Executive Function and Diabetes: A Clinical Neuropsychology Perspective.

Qian Zhao,Weiwen Wang,Xiaoyang Liao,Yonggang Zhang

doi:10.3389/fpsyg.2020.02112

Abstract

ObjectiveDiabetes is a global public health concern. Management of diabetes depends on successful implementation of strategies to alleviate decline in executive functions (EFs), a characteristic of diabetes progression. In this review, we describe recent research on the relationship between diabetes and EF, summarize the existing evidence, and put forward future research directions and applications.MethodsHerein, we provide an overview of recent studies, to elucidate the relationship between DM and EF. We identified new screening objectives, management tools, and intervention targets for diabetes management. We also discuss the implications for clinical practice.ResultsIn both types 1 and 2 diabetes mellitus (DM), hyperglycemia substantially impairs EF in people of all age groups and ethnicities. Hypoglycemia can similarly impair EF. Interestingly, a decline in EF contributes to DM progression. Glucose dysregulation and EF decline exacerbate each other in a vicious cycle: poor blood glucose control, impaired EF, diabetes management task failure, then back to poor blood glucose control. Many pathophysiological indexes (e.g., obesity, metabolic index, inflammatory and immune factors), neuropsychological indexes (e.g., compliance, eating habits, physical exercise, sleep, and depression), and genetic factors are changed by this pathological interaction between DM and EF. These changes can provide insight into the pathophysiological mechanisms of diabetes-related EF decline.ConclusionFurther studies, including large-scale prospective and randomized controlled trials, are needed to elucidate the mechanism of the interaction between diabetes and EF and to develop novel strategies for breaking this cycle.

Highlights

Executive function (EF), an important component of cognitive function, has been the focus of much research in recent years, given its close relationship with chronic non-infectious diseases (Perry et al, 2019)
Whereas the connection between hyperglycemia and EF decline remain unclear, based on the limited number of studies published to date, we propose that the following pathogenetic mechanisms may underlie this link: (1) High glucose levels directly induce neuronal apoptosis (Liu Z. et al, 2019)
Theoretical models of the relationship between EF and diabetes are not yet fully developed, but we can create a schematic of the relationship between the two in comprehensive analysis of numerous research findings

Summary

Introduction

Executive function (EF), an important component of cognitive function, has been the focus of much research in recent years, given its close relationship with chronic non-infectious diseases (Perry et al, 2019). Cognitive function includes all aspects of intellectual and thinking activities, encompassing reasoning, memory, attention, language, and information processing, which are necessary for performing. EF involves a comprehensive series of advanced cognitive activities that are defined as “one’s ability to plan, initiate, sequence, monitor, and inhibit complex behavior” in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. EFs generally refer to two different levels of cognitive behavior series. EF involve a relatively primary cognitive process, including the effective control of thinking and behavior in the process of achieving goals; on the other hand, EF involve a relatively complex and comprehensive cognitive process, such as task sequencing, problem solving, strategy selection, and so on. EFs are compromised in chronic diseases such as diabetes. Similar factors exist in the interaction between EFs and diabetes

Methods

Results

Conclusion