Cognitive Impairment and Dementia in Type 2 Diabetes Mellitus

Alexandra Mastro, Physician Assistant Candidate; James B. Caputo, RPh, PharmD; Mary C. Vagula, PhD

Disclosures

US Pharmacist. 2014;39:33-37. 

In This Article

Abstract and Introduction

Abstract

Diabetes mellitus affects millions of people, causing many complications. Recent studies have shown a link between diabetes and mild cognitive impairment (CI) in persons with earlier onset and greater severity of diabetes. Although the pathophysiology of CI is multifactorial, there is stronger evidence that lack of glycemic control resulting in hypo- or hyperglycemia leads to CI among diabetic patients. With a growing geriatric population and increasing obesity trends in America, the prevalence of diabetes and the related CI, caregiving could be a challenge. Understanding the predisposing factors and the link between diabetes and CI or dementia can help improve the quality of life of diabetic individuals.

Introduction

Millions of people around the globe are diagnosed with diabetes, and its incidence is estimated to double by 2030.[1] The American Diabetes Association (ADA) estimates that 1.7 million Americans are diagnosed with diabetes every year, which means 4,660 adults newly diagnosed daily.[2] There are two primary forms of diabetes, type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

Of the 30 million people who currently have diabetes in the United States, 90% to 95% have T2DM.[2] T2DM is a group of metabolic disorders resulting in insulin resistance leading to reduced insulin sensitivity and therefore relative insulin insufficiency.[1] This chronic disease process is accompanied by complications in various vital organs and can be associated with a higher risk for cardiovascular events, neurologic changes, and kidney impairment.

Additionally, recent studies have shown a link between T2DM and mild cognitive impairment (CI), Alzheimer's disease, and vascular dementia (VaD).[3,4] CI refers to changes in memory, mood swings, perception, react ion times, attention, and concentration.[5] Although the pathophysiology of CI in diabetic persons is not clear and is believed to be multifactorial, a strong link between lack of glycemic control resulting in hypo-or hyperglycemia is strongly associated with CI.[1] Micro- and macrovascular changes associated with T2DM are also linked to the development of dementia.[1] With a growing geriatric population and the prevalence of diabetes increasing with obesity trends in America, healthcare professionals need to be alert. Table 1 shows the different forms of dementia.[6]

Since diabetes is a chronic disease with many complications, patients must be involved in their own treatment; but with CI on the rise, clinicians need to ensure that patients be compliant with treatment. Advocating for specific pharmacologic intervention can help decrease the risk of CI. Employing healthcare modalities from a multifaceted team approach is necessary to improve the quality of life of individuals with diabetes and CI.

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