Cognitive Performance in Middle-Aged Adults with Type 2 Diabetes: Normative Comparisons and Associations with Medical and Psychological Variables.

Effects of an acute bout of localized resistance exercise on cognitive performance in middle-aged adults: A randomized controlled trial study

Sedentary behavior is increasingly recognized as a risk factor for various health issues, including cognitive decline. Objectives: This pilot study examined the acute and chronic effects of workplace-integrated exercise snacks—short, vigorous bouts of exercise—on cognitive performance in middle-aged adults. Methods: Twenty-five sedentary but healthy office workers (51.4 ± 5.3 years; 6 m/19 f) participated. The intervention group (n = 12) performed three 1 min bouts of vigorous exercise (running on the spot) daily, four days a week, for four weeks, while the control group (n = 13) maintained their usual routine. Cognitive performance was assessed pre-intervention, shortly following the first exercise bout (acute effects), and post-intervention (chronic effects) using the Trail Making Test and the Stroop Color–Word Test. Results: Significant acute improvements (p ≤ 0.05) were observed across all cognitive outcomes following a single bout of exercise. Significant interaction effects (p ≤ 0.05) were found across all cognitive outcomes after four weeks, indicating sustained cognitive benefits. Conclusion: These findings suggest that workplace-integrated brief, vigorous exercise may lead to both immediate and sustained enhancement in executive functions such as working memory, processing speed, and inhibitory control. They highlight the potential cognitive health benefits of incorporating exercise snacks into sedentary workplace environments.

Objective To investigate the cross-sectional association between depressive symptoms and metabolic risk factors with cognitive function in a middle-aged population. Methods A stratified subsample of the CARTaGENE (CaG) cohort (n = 1991) was used to compare cognitive function outcomes between groups. The stratification was based on the presence of depressive symptoms and metabolic dysregulation (MetD): the presence of a) neither condition (reference group); b) MetD only; c) depressive symptoms only; and d) both depressive symptoms and MetD. Individuals with type 2 diabetes were excluded. Three cognitive domains were assessed: processing speed, episodic memory, and executive function. An overall cognitive function score, standardized for age and education, was computed. Poor cognitive function was defined as the lower quartile of the overall cognitive function distribution. Linear and logistic regression analyses were conducted. Results The poorest cognitive performance was observed in the group with both depressive symptoms and MetD, followed by the group with depressive symptoms only, then the group with MetD only and the reference group. Mean (SD) overall cognition scores for the four groups were −0.25 (1.13), −0.13 (1.05), 0.11 (0.90), and 0.15 (0.93), respectively. Linear regression analyses suggested a linear increase in cognitive function across groups. In the logistic regression analyses, the highest risk of poor cognitive function was observed in the comorbid (depressive symptoms and MetD) group (adjusted OR = 1.99, 95% CI 1.46, 2.71). Conclusion Comorbidity of depressive symptoms and MetD was associated with reduced cognitive performance in middle-aged adults without diabetes. KEY POINTS Poor cognitive function is a major public health concern and can be potentially prevented by targeting its modifiable risk factors. Metabolic dysregulation and depression have both been independently associated with poor cognitive function. Comorbidity of metabolic dysregulation and depressive symptoms is associated with an increased risk of poor cognitive function in middle-aged individuals. Future health interventions might benefit by screening for comorbidity in patients with poor cognitive function and by targeting depression and metabolic dysregulation together.

