In the first presentation of this session on Thursday March 7 entitled “ The effect of Diabetes on brain health », during ATTD 2024, prof. Mark Strachan (UK) provided an overview of cognitive decline linked to diabetes. (1)
He recalled a certain number of studies highlighting an association between diabetes and cognitive loss, showing a higher prevalence of various forms of dementia in diabetics and therefore an increased risk.
It notably presented data from the DCCT/EDIC study (type 1 diabetes) analyzing 3 aspects of cognitive decline (short memory, long memory and psychomotor functions) under the effect of a combined score of 3 parameters linked to diabetes (HbA1c, systolic pressure and number of severe hypoglycemia events) at the various times of this study (at 2, 5, 18 and 32 years).
In type 2 diabetes, it is in particular the micro and macrovascular damage that plays a role in cognitive loss.
One of the interests of the various studies presented by Mark Strachan is, however, to highlight the role of hypoglycemia events in cognitive decline linked to diabetes (T1D and T2D).
Among the hypotheses considered that could possibly explain this association, there is in particular a biological pathway (brain damage, neuron death, induced by severe hypoglycemia, and micro/macrovascular effects and release of glutamate for hyperglycemia). However, these possible links have yet to be confirmed.
The teacher. Strachan concluded in conclusion that this relationship between cognitive decline and dementia on the one hand and events of severe hypoglycemia and/or severe hyperglycemia on the other hand is undoubtedly bidirectional.
In the 2e presentation of the same session on the brain health of diabetics, prof. Tali Cukierman-Yaffe (Israel) pleaded with infectious enthusiasm for better detection and management of cognitive decline in people with diabetes.
In this regard, she insisted on the importance of a good cognitive assessment and good monitoring (in the form of annual measurements), in particular in terms of early intervention to delay the effects, identification of people at risk, but also the ability to take care of oneself. The risk being that under the effect of cognitive disorders, even mild, diabetic patients are no longer able to comply with their treatment correctly.
She reviewed the various instruments at our disposal: cognitive assessment tools, medical imaging (structural anomalies, but also advanced MRI techniques allowing us to identify and evaluate brain functioning before the appearance of lesions), biomarkers ( neurofilament-light [NEFL]retinal markers, etc.).
Retinal sensitivity measured by microperimetry appears to be promising and could be a tool to assess cognitive decline, particularly in diabetics. Research is currently underway in this area.
Tali Cukierman-Yaffe then returned to the excessively numerous cognitive assessment tools, and in particular to the DSST (Digit Symbol Substitution Test), a widely known and validated tool of which his team has prepared a digital version, which allows other data such as reaction time to be recorded. A good predictive and evaluation tool, it gives good results in diabetic patients.
In conclusion, the professor. Cukierman-Yaffe calls for the development of a single standardized and validated tool, easy to use in consultations where there is always a shortage of time.
Article originally published on MediQuality.fr.
