Measuring Cognition In Diabetes
The present chapter does not summarize the cognitive findings typical for diabetes type 1 and type 2. Nevertheless, we wish to address issues that need to be considered in order to design an optimal test battery for the assessment of diabetes-associated cognitive decline. Firstly, when patients with diabetes are compared with non-diabetic controls, effect sizes for the differences in performance between the groups are generally small Chapters 10-12 . This indicates that an optimal test battery...
Augustina MA Brands Roy PC Kessels and Christopher M Ryan
Adult Patients with Type 1 Diabetes Cognitive Performance in Older People with Type 1 Diabetes Mri Findings in Type 1 Diabetes Psychiatric Comorbidity in Diabetes Mellitus Is There a Relationship with Cognitive Impairment Risk Factors for Cognitive Dysfunction The Paradox Diabetic Encephalopathy Versus Cognitive Resilience Implications for Clinical Practice References In this chapter, the literature on the neuropsychology of type 1 diabetes is reviewed. First, the pattern and magnitude of...
Neuroendocrine Findings Associated With Depression
The hypothalamic-pituitary-adrenal HPA axis mediates the ability of an organism to respond to threats, including stress. Interestingly, the determining characteristics of stressors which provoke depression in humans namely entrapment, humiliation, and loss provoke animal models of depression. Following exposure to a stressor, the hypothalamus releases corticotrophin-releasing hormone CRH which in turn stimulates the release of adrenocorticotrophic hormone ACTH by the anterior pituitary gland....
Type Diabetes And Its Related Conditions
There is a concerning epidemic of obesity, insulin resistance, and T2D in the world 1 . With the aging of the population and greater longevity, the long-term consequences of these conditions are serious and burdensome. Adiposity refers to the amount of adipose fat tissue in the body 2 . Some refer to adiposity as fatness or obesity. Adiposity is a continuum, and the normal or ideal threshold of adiposity is not clear. However, as adiposity increases it is associated with higher risk of insulin...
Spinal Cord Involvement In Diabetic Neuropathy
Previously considered a disease of the peripheral nervous system PNS , there is mounting evidence to support concomitant involvement of the CNS in diabetic neuropathy. Involvement of the spinal cord has been reported in post-mortem studies, which demonstrated axonal loss, gliosis, and demyeli-nation within the spinal cord 2-6 . However, many of these studies did not examine patients with diabetic neuropathy specifically therefore, it is not possible to conclude whether these changes were due to...
Relationship Between Depression And Cognitive Impairment
Certain symptoms of cognitive impairment psychomotor retardation, loss of affect, concentration, and memory difficulties are frequent among persons with depression and other mood disorders, and prevalence of both cognitive impairment and depression increases significantly with age 73 . People with depression have been shown to perform worse on tests of cognitive performance and neuropsychological measures than non-depressed persons 73 . Similar to the relationship between diabetes and...
PREDIABETES AND COGNITION Prediabetic Stages
The progression from normal glucose tolerance to type 2 diabetes is a gradual process which generally proceeds unnoticed. In most cases, the very first changes in insulin and glucose metabolism already occur years before type 2 diabetes is actually diagnosed. Essential to type 2 diabetes is the reduction of insulin sensitivity in the tissue, referred to as insulin resistance 35 see Chapter 2 . Insulin resistance results in a compensatory increase in insulin secretion of the pancreas and...
INTRODUCTION Pww
Dementia is one of the most widely feared age-related neurological diseases, and together with stroke, it is the only neurological disease listed in the ten most important causes of disease burden in developed countries 1 . The life-time risk of any dementia has been estimated to be more than 1 in 5 for women and 1 in 6 for men 2 . Worldwide, about 24 million people have dementia, with 4.6 million new cases of dementia every year 3 . The term dementia encompasses the spectrum of clinical...