Midlife Type 2 Diabetes Mellitus (T2DM) is associated with a greater risk of dementia in later life. Peripheral inflammation and its impact on cognition is proposed as one of the pathological mechanisms mediating this link. However, studies have primarily focused on older individuals with established cognitive impairment and a long duration of T2DM. Importantly, knowledge of which individuals with midlife T2DM who are at greatest risk of later cognitive decline is lacking. We examined the cross-sectional relationship between serum levels of 8 pro-inflammatory markers (IL-1β, IL-6, TNF-α, IL-8, MCP-1, CXCL10, IL-12p70, CRP) and performance on a detailed neuropsychological assessment battery in middle-aged adults with uncomplicated T2DM (N = 89; 52 ± 8.1 years, 47% female) and matched healthy controls (N = 50; 52 ± 8.3 years, 59% female). Linear regression was used to analyze associations between serum markers and cognitive performance in the overall cohort, followed by a T2DM∗protein concentration interaction analysis to identify any T2DM-specific effects. We observed a significant T2DM-specific association between serum TNF-α levels and scores on the Paired Associates Learning (PAL) task (β: −3.16, SE: 1.32, p = 0.01, Std. Beta: −0.94), a task with significant working memory demands previously implicated in T2DM-related cognitive dysfunction. However, this did not persist on controlling for multiple testing. We provide exploratory evidence for a significant T2DM-specific relationship between serum TNF-α and memory performance. These findings require further replication and longitudinal analysis with the aim of selecting-out individuals with midlife T2DM at risk of future cognitive decline for potential preventative interventions.

PurposeResearch has demonstrated cognitive benefits following acute polyphenol-rich berry consumption in children and young adults. Berry intake also has been associated with metabolic benefits. No study has yet examined cognitive performance in middle-aged adults. We investigated the relationships among cognitive and metabolic outcomes in middle-aged adults following wild blueberry (WBB) consumption.MethodsThirty-five individuals aged 40–65 years participated in a randomized, double blind, cross-over study. Participants consumed a breakfast meal and 1-cup equivalent WBB drink or matched placebo beverage on two occasions. Participants completed cognitive tasks and had blood drawn before and at regular intervals for 8 h after each meal/treatment. Changes in episodic memory and executive function (EF) were assessed alongside plasma levels of glucose, insulin, and triglyceride.ResultsAnalysis of the memory-related Auditory Verbal Learning Task (AVLT) word recognition measure revealed a decrease in performance over the test day after placebo intake, whereas performance after WBB was maintained. For the AVLT word rejection measure, participants identified more foils following WBB in comparison to placebo. Benefits were also observed for EF on the Go/No-Go task with fewer errors following WBB intake on cognitively demanding invalid No-Go trials in comparison to placebo. Furthermore, in comparison to placebo, response times were faster for the Go/No-Go task, specifically at 4 h and 8 h following WBB treatment. We also observed reduced post-meal glucose and insulin, but not triglyceride, concentrations in comparison to placebo over the first 2 h following ingestion. Though the addition of Age, BMI, glucose and insulin as covariates to the analysis reduced the significant effect of beverage for AVLT word rejection, metabolic outcomes did not interact with treatment to predict cognitive performance with the exception of one isolated trend.ConclusionsThis study indicated acute cognitive benefits of WBB intake in cognitively healthy middle-aged individuals, particularly in the context of demanding tasks and cognitive fatigue. WBB improved glucose and insulin responses to a meal. Further research is required to elucidate the underlying mechanism by which WBB improves cognitive function.

Declining grip strength is an indicator of cognitive loss in older individuals but it has not been explored people younger than 65 years old. The purpose of this study was to investigate the relationship between grip strength and specific cognitive tests known to decline with mild cognitive impairment in young and middle-aged adults. Declines in cognitive performance in middle-aged adults may provide evidence that these changes occur earlier than previously reported. A cross sectional design was used to compare differences between young and middle-aged healthy adults and to investigate associations between cognitive and grip strength measures within groups. Healthy young (20–30 years old) and middle-aged (45–65 years old) adults completed five cognitive tests including the Stroop, California Verbal Learning Test, Symbol Digit Modalities Test, Trail Making Tests and the Controlled Oral Word Association Test. All participants completed right and left maximum grip strength measures. Middle-aged adults performed significantly worse on right and left grip strength and the Stroop test (p<0.05) when compared to the younger group. There were no significant relationships among grip strength and cognitive performance at the whole-group level or within the younger-age group; however, weaker grip strength was significantly associated with poorer Controlled Oral Word Association Test total cluster (r = 0.458; p < .05) and Stroop interference (r = 0.471; p < .05) scores in the middle-aged group. Findings from this study suggest that cognitive changes may occur earlier than previously thought (prior to age 65). Weaker grip strength was significantly associated with poorer function in two of the cognitive measures in the middle-age group, suggesting that some domains of cognition, specifically semantic categorization and executive function, may be particularly sensitive to age-related changes.

