How diabetes impairs cognition


Diabetes affects approximately 26 million Americans, according to a report from the Centers for Disease Control and Prevention released in 2011. This life-altering disease affects the entire body from the feet to the brain, and sugar is the main culprit. Diabetes results from the inability of the pancreas to regulate insulin release. Insulin is the primary hormone that is responsible for sugar regulation in the body. If an individual consumes a large meal or a sugary snack, the pancreas, when in a healthy state, will release insulin to decrease the sugar overload in the body.

Type 1 diabetes occurs in 10 percent of all diabetics and results from autoimmune destruction of the pancreas, meaning that the pancreas cannot secrete any amount of insulin, causing the organ to become dysfunctional. Type 2 diabetes occurs in 90 percent of diabetic patients and results from insulin resistance on the pancreas, meaning over time the pancreas is injured continually, resulting in slow chronic insult to the organ.

Diabetes plays a major devastating role in chronically destroying the blood vessels that carry oxygen-rich blood to the brain. Blood vessels are usually soft and malleable, allowing them to contort their shape to become more dilated when an increase in blood is needed during intense activities.

The role of hardening blood vessels

The brain is a vital organ, expending an enormous amount of energy and, as a result, requires a large amount of oxygen-rich blood. In individuals with diabetes, the blood vessels become damaged secondary to the buildup of sugar, and byproducts on the vessels cause them to become hardened in a state similar to atherosclerosis. When these blood vessels harden, they are not able to carry as much oxygen-rich blood to the brain and, as a result, the brain becomes deprived of oxygen, a state known as hypoxia or more specifically anoxia.

Anoxic brain injury from hardening of blood vessels secondary to diabetes results in cognitive changes that ultimately affect brain function. A decrease in blood flow to the brain results in anoxia, which over time decreases the amount of white matter in the brain, impairing cognitive function (CI). “Brain imaging using MRI of patients with hyperglycemia for long periods of time can show visible lesions. These lesions represent damage to the neurons, which in turn translates to CI in that patient. A decrease in white matter volume in particular has been linked to reduced processing of information and loss of executive function,” according to a report released by U.S. Pharmacist.

The cognitive impairments associated with diabetes include a decrease in memory, language and executive functioning, and an increase in dementia over time. The hypothalamus, an area of the brain that plays a role in memory is often affected. Although the specific pathophysiologic pathways involved in cognitive impairment due to diabetes are not perfectly understood, it is known that a deprivation of oxygen affects certain areas in the brain including a decrease in white matter. Other factors that precipitate these cognitive impairments include hypertension, smoking and obesity, as all of these factors are known to cause hardening of the blood vessels.


More research needed

Maintaining excellent glycemic control by eating a healthy diet, monitoring daily blood sugar and following proper medication regimens have been shown to decrease the onset of cognitive delays, but no known specific treatment has been tailored to prevent cognitive impairment in diabetics. More research and understanding of the specific pathways and anatomical circuits are necessary to fully understand how cognitive delay secondary to diabetes occurs. Once these underlying mechanisms are solidified, a proper treatment and cure can be investigated to prevent cognitive decline in those with diabetes.

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About the author

Kristen Fuller, M.D., enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author, who also teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast.

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