Download PDF
CC BY-NC-ND 4.0 · Journal of Social Health and Diabetes 2017; 05(01): 047-053
DOI: 10.4103/2321-0656.193996
Original Article
NovoNordisk Education Foundation

The prevalence and predictors of cognitive impairment in type 2 diabetic population of Punjab, India

Shallu Khullar
Department of Human Genetics, Punjabi University, Patiala, Punjab, India
,
Gurpreet Kaur
Department of Human Genetics, Punjabi University, Patiala, Punjab, India
,
Harjot Dhillon
Department of Human Genetics, Punjabi University, Patiala, Punjab, India
,
Ritu Sharma
Department of Human Genetics, Punjabi University, Patiala, Punjab, India
,
Kanchan Mehta
Department of Human Genetics, Punjabi University, Patiala, Punjab, India
,
Monica Singh
Department of Human Genetics, Punjabi University, Patiala, Punjab, India
,
Puneetpal Singh
Department of Human Genetics, Punjabi University, Patiala, Punjab, India
› Author Affiliations
Further Information

Publication History

Publication Date:
23 November 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Background: The present cross sectional study was carried out on 516 subjects with type 2 diabetes from a tertiary health care hospital to identify the prevalence and predictors of cognitive impairment in diabetes.

Materials and Methods: Cognitive impairment was tested using Mini Mental Scale Examination (MMSE), Trail making tests-A and B (TMT-A and TMT-B). Efficiency of these tests to diagnose cognitive impairment was analysed using reliability index (Cronbach's α = 0.82), which ruled out any internal inconsistency. Of the study participants, 174 (33.73%) met the criteria for cognitive impairment and 342 (66.27%) were having normal cognition. Out of 174, 156 diabetic subjects (89.65 percent) were not diagnosed for neurocognitive impairment prior participation.

Results: Cognitive impairment was observed to be strongly associated with being a woman (P < 0.001), divorced or separated (P = 0.007), sedentary life style (P = 0.001), smoking (P < 0.001), drinking alcohol (P < 0.001), systolic blood pressure >120 mmHg (P = 0.003), triglycerides (TG) >150 mg/dl (P = 0.001), high density lipoprotein <40 mg/dl (P = 0.001), statin use (P = 0.009), waist hip ratio in both males and females (P = 0.001), glucose levels >125 mg/dl (P = 0.005) and duration of diabetes >2 years upto 10 years and more than 10 years (P = 0.001) in univariate testing. In multivariate logistic regression model, being a woman was an independent risk factor for cognitive decline, which is two fold higher (OR 2.00 95%CI 1.25-3.20, P = 0.004) than being a man. Other risk factors like glucose levels > 125 mg/dl, systolic blood pressure >120 mmHg, sedentary life style and duration of diabetes >10 years emerged as independent predictors of cognitive impairment in diabetes.

Conclusion: In conclusion, the present study revealed that higher prevalence of cognitive impairment in diabetes is evident in population of Punjab, especially in women and majority of these patients remain undiagnosed for it.