How Does Hyperglycemia Affect The Ischemic Brain
Although an accumulating number of studies have convincingly demonstrated an association between hyperglycemia and poor outcome after stroke, it remains controversial whether this association is causal, i.e., hyper-glycemia is actually causing poor outcome. Hyperglycemia could also be epiphenomenal to a more pronounced stress reaction with higher levels of blood glucose in more severe stroke. Indeed, higher levels of glucose have been associated with more severe stroke 7, 7375 . On the other...
Info Eim
0.009 SU Rx 0.005 metformin Rx 0.12 insulin 0.35 Study Group 18 7 lt 2 years duration 0.1 lt 2 years duration 25 gt 5 years duration 0.7 gt 5 years duration Nocturnal hypoglycemia is common with all insulin regimens, is usually asymptomatic, and is often unidentified as symptoms are absent during sleep and because blood glucose is rarely measured routinely during the night 26 . Surveys have demonstrated biochemical hypoglycemia in up to 50 of overnight blood glucose profiles in adults and in...
Diagnosis And Ancillary Investigations
A diagnosis of dementia is preferentially made in a multidisciplinary setting, based on clinical criteria 4, 5 . These criteria include the presence of multiple cognitive deficits leading to a significant impairment in social and occupational functioning and a significant decline from a previous level of functioning. The clinical challenge is to define the aetiological diagnosis in an early phase, based on criteria such as those reviewed on the previous pages. This is crucial with regard to...
Etiology And Precipitating Factors 1
Glucose levels rise in the setting of relative insulin deficiency. The low levels of circulating insulin prevent lipolysis, ketogenesis, and ketoacidosis 62 but are unable to suppress hyperglycemia, glucosuria, and water losses. Levels of counter-regulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone are elevated, increasing gluconeogenic substrates, gluconeogenesis, and glycogenolysis. Meanwhile, glucose utilization is decreased. Glucose levels rise, leading to...
And Groups
Neuropsychological assessment is more than just administering a number of tests in a patient. Although each test is presented and scored in a standardized manner, raw test results do not have any meaning. Only few tests measure functions at a ceiling level, allowing immediate interpretation. However, ceiling effects in test performance often result in a lack of sensitivity. Subtle impairments are easily missed, resulting in a high proportion of false-negative cases people classified as...
Therapeutic Interventions In Dkarelated Cerebral Edema
Children should be monitored closely including hourly vitals, capillary blood glucose monitoring, and frequent neurological observations 1 . Laboratory testing every 2-4 h should include electrolytes, urea, hematocrit, blood glucose, and blood gases 1 . In more severe cases, electrolytes and glucose may need to be monitored more closely. If cerebral edema is suspected, treatment should begin immediately by reducing intravenous fluid administration 1, 57 and by providing supportive care....
REFERENCES Mun
1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001 systematic analysis of population health data. Lancet 2006 367 1747-1757. 2. Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003 2 43-53. 3. Strong K, Mathers C, Bonita R. Preventing stroke saving lives around the world. Lancet Neurol 2007...
REFERENCES Yyx
1. Mijnhout GS, Scheltens P, Diamant M, et al. Diabetic encephalopathy A concept in need of a definition. Diabetologia 2006 49 1447-1448. 2. Leichtentritt H. Erkrankung Peripherer nerven und des rucken-marks bei diabetes mellitus. Berlin G. Schade, 1893 32. 3. Pryce TD. On diabetic neuritis with a clinical and pathological description of three cases of diabetic pseudo-tabes. Brain 1893 1. 4. Williamson RT. 1904 . Changes in the spinal cord in diabetes mellitus. Br Med J 1904 1. 5. Reske-Nielsen...
Epidemiology
Several studies report T1D incidence numbers of 0.1-36.8 100,000 subjects worldwide 2 . Above the age of 15 years ketoacidosis at presentation occurs on average in 10 of the population in children ketoacidosis at presentation is more frequent 3, 4 . Overall, publications report a male predominance 1.8 male female ratio and a seasonal pattern with higher incidence in November through March in European countries. Worldwide, the incidence of T1D is higher in more developed countries 1, 2, 4-6 ....
