD, PhD, an HMS associate professor of medicine at Beth Israel Deaconess Medical Center. “It cannot be without it.” Although the brain needs glucose, too much of this energy source can be a bad thing.
A 2012 study in animals by researchers at the University of California at Los Angeles indicated a positive relationship between the consumption of fructose, another form of sugar, and the aging of cells, while a 2009 study, also using an animal model, conducted by a team of scientists at the University of Montreal and Boston College, linked excess glucose consumption to memory and cognitive deficiencies.
The effects of glucose and other forms of sugar on the brain may be the most profound in diabetes, a group of diseases in which high blood glucose levels persist over a prolonged period of time. Type 1 diabetes is a disease in which the immune system destroys the cells in the pancreas that produce insulin, a hormone used by the body to keep blood glucose levels in check. 
Long-term diabetes—either type 1 or type 2—has many consequences for the brain and for neurons in the brain, says Novak. High blood glucose levels can affect the brain’s functional connectivity, which links brain regions that share functional properties, and brain matter.
- It can cause the brain to atrophy or shrink.
- And it can lead to small-vessel disease, which restricts blood flow in the brain, causing cognitive difficulties and, if severe enough, spurring the development of vascular dementia.
- In her laboratory, Novak is studying ways to prevent these effects in people with type 2 diabetes.
One of these ways involves a nasal spray called intranasal insulin (INI). When used, INI enters the brain and binds to receptors in its memory networks, including the hippocampus, hypothalamus, and insular cortex. As signaling within these memory networks become more efficient, the cognitive functions associated with these areas, such as learning and visual perceptions of spatial relationships, improve.
- Type 2 diabetes accelerates brain aging,” says Novak, “which, in turn accelerates the progression of functional decline.
- With intranasal insulin, we’re hoping to find a new avenue for treatment to slow down these effects or prevent them altogether.” In a pilot study, Novak and her colleagues found that a single dose of INI had a positive effect on memory, verbal learning, and spatial orientation.
She is now planning the first clinical trial of INI in older adults with type 2 diabetes. The results of the trial are especially relevant because of the high prevalence of dementia and significant cognitive decline among older adults with diabetes. Scott Edwards is a freelance science writer based in Massachusetts. : Sugar and the Brain