BAOJ Diabetes

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Mar 24, 2017 - Empagliflozin, cardiovascular outcomes, and mortality in type 2 dia- betes. Ne Eng Jo Med 373: 2117-2128. 5. Huang ES, Laiteerapong N, Liu ...
BAOJ Diabetes Manisha Choudhury and Himanshu Kumar Sanju, BAOJ Diabet 2017 3: 1 3: 019

Review

Cognitive Evaluation Should be Mandatory for Individuals with Diabetes Mellitus Manisha Choudhury1 and Himanshu Kumar Sanju1* 1

Department of Audiology and Speech-Language Pathology, Amity Medical School, Amity University, Haryana

Abstract Diabetes is a severe metabolic condition which is currently affecting a huge population all over the world. Various investigations have shown that diabetes mellitus can damage to various system of body, which leads complications such as heart disease, cerebrovascular disorders, audiological disorders, ophthalmological disorder and cancer. Recent studies suggested that individuals with diabetes mellitus are at risk of cognition deficit. Diabetes mellitus type 1 and 2 can lead to slowing of mental processing speed, psychomotor speed, executive function and attention. Earlier literature have also reported that chronic hyperglycemia and other micro vascular diseases are the most common cause of cognition deficit in the individuals with diabetes mellitus. Thus, present review will highlight the scope of speech language pathologists and early intervention for cognition deficit in individuals with diabetes mellitus. Management of cognition deficit at initial stage in these individuals may lower the risk of communication disorder and it will also help in preventing further complications related to cognition issues. Keywords: Diabetes Mellitus; Cognition; Speech Language Pathologists

Introduction Diabetes mellitus is a health condition which is a mixture of various disorders indicating the symptoms of hyperglycaemia or glucose intolerance. Diabetes mellitus can be either due to lack of insulin ,or malfunctioning of insulin secretion, or both [1]. These kind of issues tend to generate due to the complications in one’s regulatory systems. This may be responsible for storing and activating different types of metabolic fuels, which also includes the abnormal metabolic action of lipids, carbohydrate and proteins caused due to faulty insulin and action or sometimes both [2]. Diabetes mellitus has been classified into four types based on the etiology namely; Diabetes Type I and II, gestational diabetes, and other distinct types [1]. Diabetes Type-I is also identified as Insulin Dependent Diabetes Mellitus (IDDM),which is caused due to deficit of insulin secretion by beta cells of the pancreas. Whereas, Diabetes Type-II is known as non-insulin dependent diabetes mellitus (NIDDM), that is caused due to reduced sensitivity of target tissues which is responsible for controlling the mechanism of insulin [3]. Previous literature have shown that diabetes mellitus can damage to various systems of body, which leads to many impediments such as heart disease, cerebrovascular disorders, audio logical disorder, ophthalmological disorder and cancer [4-10]. Recent studies also showed that patients with diabetes mellitus are at risk of cognition deficit [11-12]. Diabetes mellitus type 1 and 2 can BAOJ Diabet, an open access journal

lead to slowing of mental processing speed, psychomotor speed, executive function and attention. Earlier literature also suggested that chronic hyperglycemia and other micro vascular diseases are the most common cause of cognition deficit (dementia) in the individuals with diabetes mellitus [13]. American Speech and Hearing Association (ASHA) define dementia as a “syndrome resulting from acquired brain disease which is characterized by progressive deterioration in memory and other cognitive domains (e.g., language, judgment, abstract thinking, and executive functioning)”. In other words, dementia related with cognitive decline has an impact on the ability of an individual to analyze, understand and produce the required linguistic information [14]. There are many research articles which supports the fact that there has been a strong association between dementia and diabetes, wherein older adults with low blood sugar (hypoglycemia) tend to have dementia, which can create a dangerous spiral, and can also lead to mental deterioration [15,16]. The most consistent epidemiologic studies reveals that patients with diabetes are more prone to vascular dementia and possibly Alzheimer disease [16]. As per the survey conducted by Centers for Disease Control and Prevention (CDC) in the year 2014 [17],reveals that individuals within the age range of about 20-79 among 285 million people suspected to have diabetes worldwide, out of which 70% of population belong to developing nations. This estimate is expected to increase to about 438 million, by 2030. It has also been seen that hyperglycemia and hyperinsulinemia perhaps directly effects the cognitive function or may be via the micro vascular effects and subclinical vascular disease [18,19].  A study done by in 2014 showed the patient with diabetes mellitus showed faster cognitive decline compared to individuals without diabetes mellitus [20]. In the present article we have highlighted the importance of cognitive *Corresponding author: Himanshu Kumar Sanju, Department of Audiology and Speech-Language Pathology, Amity Medical School, Amity University, Haryana, Tel: +91-8447353649; E-mail: [email protected] Sub Date: March 7, 2017, Acc Date: March 23, 2017, Pub Date: March 24, 2017. Citation: Manisha Choudhury and Himanshu Kumar Sanju (2017) Cognitive Evaluation Should be Mandatory for Individuals with Diabetes Mellitus. Linn. BAOJ Diabet 3: 019. Copyright: © 2017 Manisha Choudhury and Himanshu Kumar Sanju. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Volume 3; Issue 1; 019

