Diabetes is a serious chronic disease that can be managed through lifestyle changes and medication. Over 18 million US adults have diabetes, and another 41 million, age 40 to 74 have pre-diabetes. Beside all possible complications that diabetes can carry, these last couple of years there has been a lot of talk about a possible impact of diabetes on cognitive abilities of the patient. How much is diabetes responsible for cognitive dysfunction in older people is still under investigation. There have been several researches on this subject, done comparing cognitive functioning of older people with and without diabetes, and the results are confusing.
Today, most experts agree that cognitive functioning, beside diabetes, is probably also adversely affected by age, illness duration, glycemic control, and the presence of other co-morbid conditions which are common in older people. Another study has proven that older people with diabetes are at an increased risk of developing dementia.
Overview of Diabetes
Diabetes mellitus is a serious metabolic disorder characterized by hyperglycemia (high blood sugar). There are several types of diabetes; the WHO recognizes three main forms which have similar signs, symptoms, and consequences, but different causes. What's characteristic for all three types is that they are caused by the beta cells of the pancreas being unable to produce enough insulin to prevent hyperglycemia!Three types of diabetes are:
%26bull; Type 1 diabetes: This form of diabetes is usually due to autoimmune destruction of the pancreatic beta cells.
%26bull; Type 2 diabetes: This form of diabetes is characterized by tissue resistance on insulin, although there is enough insulin in the circulation.
%26bull; Gestational diabetes: Similar to type 2, gestational diabetes involves insulin resistance, but occurs in pregnancy. The hormones of pregnancy cause insulin resistance in women genetically predisposed to developing this condition.
Gestational diabetes typically resolves with delivery., but types 1 and 2 are incurable chronic conditions. They have been treatable since insulin became medically available on the market, though.
Common diabetes complications
Diabetes can cause several possible complications. These could be divided into acute and chronic.
The most common acute complications are:
%26bull; hypoglycemia
%26bull; ketoacidosis
%26bull; nonketotic hyperosmolar coma
The most common long-term complications include:
%26bull; Cardiovascular disease: Diabetics have a double risk of developing heart disease
%26bull; Chronic renal failure: This serious complication leads to diabetic nephropathy, which later leads to dialysis
%26bull; Retinal damage: This complication leads to blindness
%26bull; Nerve damage
%26bull; Microvascular damage: This may cause erectile dysfunction (impotence) and poor healing of the wounds (which, in turn can later lead to gangrene).
Signs and symptoms
There is so-called classical triad of diabetes symptoms:
%26bull; Polyuria- frequent urination
%26bull; Polydipsia - increased thirst
%26bull; Polyphagia - increased appetite
When the glucose concentration in the blood is high, re-absorption of glucose in the patient%26rsquo;s kidneys is incomplete, which means that one big part of the glucose remains in urine. This condition is called glycosuria. The problem with this condition, besides sweet urine, is that it increases the osmotic pressure of the urine and inhibits the re-absorption of water by the kidney. This results in increased urine production (polyuria), and also causes dehydration and increased thirst.
When the concentration of glucose in blood is too high and prolonged, it can lead to several complications, including vision changes. Blurred vision is a common complaint leading to a diabetes diagnosis.
Diabetic ketoacidosis
A patient not regulating blood sugar properly can lead to a condition called diabetic ketoacidosis, an extreme state of metabolic dysregulation. In most cases it is characterized by:
%26bull; A smell of acetone on the patient's breath
%26bull; Kussmaul breathing
%26bull; Polyuria
%26bull; Nausea
%26bull; Vomiting
%26bull; Abdominal pain
Statistics
Diabetes affects nearly 21 million people in the United States, and 230 million people worldwide, according to the American Diabetes Association and the International Diabetes Federation. Diabetes is in the top 10, and perhaps the top 5, of the most significant diseases in the developed world, and is gaining in significance there and elsewhere.
History of cognitive impairment people with diabetes
The latest research on cognitive functioning in older people with type 2 diabetes has been fruitful. According to these studies, when people with diabetes are compared to people without, there is a strong link between diabetes and several cognitive impairment conditions in the elderly. There are some difficulties with determining the right cause of all this, though. First of all, older people with diabetes usually also have other medical conditions that impair cognitive functioning, such as hypertension and cardiovascular disease. Also, there is a lack of consensus over the cognitive functions that should be investigated, as well as the instruments that should be used. Cognitive abilities of one individual are an extremely complicated matter, including several abilities such as abstract reasoning, verbal memory, and mental flexibility, all of which is making research much more difficult!
Type 2 diabetes has been associated with an increased risk of developing dementia or Alzheimer%26rsquo;s disease. This claim is supported by large prospective studies, which have provided strong evidence that older people with diabetes are at a significantly higher risk of developing all types of dementia and Alzheimer%26rsquo;s disease. The exact mechanism of all this is still mostly unknown. There are some theories, but the exact pathogenic mechanism remains unclear. Experts proposed that diabetes doubles the risk of developing dementia, and that this is particularly true for people controlling the illness with insulin rather than oral hypoglycemic agents.
Age of the patients with cognitive impairment
Although, we%26rsquo;ve mentioned several times that all this happens only to the people of advanced age, this isn't entirely true! Age does not seem to affect all areas of cognition and all older adults in the same way. Cognitive deficits have been observed in cross-sectional studies of younger, middle-aged, and older adults with diabetes. Therefore, the conclusion could be that increasing age is not associated with a level or type of cognitive impairment in older people with diabetes.
Conclusion
Older people with type 2 diabetes are indeed more likely to have some cognitive impairment, compared to people without the illness. However, there are no rules or similar symptoms because such impairment is very complex, because of the complexity of associated cognitive processes. Conditions other than diabetes itself can also contribute to the cognitive impairment. These can be confused with the effect of diabetes.
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