Abstract
Older people with type 2 diabetes are at increased risk of developing cognitive impairment, for which several potential risk factors have been proposed. The present article reviews evidence in people with type 2 diabetes for associations of cognitive impairment with a range of vascular, metabolic, and psychosocial risk factors, many of which have a higher prevalence in people with type 2 diabetes than in non-diabetic adults of a similar age. Definitive research studies in this field are few in number. The risk factors may be involved in causal pathways or may act as useful markers of cerebrovascular damage (or both), and for which relatively consistent evidence is available, include poor glycemic control, hypoglycemia, microvascular disease, inflammation, and depression. For macrovascular disease, the strength of the association with cognitive impairment appears to depend on which vascular system has been examined. A role for pre-morbid ability in young adulthood as influencing the risk of both diabetes and cognitive impairment has also been suggested. The importance of considering inter-relationships between risk factors when investigating their potential contribution to cognitive impairment in future investigations is discussed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-015-0130-5) contains supplementary material, which is available to authorized users.
Highlights
The global pandemic of diabetes is exerting an everincreasing burden on health-care systems
Diabetes, which is characterized by chronic hyperglycemia, appears to be associated with an increased risk of developing Alzheimer’s disease (AD) and vascular dementia (VaD), both in the general population [1] and in people who have already been diagnosed with a milder form of age-related cognitive impairment [2]
In the Edinburgh Type 2 Diabetes Study (ET2DS) of more than 1,000 adults between 60 and 75 years of age, a history of severe hypoglycemia was associated with lower cognitive function when the estimated pre-morbid cognitive function before exposure to hypoglycemia was compared with post-hypoglycemia cognitive function, with evidence of an acceleration of late-life cognitive decline that was independent of the potential influence of further episodes of hypoglycemia [38] (Fig. 2)
Summary
The global pandemic of diabetes is exerting an everincreasing burden on health-care systems. Diabetes, which is characterized by chronic hyperglycemia, appears to be associated with an increased risk of developing Alzheimer’s disease (AD) and vascular dementia (VaD), both in the general population [1] and in people who have already been diagnosed with a milder form of age-related cognitive impairment (mild cognitive impairment) [2]. Dyslipidemia dyslipidemia is common in type 2 diabetes, few observational studies have examined whether an association exists between plasma lipid concentrations and cognitive function (Table 1). Two investigations even reported protective effects: in one cross-sectional study, dislipidemia was associated with better performance on a task of processing speed [13], and higher total cholesterol was found to decrease the risk of subsequent cognitive impairment short of dementia during an 8-year period in the Fremantle Diabetes Study [14]. Hypertension Hypertension is common in people with type 2 diabetes and, in general, has received more attention than
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