Citation: Manisha Choudhury and Himanshu Kumar Sanju (2017) Cognitive Evaluation Should be Mandatory for Individuals with Diabetes Mellitus. Linn. BAOJ Diabet 3: 019.

evaluation for individuals with diabetes mellitus.

Methodology Various databases, such as Pub Med, Google, Google Scholar and Medline, were searched for references related to cognitive decline in individuals with diabetes mellitus. The research articles (original and review) included in the current review article were published from 2000 to 2016. The headings discussed in the present review articles are ‘how can diabetes leads to dementia’, ‘symptom of dementia due to diabetes mellitus’ and ‘professional perspective’. How Can Diabetes Lead to Dementia? Dementia strikes individuals with untreated diabetes, high cholesterol or blood pressure, and heart disease by making it more intolerable. These conditions triggers the risk for vascular dementia wherein the patient has problem with reasoning, planning, judgment, memory or any kind of thought processes. Studies have revealed that increase in diabetes can have a strong influence on developing mild cognitive impairment, a condition wherein the patient tends to experience cognitive and memory complications than are generally present in normal process of aging [19,21]. Even mild cognitive weakening can lead to Alzheimer’s disease and related types of dementia [22]. As a healthy brain needs proper functioning of the blood vessels to maintain the functioning of the brain cells .In case of untreated diabetes for a prolonged period , it enhances the risk of dementia as it leads to blood vessel disease, as and also can be partly responsible for the creating various kind of tangles and plaques in the brain, that can lead to brain inflammation , all of which can enhance the threat of dementia. Previous epidemiological and research studies suggest that during the old age, diabetes can be a factor for aging of the brain, including decline in cognitive functioning resulting in dementia [23,24]. These kind of associations are emblematic of a hazardous effect on the brain due to hyperglycemia, or the effects of the diabetes-associated comorbid condition like hypertension, dyslipidemia, or hyperinsulinemia [25]. Studies have also revealed that type II diabetes patients are on the verge to develop dementia compared to those without diabetes [26,27].  In some of the cases it has been seen that, people who don’t suffer from diabetes but still have difficulty with the way their body agreements with glucose and insulin for e.g, conditions like lack of insulin secretion and resistance as well as glucose intolerance are also connected with high risk of dementia [28]. Some researchers have also mentioned that lengthier duration and higher severity of Type II- Diabetes may further increase the risk of dementia in midlife as it is associated with some very general types of dementia like Alzheimer’s disease and vascular dementia which results in cognitive impairment [27].  A review of relevant studies reveals that among the patients who are associated with diabetes 47% patients tend to show greater risk of dementia, 39% indicate higher risk of Alzheimer’s disease, whereas 14% revealed high chance of vascular dementia [29,30]. Symptoms of Dementia Due to Diabetes Mellitus  As per Merck Manual of Geriatrics, if a patient with diabetes mellitus shows sudden development of disorganization and shortterm memory loss, ramble around places or getting disoriented in BAOJ Diabet, an open access journal