REFERENCES Sjk
1. Dunger DB, Sperling MA, Acerini CL, et al. European Society for Paediatric Endocrinol-ogy Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics 2004 113 2 e133-e140. 2. Umpierrez GE, Woo W, Hagopian WA, et al. Immunogenetic analysis suggests different pathogenesis for obese and lean African-Americans with diabetic ketoacidosis. Diabetes care 1999 22 9 1517-1523. 3. Balasubramanyam A, Zern JW, Hyman DJ, Pavlik V. New...
Pathogenesis
There are two underlying mechanism that lead to the onset of clinical T2D inadequate insulin action in target tissues insulin resistance and inadequate secretion from pancreatic -cells Fig. 1 14 . Insulin resistance arises prior to the onset of clinical disease, but predicts the development of diabetes 15-17 . Environmental factors, particularly obesity and a sedentary lifestyle, are important contributors to the development of diabetes, largely because of their effects on insulin sensitivity...
Cognition In Young To Middleaged Adult Patients With Type Diabetes
Individuals with type 1 diabetes have repeatedly been reported to show modest performance deficits in a wide range of neuropsychological tests compared with non-diabetic controls. In the last decades numerous studies were published on cognition and diabetes in adults. However, the results of these studies are relatively heterogeneous with respect to the severity and nature of the affected cognitive domains, which is probably due to the wide variation with respect to patient characteristics and...
INTRODUCTION Mot
Diabetic encephalopathy is now recognized as a complication of diabetes resulting in progressive cognitive deficits. It affects both type 1 and type 2 diabetes, although underlying mechanisms are likely to differ and the outcomes are different in the two types of diabetes. The term primary diabetic encephalopathy has been proposed to include encephalopathy abnormalities related to impaired insulin action and hyperglycemia, whereas secondary diabetic encephalopathy is the result of diabetic...
Glucose Levels And Lesion Volume
If hyperglycemia is indeed casually related to poor outcome after stroke, one would expect a relation between higher levels of blood glucose and an increased lesion volume. In hemorrhagic stroke, only little is known about the association between glucose levels and the size of the hemorrhage or its evolution during the clinical course. The evidence is limited to experimental settings where it has been shown that hyperglycemia exacerbates brain edema and peri-hematomal cell death after...
Hyperglycemia Introduction
The current classification of diabetes in different subtypes is based on the defect s that causes hyperglycemia, namely, aberrant or deficient insulin secretion or insufficient insulin action 1 . Type 1 diabetes T1D originates from autoimmune-mediated destruction of the pancreatic P-cells that normally produce insulin, thus resulting in absolute insulin deficiency. Other types of pancreatic disease involving destruction of the P-cells, such as alcoholic pancreatitis, are classified otherwise....
Glucose Surge Postprandial
AMI acute myocardial infarction ICU intensive care unit CABG coronary artery bypass graft IV intravenous SC subcutaneous GIK glucose insulin potassium infusion n.r. not reported. AMI acute myocardial infarction ICU intensive care unit CABG coronary artery bypass graft IV intravenous SC subcutaneous GIK glucose insulin potassium infusion n.r. not reported. The same observations as for the target levels can be made concerning the duration glucose lowering treatment. Although from a...
Insulin In The Periphery And The Cns
It has long been established that insulin plays a crucial role in peripheral energy regulation. In a tightly controlled system, plasma glucose levels are kept remarkably constant in healthy human beings. Carbohydrate consumption initiates a rise in plasma glucose levels, which in turn, stimulates insulin secretion by the pancreas. As blood glucose levels begin to fall, counter-regulatory hormones are secreted, and plasma glucose concentrations are returned to normal pre-prandial levels....