Cognitive performance includes the processes of attention, memory, processing speed, and executive functioning, which typically declines with aging. Previous research has demonstrated that aerobic and resistance exercise improves cognitive performance immediately following exercise. However, there is limited research examining the effect that a cognitively complex exercise such as martial art training has on these cognitive processes. Our study compared the acute effects of 2 types of martial art training to aerobic exercise on cognitive performance in middle-aged adults. We utilized a repeated measures design with the order of the 3 exercise conditions randomly assigned and counterbalanced. Ten recreational middle-aged martial artists (mean age = 53.5 ± 8.6 years) participated in 3 treatment conditions: a typical martial art class, an atypical martial art class, and a one-hour walk at a self-selected speed. Cognitive performance was assessed by the Stroop Color and Word test. While all 3 exercise conditions improved attention and processing speed, only the 2 martial art conditions improved the highest order of cognitive performance, executive function. The effect of the 2 martial art conditions on executive function was not different. The improvement in executive function may be due to the increased cortical demand required by the more complex, coordinated motor tasks of martial art exercise compared to the more repetitive actions of walking.

IntroductionWhile previous studies have examined the link between Type 2 Diabetes Mellitus (T2DM) and cognitive function in middle-aged adults, no review has explored the long-term effects on cognition of T2DM when diagnosed at midlife. This review aims to investigate any association between T2DM and its metabolic correlates during midlife and measures of cognitive function, spanning from midlife into later life.MethodsElectronic databases (EMBASE, Medline, CINAHL, Web of Science) were explored from their establishment until December 2023 to identify studies exploring the link between T2DM in midlife (40–65 years) and cognitive function. T2DM was defined based on ESC and AHA criteria, encompassing diabetes status, FBG, HbA1c levels, and MetS presence. Cognitive function in mid and/or later life was categorised into functioning sub-domains, with tests selected to reflect predominant cognitive functions utilised. A random-effects meta-analysis was performed, and study quality assessed using the AXIS tool.ResultsWe included 151 studies of moderate to high quality. Studies were independently screened in a step-by-step process, with a subset of studies that met the criteria selected for inclusion in a meta-analysis. Due to limited availability of raw data for cognitive measures at later life, meta-analysis was conducted on studies assessing cognitive function at midlife only. In the case of later life, the majority of longitudinal studies reported negative relationships between midlife T2DM and cognitive function, specifically in the modalities of executive function and global cognition; findings for memory were conflicting. Qualitive assessment of 107 studies where cognitive function was assessed at midlife found no association between it and midlife T2DM. However, meta-analysis of 10 studies revealed a negative impact of T2DM on memory (MD = −0.19; 95% CI = −0.26 to −0.11; I2 = 25%), executive function (MD = −0.14; 95% CI = −0.25 to −0.04; I2 = 0%), and global cognition (MD = −0.26; 95% CI = −0.34 to −0.17; I2 = 0%).DiscussionThis study highlights the impact of midlife T2DM on a variety of cognitive domains from midlife onwards, suggesting that timely diagnosis of T2DM and its careful management may be an important strategy in preserving cognitive function through the lifespan. Given the contrast in results from qualitative and quantitative analysis that we report in the case of midlife cognitive function, we also emphasise the value of combining both methodological approaches where possible.

