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Cognition in Type 2 Diabetes: Brain Imaging Correlates and Vascular and Metabolic Risk Factors

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Diabetes, Insulin and Alzheimer's Disease

Part of the book series: Research and Perspectives in Alzheimer's Disease ((ALZHEIMER))

Abstract

Patients with type 2 diabetes (DM2) manifest cognitive dysfunction relative to individuals without DM2. The domains of psychomotor efficiency, executive function, and learning and memory are most often affected, with the size of the effects varying from 0.3 to 1.0 standard deviation units in cross-sectional studies. These modest decrements in cognitive functioning appear to be due to a modest decrease in cognitive performance across the whole patient group, rather than a large deficit among a few individuals. Some individuals, however, do progress to more profound stages of cognitive impairment; longitudinal population based studies identify DM2 as a risk factor of aging-related cognitive decline and dementia.

Structural brain imaging studies in older adults with DM2 show that cerebral atrophy is relatively more pronounced and that lacunar infarcts are more common, relative to people without DM2. The association between DM2 and white matter hyperintensities has been a topic of some controversy, but analyses with sensitive volumetric techniques show a modest increase in lesion load.

Studies on risk factors for cognitive decrements and abnormalities on brain imaging in DM2 have mostly been performed in non-demented individuals. Thus far, the majority of these studies are cross-sectional. Currently available studies indicate that atherosclerotic disease, cerebrovascular or other, may be an important determinant of cognitive decrements in DM2. There may also be associations with worse glycemic control, microvascular complications, hyperinsulinemia and hypertension. Longitudinal observational studies, and ultimately intervention studies, are required to fully appreciate the relevance of these risk factors for cognitive dysfunction in DM2.

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Authors and Affiliations

  1. Department of Neurology, G03.228, University Medical Center, 85500, 3508, GA, Utrecht, The Netherlands

    Geert Jan Biessels

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  1. Geert Jan Biessels
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Correspondence to Geert Jan Biessels .

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Editors and Affiliations

  1. School of Medicine, University of Washington, S. Columbian Way 1660, Seattle, 98108, USA

    Suzanne Craft

  2. Recherche Therapeutique, Fondation IPSEN pour la, quai George Gorse 65, Boulogne Billancourt Cedex, 92650, France

    Yves Christen

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Biessels, G.J. (2010). Cognition in Type 2 Diabetes: Brain Imaging Correlates and Vascular and Metabolic Risk Factors. In: Craft, S., Christen, Y. (eds) Diabetes, Insulin and Alzheimer's Disease. Research and Perspectives in Alzheimer's Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-04300-0_6

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