Update on cognitive decline and dementia in elderly patients with diabetes.
OBJECTIVE
This article is an update of the relationship between type 2 diabetes (T2D), cognitive dysfunction and dementia in older people.


RESULTS
The number of older patients consulting for diabetes who also exhibit cognitive difficulties is consistently growing because of the increased longevity of the population as a whole and, according to a number of studies, the increased risk of cognitive impairment and dementia in older diabetic patients. Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabetic patients. A history of severe hypoglycaemic episodes has also been associated with a greater risk of late-in-life cognitive deficits and dementia in patients with T2D. Several processes are thought to promote cognitive decline and dementia in diabetics. Based on both clinical and non-clinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycaemia. Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression-related symptoms, greater incidence of recurrent hypoglycaemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies.


CONCLUSIONS
Clinical guidelines have recently been devised for older diabetic patients, particularly those with cognitive deficits and a reduced capacity to self-manage. In the most vulnerable patients, specific treatment strategies have been proposed for glycaemic control to limit metabolic decompensation and avoid the risk of hypoglycaemia. Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients' cognitive and functional status.
Endocrinology Department, hôpital Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France. Electronic address: lbordier@club-internet.fr.
L
L
Bordier
Geriatric Therapy and Internal Medicine Department, hôpital Saint-Julien, CHU de Rouen, 76031 Rouen cedex, France.
J
J
Doucet
Medical Endocrinology Department, Lilly France, boulevard Vital-Bouhot, 92521 Neuilly-sur-Seine cedex, France.
J
J
Boudet
Endocrinology Department, hôpital Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
B
B
Bauduceau
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D002561:Cerebrovascular Disorders / Q000150:complications / Q000209:etiology / Q000517:prevention & control; D003072:Cognition Disorders / Q000139:chemically induced / Q000209:etiology*; D003704:Dementia / Q000139:chemically induced / Q000209:etiology*; D003863:Depression / Q000150:complications* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D003925:Diabetic Angiopathies / Q000150:complications* / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000150:complications*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D008137:Longitudinal Studies; D055118:Medication Adherence / Q000523:psychology; D010353:Patient Education as Topic; D015995:Prevalence; D012307:Risk Factors; D012648:Self Care / Q000523:psychology
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
Cognitive impairment; Dementia; Diabetes; Elderly patient; Hypoglycaemia