REFERENCES Gey
1. Lezak MD, Howieson DB, Loring DW eds. Neuropsychological Assessment, 4th ed. New York Oxford University Press, 2004. 2. Strauss E, Sherman EMS, Spreen O eds. A Compendium of Neuropsychological Tests Administration, Norms, and Commentary, 3rd ed. New York Oxford University Press, 2006. 3. Beauducel A, Brocke B, Liepmann D. Perspectives on fluid and crystallized intelligence facets for verbal, numerical, and figural intelligence Pers Indiv Diff 2001 30 977-994. 4. Wechsler D. WAIS-IV...
fMRI AND PAINFULDPN
The exact pathophysiological mechanisms of neuropathic pain remain unknown although based on experiments in animal models both peripheral and central mechanisms have been postulated 41 . However, there are no consistent differences in peripheral nerve morphological parameters between painful-DPN and painless-DPN. It is likely that the pathophysio-logical changes resulting in pain may in part lie elsewhere within the nervous system. Recent advances in neuroimaging methods have led to better...
What Is Fehm Hl Kern W Peters A 2006 The Selfish Brain Competition For Energy
1. Brands AMA, Biessels GJ, De Haan EHF, Kappelle LJ, Kessels RPC. The effects of type 1 diabetes on cognitive performance A meta-analysis. Diabetes Care 2005 28 726-735. 2. Kodl CT, Seaquist ER. Cognitive dysfunction and diabetes mellitus. Endocr Rev 2008 29 494-511. 3. Cohen, J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ Erlbaum, 1988. 4. Kahneman D. Attention and effort. Englewood Cliffs, NJ Prentice Hall Inc., 1973. 5. Park DC, Lautenschlager G, Hedden T,...
Hyperglycemia Causing Cardiac Conduction Defect
Adapted from MacCuish 36 , with permission of Edward Arnold Publishers Adapted from MacCuish 36 , with permission of Edward Arnold Publishers hypoglycemia, a continuous intravenous infusion of dextrose and frequent oral feeding will be required. When hypoglycemic coma does not respond to intravenous dextrose, neuroimaging must be performed urgently to look for cerebral edema, a recognized complication of severe hypoglycemia that is associated with a high mortality, and to exclude other...
Novel Treatment Strategies For Alzheimers Disease
In this final section, we will discuss three novel treatment strategies for Alzheimer's disease and for its prodromal stage, mild cognitive impairment Table 1 . The three strategies have a common thesis that improving insulin sensitivity will have a beneficial effect on patients with memory loss. Novel therapeutic strategies for Alzheimer's disease and mild cognitive Raises brain insulin levels Increases brain insulin without affecting plasma activity glucose or insulin levels Modulates Aft...
Biomedical Risk Factors
Three types of diabetes-related biomedical variables have been linked to the appearance of neurocognitive anomalies in children with diabetes moderately severe episodes of hypoglycemia, ketoacidosis, and chronic hyperglycemia. our understanding of these associations remains imperfect, unfortunately, because so few studies have adequately ascertained those biomedical variables in pediatric samples. Rather than capturing most, or even a representative number, of those events over the course of...
PEROXISOME PROLIFERATORACTIVATED RECEPTOR PPARy AGONISTS AND TREATMENT OF
Drugs of the PPAR-y class have been approved by the FDA to treat T2DM for approximately a decade. Members of this class currently in clinical use include rosiglitazone and pioglitazone. They are ligand-activated nuclear transcription factors that improve insulin sensitivity. PPAR-y, expressed in adipocytes, regulates adipogenesis and increases the uptake of fatty acids into adipocytes. Thus, PPAR-y agonists reduce the burden of fatty acid uptake for striated muscles, which likely explains their...
Assessment Of Cognitive Function
In assessing cognitive deficits, two important questions must be answered. Firstly, the question is whether an individual patient, or a patient group, has cognitive dysfunction compared to a reference group. Secondly, we need to look at the pattern of impairment whether selective deficits of one or more cognitive processes - or domains - exist. By establishing this pattern of cognitive deficits, we can subsequently relate this information to cerebral dysfunction in general or specific brain...
