Evaluation of Cognitive Functions in Gestational Diabetes Mellitus

Abstract

Objective: To evaluate the association between cognitive functions and metabolic status in cases with gestational diabetes mellitus (GDM).

Methods: In this study 44 patients with GDM and 45 normal pregnant were included. Depression was evaluated with Beck’s depression inventory (BDI). Cognitive functions were evaluated with Montreal cognitive assessment (MOCA), paced auditory serial addition test (PASAT), spatial recall test (SRT), symbol digit modalities (SDMT), and word list generation (WLG).

Results: The mean gestational age, educational level and account of previous birth of the subjects in the study were not statistically different between the groups. The mean scores of BDI of the 2 groups were not statistically different. MOCA score and SDMT was significantly decreased in GDM in comparison to NP (p=0.005, p=0.04 respectively). Also, SDMT score was inversely correlated with number of pregnancies, postprandial blood glucose and HbA1c.The scores of PASAT, SRT, SPART and WLG were statistically similar between the groups.

Conclusions: Our findings may be a clue for early onset of impairment in cognitive functions in cases with new onset diabetes during pregnancy.

Key words

gestational diabetes - cognitive functions - pregnancy

• References

• 1 Gradman TJ, Laws A, Thompson LW et al. Verbal learning and/or memory improves with glycemic control in older subjects with non-insulin-dependent diabetes mellitus. J Am Geriatr Soc 1993; 41: 1305-1312
• 2 Yaffe K, Blackwell T, Kanaya AM et al. Diabetes, impaired fasting glucose, and development of cognitive impairment in older women. Neurology 2004; 63: 658-663
• 3 Munshi M, Grande L, Hayes M et al. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care 2006; 29: 1794-1799
• 4 Stranahan AM, Norman ED, Lee K et al. Diet-induced insulin resistance impairs hippocampal synaptic plasticity and cognition in middle-aged rats. Hippocampus 2008; 18: 1085-1088
• 5 Moyer VA. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160: 414-420
• 6 Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25: 1862-1868
• 7 Nielsen KK, Kapur A, Damm P et al. From screening to postpartum follow-up – the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth 2014; 14: 41
• 8 Umegaki H, Hayashi T, Nomura H et al. Cognitive dysfunction: an emerging concept of a new diabetic complication in the elderly. Geriatr Gerontol Int 2013; 13: 28-34
• 9 Diagnosis and classification of diabetes mellitus. Diabetes Care 2013; 36 (Suppl. 01) S67-S74
• 10 Metzger BE, Gabbe SG, Persson B et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682
• 11 Metzger BE, Lowe LP, Dyer AR et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991-2002
• 12 Matthews DR, Hosker JP, Rudenski AS et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419
• 13 Hisli N. A study on the validity of Beck Depression Inventory. Turkish Journal of Psychology 1988; 6: 118-123
• 14 Beck AT, Steer RA, Brown GK. Beck Depression Inventory (BDI). Second ed. Rush AJ, First M, Blacker D. (eds.). Washington, DC: American Psychiatric Publishing; 2008
• 15 Boringa JB, Lazeron RH, Reuling IE et al. The brief repeatable battery of neuropsychological tests: normative values allow application in multiple sclerosis clinical practice. Mult Scler 2001; 7: 263-267
• 16 Portaccio E, Goretti B, Zipoli V et al. Reliability, practice effects, and change indices for Rao’s Brief Repeatable Battery. Mult Scler 2010; 16: 611-617
• 17 Nazaribadie M, Amini M, Ahmadpanah M et al. Executive functions and information processing in patients with type 2 diabetes in comparison to pre-diabetic patients. J Diabetes Metab Disord 2014; 13: 27
