Topic 8 - diabetes

Question 1

What is type 1 diabetes?

Answer 1

an endocrine disorder of insulin deficiency secondary to pancreatic beta cell destruction (insulin dependent diabetes)

Question 2

What is the effect of exogenous insulin replacement in T1D?

Answer 2

Exogenous insulin replacement is imperfect and results in variable blood glucose levels with risk of hyperglycemia or hypoglycemia

Question 3

In T1D, chronic exposure to hyperglycemia is related to …

Answer 3

micro- and macrovascular damage which relate to reduced psychomotor efficiency

Question 4

What are the core features of cognitive dysfunction in T1D?

Answer 4

reduced psychomotor efficiency and mental inflexibility

Question 5

What is the effect of mild hypoglycemia on cognition in adults with T1D?

Answer 5

cognitive slowing in mental processing, attention and planning

Question 6

what is the effect of severe hypoglycemia in adults with T1D?

Answer 6

absence of all neuro-electrical activity for several minutes - necessary to produce cell death

Question 7

What ar the consequences of insufficient glucose levels in adults with T1D?

Answer 7

insufficient glucose disrupts normal neuronal functioning and is related to reduced cerebral blood flow, particularly to the frontal cortex, followed by 2-4 x increased cerebral hyperperfusion

Question 8

Recurrent hypo’s in adults with T1D can cause ..

Answer 8

lasting neuroanatomical effects (basal ganglia). It is also associated with reduced gray matter density in brain regions associated with language and limbic memory and in the cerebellum associated with attention and planning

Question 9

What is the effect of an acute hyper on cognition in adults with T1D?

Answer 9

reduced speed of information processing, verbal fluency and executive functioning

Question 10

What is the effect of a chronic hyper in adults with T1D?

Answer 10

a lasting detrimental cognitive effect (indexed by glycohemoglobin or microvascular disease complications)

Question 11

What are the neuroanatomical consequences of hyper’s in adults with T1D?

Answer 11

smaller white matter volume (advanced retinopathy, slower speed of info processing, attention and EF) + reductions in gray matter volume

Question 12

What is the effect of an acute hypo on cognition in children with T1D?

Answer 12

reduced attention, EF and speed of responding. Similar to adults, however, effects may linger for up to 45 minutes.

Question 13

What is the effect of recurrent mild hypo’s on cognition in children with T1D?

Answer 13

may have a lasting impact on visuospatial abilities

Question 14

What is the effect of a nocturnal hypo in children with T1D?

Answer 14

impacts mood the following day but not cognitive status

Question 15

What is the effect of a hyper on cognition in children with T1D?

Answer 15

slowed mental processing

Question 16

What is the effect of chronic hyper in children with T1D?

Answer 16

poor metabolic control is related to reduced visuospatial and math performance, disrupted attention, memory and EF

Question 17

Recurrent hypo’s and chronic hyper’s in children with T1D have an effect on ..

Answer 17

memory and learning, limbic system appears to be vulnerable

Question 18

Early onset diabetes shows ..

Answer 18

white matter lesions in the hippocampus and lateral ventricle increase + reduced whole brain volume.
-> relates to reduced attention and EF and slowed information processing

Question 19

What are the vascular consequences of recurrent hypo’s

Answer 19

• disruptions in cerebral blood flow: contribute to the inability of cerebral blood vessels to adequately vasodilate and result in cerebral ischemia
• neuronal damage: lactate + glutamate results in cellular acidosis
• loss of white and gray matter

Question 20

What is the effect of depression in T1D on cognitive status?

Answer 20

the effect of depression to T1D cognitive status is negligible

Question 21

What is the effect of hypertension in T1D on cognitive status?

Answer 21

comorbid hypertension is slightly in T1D and it’s not likely to have a major influence on cognition

Question 22

What is type 2 diabetes?

Answer 22

a metabolic disorder that is characterized by elevated glucose levels that result from insulin resistance and relative insulin insufficiency

Question 23

What are the cognitive dysfunctions found in T2D?

Answer 23

disrupted psychomotor efficiency and memory and learning impairments

Question 24

What is the effect of an acute hyper in T2D?

Answer 24

slowed psychomotor speed

Question 25

What is the effect of chronic hyper in T2D?

Answer 25

lowered HbA1c levels which is related to slowed psychomotor efficiency and processing, memory and abstract reasoning

Question 26

Which microvascular changes are associated with T2D?

Answer 26

retinopathy, neuropathy and angiopathy

Question 27

Which cerebrovascular abnormalities are associated with T2D?

Answer 27

deep white matter lesions
(sub)cortical atrophy -> reduced attention and EF
reduced hippocampal volume -> memory impairments
infarcts

Question 28

What are comorbid macrovascular diseases in T2D?

Answer 28

Hypertension: T2D + hypertension = MCI
Obesity: effects of obesity on cognitive function only in men
Smoking: T2D + smoking -> lower semantic/WM + perceptual speed

Question 29

What is the prevalence and consequence of depression in T2D?

Answer 29

prevalence doubled in T2D. Depression + T2D leads to poorer self-care and diabetes management

Question 30

Why have T2D a higher genetic predisposition to AD?

Answer 30

because of the higher incidence of APOE genotype

Question 31

What are the common symptoms of T2D and AD?

Answer 31

hippocampal atrophy and related memory dysfunction common in both AD and T2D. However, diabetes is associated with damage to the dentate gyrus, while AD is related to damage of the entorhinal cortex

Question 32

What about the cognitive pattern of T2D and T1D?

Answer 32

the cognitive pattern of T2D is mostly similar to that of T1D after 7 years. Also hemodynamic changes in reduced blood flow and cerebral atrophy occur similar

Question 33

What kind of damage may relate to chronic hyperglycemia

Answer 33

damage to the dental gyrus of the hippocampus: associated with reduced verbal memory