Brain Mr Spectroscopy In Dpn
Findings from the spinal cord studies described above suggest that the metabolic insult of diabetes has a generalised effect on the whole nervous system and has made us question whether the brain too may be involved. Anatomical studies have demonstrated that the ascending sensory pathways of the spinal cord terminate within the thalamus before high-order sensory projections are sent to the cortex 11 . Recent studies have shown that the thalamus does not merely act as a sensory relay station but...
Info Obo
FPG, fasting plasma glucose FPG 2-HPG, plasma glucose 2h after a challenge with 75 g glucose CPG, casual plasma glucose Sx symptoms of diabetes polydipsia, polyuria, and unexplained weight loss. Adapted from American Diabetes Association 1 . FPG, fasting plasma glucose FPG 2-HPG, plasma glucose 2h after a challenge with 75 g glucose CPG, casual plasma glucose Sx symptoms of diabetes polydipsia, polyuria, and unexplained weight loss. Adapted from American Diabetes Association 1 . The 2006 joint...
Lifestyle
Patients are encouraged to maintain an active lifestyle and to exercise. They should receive advice on how to modify insulin dosage according to the amount and duration of exercise to avoid related hypoglycemia and potential late hypoglycemia at night. Vigorous exercise can deteriorate severe hypertension, retinopathy, and autonomic neuropathy and should be avoided without previous medical consultation 51 . Patients with normal body weight do not have dietary restrictions with respect to...
Post Thrombolysis Ct
Patients with ischemic stroke usually present with focal neurological deficit of sudden onset. Occasionally a more gradually or stepwise onset can be found, especially in patients with a hemodynamic origin of cerebral ischemia. Common deficits include dysphasia, dysarthria, hemianopia, weakness, ataxia, sensory loss, and cognitive disorders such as spatial neglect 9 . Symptoms are unilateral except in some patients with posterior circulation stroke. Most patients remain alert. Mild-to-moderate...
Hyperglycemia in Acute Stroke
Background Stroke Stroke and Hyperglycemia Hyperglycemia After Stroke Etiology of Hyperglycemia in Acute Ischemic Stroke Admission Hyperglycemia and Clinical Outcome After Stroke Glucose Levels and Lesion Volume How Does Hyperglycemia Affect the Ischemic Brain Treatment of Hyperglycemia Conclusions Recommendations References Hyperglycemia is frequently found 40-60 after all kinds of stroke and it has been related to increased lesion size and poor clinical outcome. In this chapter, we will...
Descending Pain Modulation
Nociceptive inputs are subjected to modulation by the descending pain modulatory systems prior to arrival at higher cortical centres. This well-characterised functional anatomical network regulates nociceptive processing, largely within the dorsal horn, to produce either facilitation prono-ciceptive or inhibition antinociceptive Fig. 9 53 . The brain regions involved in this descending modulation include the frontal lobe, anterior cin-gulate cortex, insula, amygdala, hypothalamus,...
Christopher M Ryan PhD
Methodological Considerations School Performance Identifying Neurocognitive Phenotypes Biomedical Risk Factors Pathophysiological Models Are We There Yet Future Directions References Diabetes has a marked effect on brain function and structure in children and adolescents. As a group, diabetic children are more likely to perform more poorly than their nondiabetic peers in the classroom and earn lower scores on measures of academic achievement and verbal intelligence. Specialized...
Scheltens Scale
A score of 0-4 is given separately for the left and right side. f increase decrease. A score of 0-4 is given separately for the left and right side. f increase decrease. Fig. 4. Examples of scores on medial temporal lobe atrophy visual rating scale on coronal T1-weighted coronal MRI scans. Fig. 4. Examples of scores on medial temporal lobe atrophy visual rating scale on coronal T1-weighted coronal MRI scans. atrophy in subjects with amnestic MCI is associated with a diagnosis of dementia at...
