The influence of diabetes mellitus II on cognitive performance

Silva, Juliana Luchin Diniz; Ribeiro, Lucas Trindade Cantú; Santos, Nina Razzo Pereira dos; Beserra, Vanessa Cristina Almeida de Sousa; Fragoso, Yara Dadalti

doi:10.1590/S1980-57642012DN06020003

ABSTRACT

Background:

The association between diabetes mellitus and cognitive dysfunction is becoming increasingly clear, rendering it necessary for physicians in charge of diabetic patients to have the means to assess cognitive performance. Simple tests that can be applied during routine consultations may be useful for monitoring cognitive function during the course of diabetes.

Objective:

The objective of the present study was to assess cognition in diabetes mellitus type II (DM-II) using simple tests that can be incorporated into routine medical practice.

Methods:

A cross-sectional study including healthy controls and DM-II patients was carried out between May and September 2011. Volunteers aged 60 years and over were assessed by means of figure recognition, verbal fluency and the 10×36 tests.

Results:

A group of 100 participants was divided into a subgroup of 50 DM-II patients and a subgroup of 50 healthy volunteers. No statistical difference regarding demographic characteristics was found between the two groups. Results on the 10×36 test showed significantly worse performance among DM-II patients (p<0.0001). Assessment of the DM-II subgroup in terms of disease duration showed statistically significant differences (p<0.001) on figure recognition and verbal fluency, with worse cognitive performance among individuals with longer disease duration, irrespective of gender or age.

Conclusion:

Figure recognition, verbal fluency and 10×36 tests are easy to apply and could be used in routine medical practice for the early detection of cognitive dysfunction among patients with DM-II.

Key words:
diabetes mellitus; cognition; figure recognition; verbal fluency; 10×36 test.

RESUMO

Introdução:

A associação entre diabetes mellitus e disfunção cognitiva está se tornando clara, exigindo que o médico que atende o paciente diabético tenha condições de fazer uma avaliação cognitiva. Testes simples que podem ser aplicados durante consultas de rotina podem ser de importância para monitorar disfunção cognitiva durante o curso do diabetes.

Objetivo:

O objetivo do presente estudo foi a avaliação da cognição em diabetes mellitus tipo II (DM-II) usando testes simples que podem ser incorporados na prática médica diária.

Métodos:

Um estudo transversal foi realizado no período entre maio e setembro de 2011, incluindo controles saudáveis e pacientes com DM-II. Voluntários com 60 anos ou mais foram avaliados para Reconhecimento de Figuras, Fluência Verbal e Teste 10×36.

Resultados:

Um grupo de 100 participantes foi dividido em um subgrupo de 50 pacientes com DM-II e um subgrupo de 50 voluntários saudáveis. Não houve diferença estatística entre as características demográficas O teste 10×36 mostrou desempenho significativamente pior nos pacientes com DM-II (p<0.0001). Quando o subgrupo de DM-II foi avaliado com relação à duração da doença, houve diferença significativa (p<0.001) para o Reconhecimento de Figuras e para Fluência Verbal, com pior desempenho cognitivo para indivíduos com maior tempo de doença, independente do gênero e idade.

Conclusão:

Reconhecimento de Figuras, Fluência Verbal e Teste 10×36 são testes fáceis de aplicar que poderiam ser utilizados na prática médica diária para identificação precoce de disfunção cognitiva em pacientes com DM-II.

Palavras-chave:
diabetes mellitus; cognição; reconhecimento de figuras; fluência verbal; teste 10×36.

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Full text available only in PDF format.