Cognition - India - prevalence - Punjab - type 2 diabetes
 

  • References

  • 1 Singh P, Khullar S, Singh M, Kaur G, Mastana S. Diabetes to cardiovascular disease: Is depression the potential missing link?. Med Hypotheses 2015; 84: 370-378
    CrossrefPubMedGoogle Scholar
  • 2 Awad N, Gagnon M, Messier C. The relationship between impaired glucose tolerance, type 2 diabetes, and cognitive function. J Clin Exp Neuropsychol 2004; 26: 1044-1080
    CrossrefPubMedGoogle Scholar
  • 3 Luchsinger JA, Reitz C, Patel B, Tang MX, Manly JJ, Mayeux R. Relation of diabetes to mild cognitive impairment. Arch Neurol 2007; 64: 570-575
    PubMedGoogle Scholar
  • 4 Saczynski JS, Jónsdóttir MK, Garcia ME, Jonsson PV, Peila R, Eiriksdottir G. et al. Cognitive impairment: An increasingly important complication of type 2 diabetes: The age, gene/environment susceptibility — Reykjavik study. Am J Epidemiol 2008; 168: 1132-1139
    CrossrefPubMedGoogle Scholar
  • 5 Elias PK, Elias MF, D'Agostino RB, Cupples LA, Wilson PW, Silbershatz H. et al. NIDDM and blood pressure as risk factors for poor cognitive performance. The Framingham Study. Diabetes Care 1997; 20: 1388-1395
    CrossrefPubMedGoogle Scholar
  • 6 Stewart R, Liolitsa D. Type 2 diabetes mellitus, cognitive impairment and dementia. Diabet Med 1999; 16: 93-112
    CrossrefPubMedGoogle Scholar
  • 7 Strachan MW, Deary IJ, Ewing FM, Frier BM. Is type II diabetes associated with an increased risk of cognitive dysfunction. A critical review of published studies?. Diabetes Care 1997; 20: 438-445
    CrossrefPubMedGoogle Scholar
  • 8 Ott A, Stolk RP, Hofman A, van Harskamp F, Grobbee DE, Breteler MM. Association of diabetes mellitus and dementia: The Rotterdam Study. Diabetologia 1996; 39: 1392-1397
    CrossrefPubMedGoogle Scholar
  • 9 Yoshitake T, Kiyohara Y, Kato I, Ohmura T, Iwamoto H, Nakayama K. et al. Incidence and risk factors of vascular dementia and Alzheimer's disease in a defined elderly Japanese population: The Hisayama Study. Neurology 1995; 45: 1161-1168
    CrossrefPubMedGoogle Scholar
  • 10 Grodstein F, Chen J, Wilson RS, Manson JE. Type 2 diabetes and cognitive function in community-dwelling elderly women. Diabetes Care 2001; 24: 1060-1065
    CrossrefPubMedGoogle Scholar
  • 11 Stegmayr B, Asplund K. Diabetes as a risk factor for stroke. A population perspective. Diabetologia 1995; 38: 1061-1068
    CrossrefPubMedGoogle Scholar
  • 12 de la Monte SM, Wands JR. Alzheimer's disease is type 3 diabetes-evidence reviewed. J Diabetes Sci Technol 2008; 2: 1101-1113
    CrossrefPubMedGoogle Scholar
  • 13 American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2012; 30: S11-S63
    Google Scholar
  • 14 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198
    CrossrefPubMedGoogle Scholar
  • 15 Tsolaki M, Iakovidou V, Navrozidou H, Aminta M, Pantazi T, Kazis A. Hindi mental state examination (HMSE) as a screening test for illiterate demented patients. Int J Geriatr Psychiatry 2000; 15: 662-664
    CrossrefPubMedGoogle Scholar
  • 16 Reitan RM. The validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 1958; 8: 271-276
    CrossrefGoogle Scholar
  • 17 Aggarwal OP, Bhasin SK, Sharma AK, Chhabra P, Aggarwal K, Rajoura OP. A new instrument (scale) for measuring the socioeconomic status of a family: Preliminary study. Indian J Community Med 2005; 30: 111-114
    Google Scholar
  • 18 Ho SC, Woo J, Sham A, Chan SG, Yu AL. A 3-year follow-up study of social, lifestyle and health predictors of cognitive impairment in a Chinese older cohort. Int J Epidemiol 2001; 30: 1389-1396
    CrossrefPubMedGoogle Scholar
  • 19 Irvine K, Laws KR, Gale TM, Kondel TK. Greater cognitive deterioration in women than men with Alzheimer's disease: A meta analysis. J Clin Exp Neuropsychol 2012; 34: 989-998
    CrossrefPubMedGoogle Scholar
  • 20 Yu ES, Liu WT, Levy P, Zhang MY, Katzman R, Lung CT. et al. Cognitive impairment among elderly adults in Shanghai, China. J Gerontol 1989; 44: S97-S106
    CrossrefPubMedGoogle Scholar
