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Diabetes and Dementia

Image courtesy Praisaeng @http://www.freedigitalphotos.netMore and more information is coming out of the scientific world about the relationship between diabetes and dementia.  A recent article, published online in amednews.com, reports that elderly diabetic patients who also show signs of cognitive decline are at risk of having low blood glucose levels, which serves to worsen their dementia.

In an article published online June 10 in  JAMA Internal Medicine, Dr. Kristine Yaffe, MD (a professor of psychiatry, neurology, and epidemiology, at the University of California at San Francisco), suggested that physicians who have elderly diabetic patients should screen them for dementia.  If they do, indeed, evidence symptoms of cognitive impairment, they should take steps to simplify their diabetic regimen.  In addition, another person (for instance, a family member or close friend) should be included in their treatment plans.

One possible strategy for simplifying a patient’s dementia treatment include reducing the number of medications that the person takes.  Another would be to increase the range of acceptable blood sugar readings that the person may exhibit before further intervention is required.  Dr. Jaffe also suggests that doctors refrain from placing these patients on those diabetic medications which place them at a greater risk for hypoglycemic incidents.  These episodes may cause the person to experience even more cognitive decline, which only pushes them further into a vicious cycle leading to poor diabetic management and/or advanced dementia.

The study reported that elderly persons who are hospitalized for hypoglycemia have double the risk of developing dementia than those who don’t experience a hypoglycemic event.  It may be that a person with dementia has difficulty following his/her physician’s instructions for managing their diabetes.  (For instance, forgetting to take required medication or no longer being able to follow the steps required to check blood sugar levels.  It could be, also, that they lack the problem solving skills to recognize problems when they do occur, or to call for help.)

The previously-mentioned study included 783 adults with diabetes, who were between the ages of 70 and 79 in 1997.  Individuals were excluded from the study if they exhibited symptoms of possible cognitive impairment, had difficulty performing daily activities, or were unable to walk a quarter mile or climb ten steps without resting.  Cognitive impairment, for the purposes of the study, was defined as having a score of less than 80 on the Modified Mini-Mental Status Examination.  The presence of diabetes was determined by self-report, use of hypoglycemia medication, and a fasting blood glucose or two-hour blood glucose tolerance test that met established numerical criteria.  Study participants were then followed for 12 years.

During the interval of the study, 61 participants (7.8%) reported having a hypoglycemic episode, and 148 of them (18.9%) were identified as developing dementia.  34% of those who were hospitalized for hypoglycemia developed dementia, as opposed to 17.6% who developed dementia without having had a hypoglycemic event.  14.2% of study participants with dementia demonstrated a severe hypoglycemic episode, whereas only 6.3% of those who were cognitively healthy did.

It should be noted that researchers adjusted their results to account for stroke, hypertension, and myocardial infarction.  They suggest that further study is needed to determine risk factors and effective management strategies to reduce incidence of hypoglycemia among older adults with cognitive impairments.

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