Cognitive impairment in diabetes: the impending pandemic

Abstract

Type 2 Diabetes Mellitus affects more than 450 million people worldwide. Cognitive impairment is a less recognized chronic complication of diabetes and is referred to as accelerated cognitive aging. The Montreal Cognitive Assessment is a tool to screen for mild cognitive impairment. Our study aimed to determine the factors associated with cognitive impairment in patients with Diabetes Mellitus in a tertiary care center in South India. This was a cross-sectional study done on 109 patients with Type 2 Diabetes Mellitus over a period of 18 months. Montreal Cognitive Assessment scale was administered to subjects in the local language. Cognitive impairment was defined as a score of 25 or less. Data was analyzed using student t-test, chi square test and rank correlation; p-value <0.005 was considered significant. The mean age of subjects was 50.92±10.10 years. Fifty three percent of subjects (58) were male and 46.8% (51) were female. The prevalence of cognitive impairment was 67%. The risk of cognitive impairment increased with the number of episodes of hypoglycemia, the mean duration of diabetes and higher fasting sugars. The duration of formal schooling decreased the risk of cognitive decline. In India the prevalence of cognitive impairment in patients with diabetes is relatively high. Both hypoglycemia and hyperglycemia seem to be associated with an increased risk of cognitive impairment. The risk of impairment is directly proportional to the duration of diabetes and inversely proportional to the duration of formal education. Since therapies to treat dementia once it sets in are not infallible, prevention becomes key. A fine balance between achieving euglycemia and avoiding hypoglycemia must be achieved.