Investigate the independent associations of objectively measured or self-reported physical activity at different intensities with cognitive performance in middle-aged adults. Cross-sectional. 156 middle-aged adults (age: 40.6 ± 1.5, 58.3% female) participated in the physical activity sub-study of the Personality and Total Health through life (PATH) project. Physical activity was measured objectively with the SenseWear™ armband (SWA), worn for seven consecutive days, and measured via self-report with a Physical Activity Recall survey (PAR). Cognitive performance was assessed with the Symbol Digit Modalities Test, the Digit Span Backwards, and an Immediate and Delayed Recall task. Associations between physical activity intensity and cognitive function were investigated in general linear models, controlling for age, sex, and education. Neither objectively measured nor self-reported physical activity were associated with cognitive function at light-, moderate-, vigorous-, or combined moderate-to-vigorous intensity in this cohort of well educated, healthy middle-aged adults. Sensitivity analyses with additional moderators (e.g., body mass index, hypertension, alcohol intake) and the use of composite cognitive measures did not alter the results. In this cohort of middle-aged adults, objectively measured and self-reported physical activity do not appear to be associated with cognitive function. Longitudinal follow-ups utilising objective physical activity measures may be important in determining the impact of mid-life behaviours on the trajectory of cognitive changes into older age.

Type 2 Diabetes Mellitus (T2DM) in midlife is associated with a greater risk of dementia in later life. Both gait speed and spatiotemporal gait characteristics have been associated with later cognitive decline in community-dwelling older adults. Thus, the assessment of gait characteristics in uncomplicated midlife T2DM may be important in selecting-out those with T2DM at greatest risk of later cognitive decline. We assessed the relationship between Inertial Motion Unit (IMUs)-derived gait characteristics and cognitive function assessed via Montreal Cognitive Assessment (MoCA)/detailed neuropsychological assessment battery (CANTAB) in middle-aged adults with and without uncomplicated T2DM using both multivariate linear regression and a neural network approach. Gait was assessed under (i) normal walking, (ii) fast (maximal) walking and (iii) cognitive dual-task walking (reciting alternate letters of the alphabet) conditions. Overall, 138 individuals were recruited (n = 94 with T2DM; 53% female, 52.8 ± 8.3 years; n = 44 healthy controls, 43% female, 51.9 ± 8.1 years). Midlife T2DM was associated with significantly slower gait velocity on both slow and fast walks (both p < 0.01) in addition to a longer stride time and greater gait complexity during normal walk (both p < 0.05). Findings persisted following covariate adjustment. In analyzing cognitive performance, the strongest association was observed between gait velocity and global cognitive function (MoCA). Significant associations were also observed between immediate/delayed memory performance and gait velocity. Analysis using a neural network approach did not outperform multivariate linear regression in predicting cognitive function (MoCA) from gait velocity. Our study demonstrates the impact of uncomplicated T2DM on gait speed and gait characteristics in midlife, in addition to the striking relationship between gait characteristics and global cognitive function/memory performance in midlife. Further studies are needed to evaluate the longitudinal relationship between midlife gait characteristics and later cognitive decline, which may aid in selecting-out those with T2DM at greatest-risk for preventative interventions.

Assessing risk factors exposure, such as stress in the workplace during adulthood, may contribute to detecting early signs of cognitive impairment in order to implement effective actions to improve brain health and consequently to decrease cognitive disorders later in life. In this cross-sectional study, we aimed to investigate whether work-related stress is associated with low cognitive performance in middle-aged adults from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and whether social support mediates this relationship. Work-related stress was evaluated in 9,969 workers using the Demand-Control-Support Questionnaire. Cognitive function was assessed using the verbal fluency, trail-making version B, and delayed recall word tests. Work-related stress was associated with lower performance on the delayed recall, verbal fluency, and executive function tests in middle-aged adults. Social support may mediate the association between work demands and cognitive performance. These findings support that work-related stress is associated with cognitive performance during adulthood.

