• alternative health, complimentary and alternative medicine, diabetes, Health News

    Posted on January 19th, 2011

    Written by Dr. Nelson Mañé

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    Diabetes is a systemic disorder and therefore affects many organ systems.  Complications from diabetes include stroke and heart disease, neuropathy, kidney disease, erectile dysfunction, damage to your retina( eye), gastroparesis (delayed stomach emptying) as well as joint problems.  As a doctor who practices functional neurology, the most common presentation in our office of the diabetic patient is peripheral neuropathy.  The second most common presentation that I see is dizziness and balance disorders.  However it is not uncommon to see diabetic patients who presents with the joint pain, headaches relating to uncontrolled blood pressure and a general brain fog or confuse state. This article is in fact related to cognitive decline and diabetes.  In functional neurology, it is often said that nerve cells need two critical components.  Those components are fuel and activation.  The most important part of the fuel component is oxygen and glucose (blood sugar.)  When the patient is diabetic he has blood sugar dysregulation.  These swings in blood pressure and insulin levels tend to affect cognition or thought processing. This is when the patient tells you that he is dizzy, foggy, confused and having difficulty with his memory.  These issues are so prevalent in my patient population proper analysis and nonpharmaceutical treatment of diabetes has become  part our practice.  Although many patients are comfortable with taking medication, many would like nothing more than to no longer be insulin dependent. Most times the patient will not present with this brain fog as his chief complaint.  However, if you ask the patient,  you will find that most diabetics, in fact, have this complaint of confusion  and cognitive deficit as part of their clinical picture. Thus if you are diabetic and complications such as heart disease, erectile dysfunction and stroke cannot motivate you to at least manage your diabetes appropriately if not try to rever.

    Neurology. 2010 Sep 14;75(11):997-1002.

    Progression of brain atrophy and cognitive decline in diabetes mellitus: a 3-year follow-up.

    van Elderen SG, de Roos A, de Craen AJ, Westendorp RG, Blauw GJ, Jukema JW, Bollen EL, Middelkoop HA, van Buchem MA, van der Grond J.

    Department of Radiology, Leiden University Medical Center, RC, Leiden, The Netherlands.

    Abstract

    OBJECTIVE: To investigate progression of MRI-assessed manifestations of cerebral degeneration related to cognitive changes in a population of elderly patients with diabetes mellitus (DM) compared to age-matched control subjects.

    METHODS: From a randomized controlled trial (PROSPER study), a study sample of 89 patients with DM and 438 control subjects without DM aged 70-82 years were included for brain MRI scanning and cognitive function testing at baseline and reexamination after 3 years. Changes in brain atrophy, white matter hyperintensities (WMHs), number of infarctions, and cognitive function test results were determined in patients with DM and subjects without DM. Linear regression analysis was performed with correction for age, gender, hypertension, pravastatin treatment, educational level, and baseline test results. In patients with DM, baseline MRI parameters were correlated with change in cognitive function test result using linear regression analysis with covariates age and gender.

    RESULTS: Patients with DM showed increased progression of brain atrophy (p < 0.01) after follow-up compared to control subjects. No difference in progression of WMH volume or infarctions was found. Patients with DM showed increased decline in cognitive performance on Stroop Test (p = 0.04) and Picture Learning Test (p = 0.03). Furthermore, in patients with DM, change in Picture Learning Test was associated with baseline brain atrophy (p < 0.02).

    CONCLUSION: Our data show that elderly patients with DM without dementia have accelerated progression of brain atrophy with significant consequences in cognition compared to subjects without DM. Our findings add further evidence to the hypothesis that diabetes exerts deleterious effects on neuronal integrity.

    PMID: 20837967 [PubMed - indexed for MEDLINE]

    Neurology. 2010 Jul 13;75(2):160-7.

    White matter changes and diabetes predict cognitive decline in the elderly: the LADIS study.

    Verdelho A, Madureira S, Moleiro C, Ferro JM, Santos CO, Erkinjuntti T, Pantoni L, Fazekas F, Visser M, Waldemar G, Wallin A, Hennerici M, Inzitari D; LADIS Study.

    Collaborators (70)

    Erkinjuntti T, Pohjasvaara T, Pihanen P, Ylikoski R, Jokinen H, Somerkoski MM, Mäntyla R, Salonen O, Fazekas F, Ropele S, Rous B, Petrovic K, Seewann A, Ferro JM, Verdelho A, Madureira S, Moleiro C, Scheltens P, van Straaten I, Gouw A, van der Flier W, Wallin A, Jonsson M, Lind K, Nordlund A, Rolstad S, Isblad I, Wahlund LO, Crisby M, Pettersson A, Amberla K, Chabriat H, Hernandez K, Kurtz A, Hervé D, Guichard JP, Hennerici M, Blahak C, Baezner H, Wiarda M, Seip S, Waldemar G, Rostrup E, Ryberg C, Dyrby T, Paulson OB, Garde E, O’Brien J, Pakrasi S, Teodorczuk A, Firbank M, English P, Minett T, Inzitari D, Bartolini L, Basile AM, Magnani E, Martini M, Mascalchi M, Moretti M, Pantoni L, Poggesi A, Pracucci G, Salvadori E, Simoni M, Erkinjuntti T, Scheltens P, Visser M, Langhorne P, Asplund K.

    Neurosciences Department, Lisbon University, Santa Maria Hospital, Lisbon, Portugal. averdelho@fm.ul.pt

    Abstract

    OBJECTIVE: We aimed to study if age-related white matter changes (WMC) and vascular risk factors were predictors of cognitive decline in elderly subjects with WMC living independently.

    METHODS: The Leukoaraiosis and Disability prospective multinational European study (LADIS) evaluates the impact of WMC on the transition of independent elderly subjects into disability. Independent elderly were enrolled due to the presence of WMC. Subjects were evaluated yearly during 3 years with a comprehensive clinical protocol and a neuropsychological battery. Additionally, dementia, subtypes of dementia, and cognitive decline without dementia were classified according to usual clinical criteria. MRI was performed at entry and at the end of the study.

    RESULTS: A total of 639 subjects were included (74.1 +/- 5 years, 55% women, 9.6 +/- 3.8 years of schooling). At end of follow-up, 90 patients had dementia and 147 had cognitive impairment no dementia. Using Cox regression analysis, WMC severity independently predicted cognitive decline (dementia and not dementia), independently of age, education, and medial temporal atrophy (MTA). Diabetes at baseline was the only vascular risk factor that independently predicted cognitive decline during follow-up, controlling for age, education, WMC severity, and temporal atrophy. Considering subtypes of dementia, Alzheimer disease (AD) was predicted only by MTA, while vascular dementia was predicted by previous stroke, WMC severity, and MTA.

    CONCLUSION: WMC severity and diabetes are independent predictors of cognitive decline in an initially nondisabled elderly population. Vascular dementia is predicted by previous stroke and WMC, while AD is predicted only by MTA.

    PMID: 20625169 [PubMed - indexed for MEDLINE]

     
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