  • 21 Solanki RK, Dubey V, Munshi D. Neurocognitive impairment and comorbid depression in patients of diabetes mellitus. Int J Diabetes Dev Ctries 2009; 29: 133-138
    CrossrefPubMedGoogle Scholar
  • 22 Allen KV, Frier BM, Strachan MW. The relationship between type 2 diabetes and cognitive dysfunction: Longitudinal studies and their methodological limitations. Eur J Pharmacol 2004; 490: 169-175
    CrossrefPubMedGoogle Scholar
  • 23 Ryan CM, Freed MI, Rood JA, Cobitz AR, Waterhouse BR, Strachan MW. Improving metabolic control leads to better working memory in adults with type 2 diabetes. Diabetes Care 2006; 29: 345-351
    CrossrefPubMedGoogle Scholar
  • 24 Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV. et al. Current concepts in mild cognitive impairment. Arch Neurol 2001; 58: 1985-1992
    CrossrefPubMedGoogle Scholar
  • 25 Coker LH, Shumaker SA. Type 2 diabetes mellitus and cognition: An understudied issue in women's health. J Psychosom Res 2003; 54: 129-139
    CrossrefPubMedGoogle Scholar
  • 26 Yaffe K, Blackwell T, Kanaya AM, Davidowitz N, Barrett-Connor E, Krueger K. Diabetes, impaired fasting glucose, and development of cognitive impairment in older women. Neurology 2004; 63: 658-663
    CrossrefPubMedGoogle Scholar
  • 27 Kalmijn S, Feskens EJ, Launer LJ, Stijnen T, Kromhout D. Glucose intolerance, hyperinsulinaemia and cognitive function in a general population of elderly men. Diabetologia 1995; 38: 1096-1102
    CrossrefPubMedGoogle Scholar
  • 28 Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME. et al. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: The action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care 2009; 32: 221-226
    CrossrefPubMedGoogle Scholar
  • 29 Ebady SA, Arami MA, Shafigh MH. Investigation on the relationship between diabetes mellitus type 2 and cognitive impairment. Diabetes Res Clin Pract 2008; 82: 305-309
    CrossrefPubMedGoogle Scholar
  • 30 Bruehl H, Wolf OT, Convit A. A blunted cortisol awakening response and hippocampal atrophy in type 2 diabetes mellitus. Psychoneuroendocrinology 2009; 34: 815-821
    CrossrefPubMedGoogle Scholar
  • 31 Scott RD, Kritz-Silverstein D, Barrett-Connor E, Wiederholt WC. The association of non-insulin-dependent diabetes mellitus and cognitive function in an older cohort. J Am Geriatr Soc 1998; 46: 1217-1222
    CrossrefPubMedGoogle Scholar
  • 32 Gottesman RF, Rawlings AM, Sharrett AR, Albert M, Alonso A, Bandeen-Roche K. et al. Impact of differential attrition on the association of education with cognitive change over 20 years of follow-up: The ARIC neurocognitive study. Am J Epidemiol 2014; 179: 956-966
    CrossrefPubMedGoogle Scholar
  • 33 Böhm M, Schumacher H, Leong D, Mancia G, Unger T, Schmieder R. et al. Systolic blood pressure variation and mean heart rate is associated with cognitive dysfunction in patients with high cardiovascular risk. Hypertension 2015; 65: 651-661
    CrossrefPubMedGoogle Scholar
  • 34 Sink KM, Espeland MA, Rushing J, Castro CM, Church TS, Cohen R. et al. The LIFE Cognition Study: Design and baseline characteristics. Clin Interv Aging 2014; 9: 1425-1436
    PubMedGoogle Scholar
  • 35 Loprinzi PD, Kane CJ. Exercise and cognitive function: A randomized controlled trial examining acute exercise and free-living physical activity and sedentary effects. Mayo Clin Proc 2015; 90: 450-460
    CrossrefPubMedGoogle Scholar
  • 36 Gregg EW, Yaffe K, Cauley JA, Rolka DB, Blackwell TL, Narayan KM. et al. Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group. Arch Intern Med 2000; 160: 174-180
    CrossrefPubMedGoogle Scholar
  • 37 Fontbonne A, Berr C, Ducimetière P, Alpérovitch A. Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: Results of the epidemiology of vascular aging study. Diabetes Care 2001; 24: 366-370
    CrossrefPubMedGoogle Scholar
  • 38 Hazari MA, Reddy BR, Uzma N, Kumar BS. Cognitive impairment in type 2 diabetes mellitus. Int J Diabetes Mellit 2015; 3: 19-24
    CrossrefGoogle Scholar