Background Diabetes mellitus is a chronic metabolic disorder characterized by increased level of blood sugar for a prolonged period of time. Apart from its impact on the bodily functions, the disorder has its own psychological consequences, commonly in terms of stress reaction, anxiety, and depression. Diabetes is also known to affect cognitive functions, but it is less studied in the Indian population and relatively ignored in the management plan. Discerning the cognitive functions in middle-aged adults diagnosed with diabetes can give valuable insight into comprehensive management of the disorder. With this background, the study attempted to explore the cognitive functioning and psychological well-being of middle-aged adults with diabetes and compared with healthy individuals. Methods A total of 30 middle-aged adults of both sexes diagnosed with diabetes type 2 were undertaken for the study and compared with 30 healthy adults regarding measures of cognitive functioning and psychological well-being. The measures were also explored for relationship if any with illness duration. Results Middle-aged adults with diabetes differed significantly in terms of response inhibition and processing speed compared with healthy controls. The groups significantly differed on subjective Psychological well-being in terms of self-control, anxiety and depression, and vitality. Duration of illness was found to be related to anxiety symptoms. Conclusion Diabetes affects response inhibition and processing speed in middle-aged adults. Assessing and addressing impairment in cognitive functions is recommended for a comprehensive management of diabetes in middle-aged adults.

To assess the cross-sectional association of dietary and supplemental antioxidant (carotenoids, vitamins C and E) intake with cognitive function in 12 187 individuals, aged 48-67 years, participating in the Atherosclerosis Risk in Communities (ARIC) Study. Dietary intake of antioxidant vitamins, as assessed by a food frequency questionnaire, and use of supplements were analysed in relation to the results of three cognitive tests, the delayed word recall test, the Wechsler adult intelligence scale, revised (WAIS-R) digit symbol subtest and the word fluency test. After adjustment for covariates previously found to be associated with cognition in this sample, we found no consistent associations between dietary antioxidant vitamin intake or supplement use and any of the cognitive tests. This study suggests little, if any, association between antioxidant vitamin intake and better cognitive function in middle-aged adults.

Objective: Carotid flow velocity and peripheral blood pressure were independently associated with cognitive function among the elderly population, but unknown among middle-aged adults. We aimed to investigate the association between carotid hemodynamics and cognitive performance among the middle-age population. Design and method: A total of 490 middle-age adults (between 30 and 60 years) participated in the ongoing survey (2017–2020) of the Cardiovascular Disease Risk Factors two-Township study and received the Montreal Cognitive Assessment (MOCA) to evaluate the global cognitive function. Carotid-formal pulse wave velocity (cf-PWV) was measured using carotid and femoral arterial tonometry. Carotid vascular resistance was calculated by mean carotid pressure divided into mean carotid volume flow. Results: MOCA levels were similar between men and women (27.1 vs. 27.2, p = 0.6036). Age(r = -0.22, P &lt; 0.001), and education(r = 0.39, p &lt; 0.001) were associated with MOCA. Controlled for age, gender and education, peak systolic velocity (r = 0.077 @left; r = 0.012@Right, all p &gt; 0.05), end diastolic velocity (r = 0.029, r = -0.062, all p &gt; 0.05), mean flow (r = 0.060; r = -0.038, all p &gt; 0.05), carotid resistive index (r = 0.020, r = 0.05, all p &gt; 0.05), carotid pulsatility(r = 0.015; r = 0.058; p &gt; 0.05), diameter(r = 0.060; r = -0.008, all p &gt; 0.05) at both sides were not associated with MOCA. Only carotid vascular resistance (CVR) at left side was associated with MOCA (r = -0.158, p = 0.0010), but not at right carotid artery (r = -0.030, p = 0.5369). CVR@Left (standard beta = -0.144; p = 0.0022) remains associated with MOCA in the multivariable with further controlling glucose, low density lipoprotein and carotid-formal pulse wave velocity. Those with top, 2nd and 3th quartile of CVR@left had 2.4-fold [Odds Ratio = 2.40; 95% confidence intervals = 1.14–5.04], 1.95-fold(1.95;0.93–4.07) and 0.99-fold (0.99;0.45–2.17) risk for poor cognitive performance (MOCA &lt; 26), compared to those with lowest quartile of CVR@left in the multivariable model. Conclusions: Carotid vascular resistance is a marker of cerebrovascular resistance and associated with cognitive performance in middle-aged adults.

BackgroundPrevious studies have shown associations between the use of anticholinergics (AC) and cognitive performance in the elderly, considering AC as a homogeneous set of drugs. The present study aims to...