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familiar places, moving with swift, shuffling steps, laughing or crying inappropriately, difficulty following complex instructions and difficulty in problem solving and arithmetic calculation may be indicative towards the onset of dementia. Professional Perspective Small steps can make a big difference for patients with diabetes mellitus. Working with a multi-disciplinary health care team which consists of cardiologists, podiatrists, ophthalmologists, which is considered as the “standard of care” for individuals with diabetes mellitus can help to prevent diabetes or manage diabetes in a patient, which in turn can help to reduce the probability in a patient suffering from dementia. However, a Speech Language Pathologist should be aware of the factors related to diabetes, and should take into consideration the patient histories and recommendations accordingly, as well as have a complete knowledge of the possible complications and medications associated with these patients. Eventually, prevention of cognitive impairment in diabetic patients may be more intensified if future research determines the hidden mechanism for the association between diabetes and cognitive decline. Diabetes prevention or effective diabetes management also can thus help to prevent the most common types of dementia like vascular dementia, Alzheimer’s disease and other types of dementia. Speech language pathologists play a great role in the evaluation and treatment of person with dementia. Recently, hypothesized that anti diabetic medication may have the role in the treatment of cognitive dysfunction [31]. So, it can be assumed that indication of early sign and symptoms of cognitive dysfunction in these individuals may help the professionals to curb and prevent the adverse effect of diabetes mellitus on cognition. Therefore, cognitive evaluation should be mandatory for the individuals with diabetes mellitus, which help the speech language pathologists and other professional to know any cognitive deficit in this population. Early assessment and treatment helps the speech language pathologists and other professionals to prevent the adverse effect of diabetes mellitus on cognition among these populations [32]. The early identification and treatment for cognition related issues prevents the hazardous effect diabetes mellitus on communication problem occurred due to poor cognition and it may also slow down the contrary effect of diabetes mellitus on cognition and attention. According to ASHA (2005), Speech language pathologists can help the person with behavioral interventions to make the patient recall important information. ASHA (2005) also recommended that Speech Language Pathologists helps to make them function at the uppermost level of freedom throughout the underlying disease course[32]. Precisely, speech language pathologists manage the cognitive features of communication. They can work on memory and attention, sequencing and improve problem solving attitude. A speech language pathologists can treat them using approaches which can preserve cognitive as well as communication functioning. The strategies can be memory recall, developing “memory books” which can help recall personal information. The speech language pathologists should also train family members and caregivers in how to communicate better with the patients of dementia. The speech-language pathologists can provide group Volume 3; Issue 1; 019

Citation: Manisha Choudhury and Himanshu Kumar Sanju (2017) Cognitive Evaluation Should be Mandatory for Individuals with Diabetes Mellitus. Linn. BAOJ Diabet 3: 019.

intervention to enhance retained communication skill and to give a supportive environment for socialization. They can also include patient’s specific communication need into multidisciplinary team care plan.

Conclusion

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14. Clare L, Woods RT, Moniz cook ED, Orrell M, Spector A (2003) Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular dementia. Cochrane Database Syst Rev 5: 69-75. 15. Lin CH, Sheu WH (2013) Hypoglycaemic episodes and risk of dementia in diabetes mellitus: 7-year follow-up study. J Intern Med 273(1): 102-110.

Present review showed adverse effect of diabetes mellitus on cognition. Current review also showed contribution and role of speech language pathologists while dealing with these populations. The present review showed necessity of cognitive evaluation for individuals with diabetes mellitus.

16. Bruce DG, Davis WA, Stark stein SE, Davis TM (2014) Mid-life predictors of cognitive impairment and dementia in type 2 diabetes mellitus: the Fremantle Diabetes Study. J Alz Dis 3: 63-70.

Acknowledgement

18. Stratton IM, Adler AI, Neil HA, Matthews DR, Manely SE, et al. (2000) Association of glycaemia with macro vascular and micro vascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321(7258): 405-412.

Authors want to acknowledge the HOI of Amity Medical School and also Vice Chancellor of Amity University, Haryana. Authors also would like to express their deep gratitude to the HOD, Department of Audiology and Speech Language Pathology, Amity University, Haryana, India.

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