REFERENCES

Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: from pathophysiology to prevention and management. Lancet. 2011; 378:169-181.
Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol 2006;5:64-74.
Patiño-Fernández AM, Delamater AM, Applegate EB, et al. Neurocognitive functioning in preschool-age children with type 1 diabetes mellitus. Pediatr Diabetes. 2010;11:424-430.
Nooyens AC, Baan CA, Spijkerman AM, Verschuren WM. Type 2 diabetes and cognitive decline in middle-aged men and women: the Doetinchem Cohort Study. Diabetes Care. 2010;33:1964-1969.
Ravona-Springer R, Schnaider-Beeri M. The association of diabetes and dementia and possible implications for nondiabetic populations. Expert Rev Neurother 2011;11:1609-1617.
van den Berg E, Kloppenborg RP, Kessels RP, Kappelle LJ, Biessels GJ. Type 2 diabetes mellitus, hypertension, dyslipidemia and obesity: A systematic comparison of their impact on cognition. Biochim Biophys Acta 2009;1792:470-481.
Seaquist ER. The final frontier: how does diabetes affect the brain? Diabetes 2010;59:4-5.
Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity? JAMA. 2011;306:420-427.
Lorentz WJ, Scanlan JM, Borson S. Brief screening tests for dementia. Can J Psychiatry. 2002;47:723-733.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psych Scand 1983;67:361-670.
Nitrini R, Lefreve BH, Mathias SC, et al. Neuropsychological tests of simple application for diagnosing dementia. Arq Neuropsiquiatr 1994;52:457-465.
Brucki SM, Malheiros SM, Okamoto IH, Bertolucci PH. Normative data on the verbal fluency test in the animal category in our milieu. Arq Neuropsiquiatr 1997;55:56-61.
Rao SM, Leo GJ, Bernardin L, Uverzagt F. Cognitive dysfunction in multiple sclerosis I: frequency of patterns and predictions. Neurology 1991;41:685-691.
Brooks JBB, Borela MCM, Fragoso YDF. Assessment of cognition using the Rao's Brief Repeatable Battery of Neuropsychological Tests on a group of Brazilian patients with multiple sclerosis. Arq Neuropsquiatr 2011;69:887-91.
Alencar RC, Cobas RA, Gomes MB. Assessment of cognitive status in patients with type 2 diabetes through the Mini-Mental Status Examination: a cross-sectional study. Diabetol Metab Syndr 2010;28:2-10.
Velayudhan L, Poppe M, Archer N, Proitsi P, Brown RG, Lovestone S. Risk of developing dementia in people with diabetes and mild cognitive impairment. Br J Psychiatry. 2010;196:36-40.
Umegaki H. Pathophysiology of cognitive dysfunction in older people with type 2 diabetes: vascular changes or neurodegeneration? Age Ageing 2010;39:8-10.
Xu W, Caracciolo B, Wang HX, et al. Accelerated progression from mild cognitive impairment to dementia in people with diabtes. Diabetes 2010;59:2928-2935.
Roberts RO, Geda YE, Knopman DS, et al. Association of duration and severity of diabetes mellitus with mild cognitive impairment. Arch Neurol 2008;65:1066-1073.

Publication Dates

Publication in this collection
Apr-Jun 2012

History

Received
04 Feb 2012
Accepted
03 May 2012

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Nolan CJ, Damm P, Prentki M. Type 2 diabetes across generations: from pathophysiology to prevention and management. Lancet. 2011; 378:169-181.

[2] Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol 2006;5:64-74.

[3] Patiño-Fernández AM, Delamater AM, Applegate EB, et al. Neurocognitive functioning in preschool-age children with type 1 diabetes mellitus. Pediatr Diabetes. 2010;11:424-430.

[4] Nooyens AC, Baan CA, Spijkerman AM, Verschuren WM. Type 2 diabetes and cognitive decline in middle-aged men and women: the Doetinchem Cohort Study. Diabetes Care. 2010;33:1964-1969.

[5] Ravona-Springer R, Schnaider-Beeri M. The association of diabetes and dementia and possible implications for nondiabetic populations. Expert Rev Neurother 2011;11:1609-1617.

[6] van den Berg E, Kloppenborg RP, Kessels RP, Kappelle LJ, Biessels GJ. Type 2 diabetes mellitus, hypertension, dyslipidemia and obesity: A systematic comparison of their impact on cognition. Biochim Biophys Acta 2009;1792:470-481.

[7] Seaquist ER. The final frontier: how does diabetes affect the brain? Diabetes 2010;59:4-5.

[8] Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity? JAMA. 2011;306:420-427.

[9] Lorentz WJ, Scanlan JM, Borson S. Brief screening tests for dementia. Can J Psychiatry. 2002;47:723-733.

[10] Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psych Scand 1983;67:361-670.

[11] Nitrini R, Lefreve BH, Mathias SC, et al. Neuropsychological tests of simple application for diagnosing dementia. Arq Neuropsiquiatr 1994;52:457-465.

[12] Brucki SM, Malheiros SM, Okamoto IH, Bertolucci PH. Normative data on the verbal fluency test in the animal category in our milieu. Arq Neuropsiquiatr 1997;55:56-61.

[13] Rao SM, Leo GJ, Bernardin L, Uverzagt F. Cognitive dysfunction in multiple sclerosis I: frequency of patterns and predictions. Neurology 1991;41:685-691.

[14] Brooks JBB, Borela MCM, Fragoso YDF. Assessment of cognition using the Rao's Brief Repeatable Battery of Neuropsychological Tests on a group of Brazilian patients with multiple sclerosis. Arq Neuropsquiatr 2011;69:887-91.

[15] Alencar RC, Cobas RA, Gomes MB. Assessment of cognitive status in patients with type 2 diabetes through the Mini-Mental Status Examination: a cross-sectional study. Diabetol Metab Syndr 2010;28:2-10.

[16] Velayudhan L, Poppe M, Archer N, Proitsi P, Brown RG, Lovestone S. Risk of developing dementia in people with diabetes and mild cognitive impairment. Br J Psychiatry. 2010;196:36-40.

[17] Umegaki H. Pathophysiology of cognitive dysfunction in older people with type 2 diabetes: vascular changes or neurodegeneration? Age Ageing 2010;39:8-10.

[18] Xu W, Caracciolo B, Wang HX, et al. Accelerated progression from mild cognitive impairment to dementia in people with diabtes. Diabetes 2010;59:2928-2935.

[19] Roberts RO, Geda YE, Knopman DS, et al. Association of duration and severity of diabetes mellitus with mild cognitive impairment. Arch Neurol 2008;65:1066-1073.

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