L Jaap Kappelle and H Bart van der Worp
Stroke is the second leading cause of long-term disability in high-income countries and the second leading cause of death worldwide. In Western communities, about 80 of strokes are caused by focal cerebral ischemia secondary to arterial occlusion. Stroke incidence is highly age-dependent. The median stroke incidence in persons between 15 and 49 years of age is 10 per 100,000 per year, whereas this is 2,000 per 100,000 for persons aged 85 years or older. Established treatments of acute ischemic...
References 1
1. American Diabetes Association. Standards of medical care in diabetes - 2008. Diabetes Care 2008 31 12-54. 2. Federation WHOID. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. report of WHO IDF consultation. Accessed June 27, 2008. 3. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab 2008 93 7 2447-2453. 4. World Diabetes Foundation, amp International Diabetes...
Cerebral Edema In Dka Risk Factors
Epidemiologic studies have identified several risk factors for cerebral edema in DKA. Younger age 31 and newly diagnosed diabetes both potentially increase risk of cerebral edema in DKA 6, 31, 35 . Additionally, patients presenting with longer duration of symptoms are at increased risk 26 , which may be related to severity of DKA 28 . Other risk factors have been identified in retrospective case-controlled studies. A complete list of risk factors associated with cerebral edema in DKA is shown...
Need For Improving Diabetes Care References
Type 2 diabetes T2D is the most common form of diabetes, a metabolic disorder characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Early diagnosis of T2D and the high-risk category of pre-diabetes may help reduce the associated public health and clinical burden. Available diagnostic strategies include fasting plasma glucose, oral glucose tolerance test, and casual plasma glucose in the presence of symptoms of hyper-glycemia. Potential use of...
Esther van den Berg Yael D Reijmer and Geert Jan Biessels
Diabetes Pre-Diabetes and Cognition Brain Imaging in Type 2 Diabetes Determinants and Mechanisms Treatment Opportunities Implications for Clinical Care Conclusions and Directions This chapter addresses the effects of type 2 diabetes mellitus on cognitive functioning. It covers the nature and severity of cognitive decrements in relation to diabetes and pre-diabetic stages. Possible risk factors and pathophysiological mechanisms, such as vascular risk factors, hypoglycemia and hyperglycemia,...
Prognosis
The mortality rates for HHS vary between 10 and 20 14, 93 . Mortality is usually related to the underlying precipitating illness 14, 94-97 , age 93 , degree of dehydration 93 , hemodynamic instability 96 , degree of consciousness 94 , and higher serum osmolality 93 . It is important to encourage patients with T2DM adherence to blood glucose monitoring and compliance with medications to prevent HHS. Adequate access to fluids and proper intake is especially important to prevent hyperosmolar...
Choreiform Movements
Chorea or ballismus has been observed in the hyperosmolar hyperglycemic state 76 . In a report of HHS patients presenting with chorea, the mean age was 71.1 years and had a 2 1 ratio of women to men 76 . In patients with HHS, choreiform movements are often but not always unilateral and occur concurrent with or shortly after the episode of hyperglycemia 77 . Diabetes is usually newly diagnosed in these patients and develops subacutely over days to months 77 . In states of hyperglycemia,...
Cerebral Edema In Dka Pathophysiology
Potential causes of DKA-related cerebral edema include 1 generation of inflammatory mediators 43, 44 2 disruption of cell membrane ion transport and aquaporin channels 45-47 3 generation of intracellular organic osmolytes and subsequent osmotic imbalance 48 and 4 changes in cerebral blood flow 49 . Inflammatory mediators may cause cerebral edema. Studies have demonstrated that inflammatory mediators can disrupt endothelial cells of the blood-brain barrier BBB 43 . Routes for penetration include...
School Performance
As a group, diabetic children earn somewhat lower grades in school as compared to their nondiabetic classmates, are more likely to fail or repeat a grade, perform more poorly on formal tests of academic achievement, and have lower IQ scores, particularly on tests of verbal intelligence. The most compelling evidence for a link between diabetes and poorer school outcomes has been provided by a swedish population-based register study involving 5,159 children who developed diabetes between July...