Cognitive Performance, Psychological Well-Being, and Brain Magnetic Resonance Imaging in Older Patients With Type 1 Diabetes

• Published in: Diabetes (New York, N.Y.) Vol. 55; no. 6; pp. 1800 - 1806
• Main Authors: Brands, Augustina M.A., Kessels, Roy P.C., Hoogma, Roel P.L.M., Henselmans, Johanna M.L., van der Beek Boter, Johanna W., Kappelle, L. Jaap, de Haan, Edward H.F., Biessels, Geert Jan
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.06.2006
• Subjects: Age; Aged; Aged, 80 and over; Atrophy; Biological and medical sciences; Brain - pathology; Brain mapping; Case-Control Studies; Cognition & reasoning; Cognition Disorders - complications; Cognition Disorders - pathology; Cognition Disorders - psychology; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - pathology; Diabetes Mellitus, Type 1 - psychology; Diabetes. Impaired glucose tolerance; Diabetic Retinopathy - etiology; Diabetic Retinopathy - pathology; Diabetic Retinopathy - psychology; Education; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Genetic aspects; Humans; Information processing; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical sciences; Memory; Memory Disorders - complications; Memory Disorders - pathology; Memory Disorders - psychology; Middle Aged; Neuropsychological Tests; Neuropsychology; Risk factors; Surveys and Questionnaires; Type 1 diabetes; Verbal learning; Netherlands; Endocrinopathy; Human; Immunopathology; Type 1 diabetes; Central nervous system; Autoimmune disease; Well being; Nuclear magnetic resonance imaging; Encephalon
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db05-1226

Cognitive Performance, Psychological Well-Being, and Brain Magnetic Resonance Imaging in Older Patients With Type 1 Diabetes Augustina M.A. Brands 1 2 3 , Roy P.C. Kessels 1 3 , Roel P.L.M. Hoogma 4 , Johanna M.L. Henselmans 5 , Johanna W. van der Beek Boter 6 , L. Jaap Kappelle 1 , Edward H.F. de Haan 1 3 and Geert Jan Biessels 1 1 Department of Neurology, University Medical Center, Utrecht, the Netherlands 2 Neuropsychology, Zuwe Hofpoort Hospital/Regional Psychiatric Center, Woerden, the Netherlands 3 Helmholtz Instituut, Utrecht University, Utrecht, the Netherlands 4 Department of Internal Medicine, Groene Hart Hospital, Gouda, the Netherlands 5 Department of Neurology, Zuwe Hofpoort Hospital, Woerden, the Netherlands 6 Department of Internal Medicine, Zuwe Hofpoort Hospital, Woerden, the Netherlands Address correspondence and reprint requests to Augustina M.A. Brands, Neuropsychology, Zuwe Hofpoort, Blekerijlaan 3, 3447 AC Woerden, Netherlands. E-mail: i.brands{at}altrecht.nl Abstract Modest cognitive impairment has been reported in young-adult patients with type 1 diabetes. In older patients with type 2 diabetes, cognitive impairments are more pronounced, which might be due to age but also to differential effects of type 1 diabetes and type 2 diabetes on the brain. This study therefore assessed cognitive performance and magnetic resonance imaging (MRI) of the brain in older type 1 diabetic patients. Forty type 1 diabetic patients (age >50 years) and 40 age-matched control subjects were included. Neuropsychological assessment included all major cognitive domains, and psychological well-being was assessed with questionnaires. Atrophy, white-matter abnormalities, and infarcts were rated on MRI scans. Type 1 diabetic patients performed slightly (effect sizes <0.4) worse on cognitive tasks, but only “speed of information processing” reached statistical significance. No significant between-group differences were found on any of the MRI parameters. Type 1 diabetic patients tended to report more cognitive and depressive problems than control subjects, but this did not correlate with the performance on cognitive tests. We conclude that cognition in older type 1 diabetic patients is only mildly disturbed. Chronic exposure to hyperglycemia is in itself, even at older age, apparently not sufficient to have considerable impact on the brain. BCR, bicaudate ratio BDI-II, Beck Depression Inventory-II BFR, bifrontal ratio CFT, Complex Figure Test DWML, deep white-matter lesion MRI, magnetic resonance imaging PWML, periventricular white-matter lesion WAIS-III, Wechsler Adult Intelligence Scale, third edition WML, white-matter lesion Footnotes This work is presented on behalf of the Utrecht Type 1 Diabetic Encephalopathy Study Group. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Accepted February 22, 2006. Received September 19, 2005. DIABETES