• 18 Selekler K, Cangoz B, Uluc S. Power of Discrimination of Montreal Cognitive Assessment (MOCA) Scale in Turkish Patients with Mild Cognitive İmpairment and Alzheimer’s Disease. Turkish Journal of Geriatrics 2010; 13: 166-171
• 19 Gronwall DM. Paced auditory serial-addition task: a measure of recovery from concussion. Percept Mot Skills 1977; 44: 367-373
• 20 Buschke H. Selective reminding for analysis of memory and learning. Journal of Verbal Learning and Verbal Behavior 1973; 12: 543-550
• 21 Ehrenreich JH. Normative data for adults on a short form of the Selective Reminding Test. Psychol Rep 1995; 76: 387-390
• 22 Rao SM, Leo GJ, Bernardin L et al. Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology 1991; 41: 685-691
• 23 Drake AS, Weinstock-Guttman B, Morrow SA et al. Psychometrics and normative data for the Multiple Sclerosis Functional Composite: replacing the PASAT with the Symbol Digit Modalities Test. Mult Scler 2010; 16: 228-237
• 24 Brandt J, Manning KJ. Patterns of word-list generation in mild cognitive impairment and Alzheimer’s disease. Clin Neuropsychol 2009; 23: 870-879
• 25 Anderson RJ, Freedland KE, Clouse RE et al. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001; 24: 1069-1078
• 26 Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001; 414: 813-820
• 27 Scuteri A, Tesauro M, Appolloni S et al. Arterial stiffness as an independent predictor of longitudinal changes in cognitive function in the older individual. J Hypertens 2007; 25: 1035-1040
• 28 Ryan CM, Freed MI, Rood JA et al. Improving metabolic control leads to better working memory in adults with type 2 diabetes. Diabetes Care 2006; 29: 345-351
• 29 Wisner KL, Gelenberg AJ, Leonard H et al. Pharmacologic treatment of depression during pregnancy. Jama 1999; 282: 1264-1269
• 30 Robert E. Treatment depression in pregnancy. N Engl J Med 1996; 335: 1056-1058
• 31 Kozhimannil KB, Pereira MA, Harlow BL. Association between diabetes and perinatal depression among low-income mothers. Jama 2009; 301: 842-847
• 32 Nooyens AC, Baan CA, Spijkerman AM et al. Type 2 diabetes and cognitive decline in middle-aged men and women: the Doetinchem Cohort Study. Diabetes Care 2010; 33: 1964-1969
• 33 Brands AM, Biessels GJ, de Haan EH et al. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care 2005; 28: 726-735
• 34 van Harten B, Oosterman J, Muslimovic D et al. Cognitive impairment and MRI correlates in the elderly patients with type 2 diabetes mellitus. Age Ageing 2007; 36: 164-170
• 35 Ruis C, Biessels GJ, Gorter KJ et al. Cognition in the early stage of type 2 diabetes. Diabetes Care 2009; 32: 1261-1265
• 36 Coker LH, Shumaker SA. Type 2 diabetes mellitus and cognition: an understudied issue in women’s health. J Psychosom Res 2003; 54: 129-139
• 37 Stern Y, Gurland B, Tatemichi TK et al. Influence of education and occupation on the incidence of Alzheimer’s disease. Jama 1994; 271: 1004-1010
• 38 Letenneur L, Gilleron V, Commenges D et al. Are sex and educational level independent predictors of dementia and Alzheimer’s disease? Incidence data from the PAQUID project. J Neurol Neurosurg Psychiatry 1999; 66: 177-183
• 39 Garibotto V, Borroni B, Kalbe E et al. Education and occupation as proxies for reserve in aMCI converters and AD: FDG-PET evidence. Neurology 2008; 71: 1342-1349
• 40 Kemppainen NM, Aalto S, Karrasch M et al. Cognitive reserve hypothesis: Pittsburgh Compound B and fluorodeoxyglucose positron emission tomography in relation to education in mild Alzheimer’s disease. Ann Neurol 2008; 63: 112-118
• 41 Angevaren M, Aufdemkampe G, Verhaar HJ et al. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev 2008; CD005381
• 42 Zeki Al Hazzouri A, Vittinghoff E, Byers A et al. Long-term cumulative depressive symptom burden and risk of cognitive decline and dementia among very old women. J Gerontol A Biol Sci Med Sci 2014; 69: 595-601