Info

Associated with a decrease in stroke risk by 19 , while as in the trial the same blood pressure reduction (by ACE-inhibitor captopril or beta-blocker atenolol) led to much greater actual decrease in stroke incidence - by 44 (179). These results suggest the possibility of some protective action of these agents beyond their antihypertensive efficacy. This assumption is supported by the results of the HOPE trial, which showed a greater than anticipated reduction of stroke incidence following...

Hypoglycemia In People With Diabetes Epidemiology

Most data on the frequency of hypoglycemia have been collected retrospectively in people with type 1 diabetes and predominantly focus on severe events, which are relatively robust to measure as they can be recalled with accuracy for up to 1 year in people with normal symptomatic awareness (12). Total amnesia of severe hypoglycemia is common, and obtaining an accurate estimate is often difficult in people who have impaired awareness of hypoglycemia relatives and friends may provide a more...

Secondary Prevention

Secondary prevention after a transient ischemic attack or ischemic stroke should be aimed at reduction of the chance of future cardiovascular complications. The main issue in secondary prevention is rigorous control of vascular risk factors such as hypertension, hyperlipidemia, smoking, and overweight. In patients with a cardiac source of embolism, coumarins should be the first choice (74), whereas in other patients platelet aggregation inhibitors should be prescribed (75). The combination of...

Aft or C

Neuroanatomy of pain processing. Main brain regions that activate during a painful experience, highlighted as bilaterally active but with increased activation on the contralateral hemisphere. (Reprinted from Tracey and Mantyh (56), with kind permission from Elsevier.) Utilising fMRI, a study comprising 18 type 1 diabetic subjects (6 with no-DPN, 6 with painful-DPN, and 6 with painless-DPN) was conducted to test the feasibility of monitoring the brain's response to the presentation of...

Epidemiology Of Diabetes And Depression

Approximately 16 of the population will suffer from depression at any time during their lifetime (2). This lifetime prevalence will increase significantly with age, as well as with the existence of a co-occurring physical condition. The number of Americans with diagnosed diabetes is projected to increase 165 from 11 million in 2000 to 29 million in 2050, with the largest percent increase occurring among those persons aged 75 years and older (+271 in older women +437 in older men) (3)....

Hypoglycemia In The Nondiabetic State

Physiological Changes in Response to Hypoglycemia In normal health, blood glucose is maintained within a very narrow range and many homeostatic mechanisms have evolved to preserve nor-moglycemia. This protects the normal functioning of the brain, which is almost entirely dependent on glucose as its principal fuel and source of energy. The functioning of the brain is optimal within this range cognitive function rapidly becomes impaired when the blood glucose falls below 3.0mmol l (54mg dl) (3)....

Acute Treatment Thrombolysis

Restoration of blood flow to the ischemic area by means of intravenously administered alteplase (recombinant tissue plasminogen activator rt-PA ) should be considered the most revolutionary breakthrough in the treatment of acute ischemic stroke in history. Despitean increased risk of symptomatic intracranial hemorrhage, alteplase was demonstrated to be beneficial when administered within 3 h of stroke onset in the NINDS rt-PA study, with a number needed to treat of only seven to eight to...

Depression Treatment Considerations For Diabetic Patients

Despite the lack of a definitive cause-effect model to explain the significant relationship between depression and diabetes, reports on the effects of treatment for depression have shown promise on outcomes for both diseases. Treatment for depression in patients with diabetes has demonstrated benefits on glycemic control as well as mood and even insulin sensitivity (32, 77). There is evidence that both antidepressant medication and psychotherapeu-tic treatments can improve both depressive and...

Cerebral Edema In Dka Presentation

Cerebral edema typically presents 4-12 h after the treatment for DKA is started (28, 29), but can occur at any time. In up to 5 of cases, cerebral edema may present prior to initiation of DKA therapy (6, 28-30). Signs and symptoms are variable but include headache, mental status deterioration, inappropriately slowed heart rate, and increases in blood pressure (31, 32). Subclinical presentation of cerebral edema is more common (33, 34) and may be associated with smaller third and lateral...

The Paradox Diabetic Encephalopathy Versus Cognitive Resilience

Although the combined results of the studies discussed in this chapter provide compelling evidence for the adverse effects of type 1 diabetes on the brain, several observations are incongruent with the concept of slowly progressing end-organ damage. First, the results from the study in older patients with type 1 diabetes (10) suggest that although patients suffer from significant peripheral complications, there is only a limited effect on the brain. In this context it is important to note that...

Medical Complications

Although the effectiveness of a stroke unit is largely based on optimal general care which largely consists of the prevention and treatment of complications, only few clinical trials have tested the effects of prevention and treatment of specific complications on patients with acute ischemic stroke. Venous Thrombosis and Pulmonary Embolism In an older study, deep venous thrombosis occurred in about 50 of the patients with severe stroke and was confined mainly to the paretic leg (46). Severe leg...

Neurochemical Findings Associated With Depression And Diabetes

The role of some catecholamines (most notably, dopamine and serotonin) in depression has received much attention. For example, the mesolim-bic dopamine pathway allows an organism to analyze the environment and its cues and to express appropriate approach or avoidance behaviors. One animal model for depression, which exposes mice to daily bouts of social defeat, followed by protected sensory contact with the aggressor characterizes the actions of this pathway (66). Mice are exposed to a...

References

Psychologic tests applied in diabetic patients. Arch Intern Med 1922 30 767-777. 2. Stewart R, Liolitsa D. Type 2 diabetes mellitus, cognitive impairment and dementia. Diabet Med 1999 16 93-112. 3. Strachan MWJ, Deary IJ, Ewing FME, Frier BM. Is type II diabetes associated with an increased risk of cognitive dysfunction A critical review of published studies. Diabetes Care 1997 20 438-445. 4. Awad N, Gagnon M, Messier C. The relationship between impaired glucose tolerance,...

Risk Factors For Cognitive Dysfunction

Clearly, the above-mentioned results indicate that the subtle cognitive decrements in speed of information processing and mental flexibility found in diabetic patients are not merely caused by acute metabolic derangements or psychological factors, but point to end-organ damage in the central nervous system. Although some uncertainty remains about the exact pathogen-esis, several mechanisms through which diabetes may affect the brain have now been identified more clearly. Until recently, most...

Type l Diabetes

Stades Type 1 diabetes is a life long metabolic disorder that is characterized by absolute insulin deficiency resulting in hyperglycemia and lipolysis. Type 1 diabetes accounts for 5-10 of the total diabetes population, the majority of the other patients has type 2 diabetes. Insulin deficiency originates with autoimmune mediated P-cell destruction. Without insulin treatment, type 1 diabetes leads to dehydration and ketoacidosis and can ultimately be fatal....

Measuring Cognition In Diabetes

The present chapter does not summarize the cognitive findings typical for diabetes type 1 and type 2. Nevertheless, we wish to address issues that need to be considered in order to design an optimal test battery for the assessment of diabetes-associated cognitive decline. Firstly, when patients with diabetes are compared with non-diabetic controls, effect sizes for the differences in performance between the groups are generally small Chapters 10-12 . This indicates that an optimal test battery...

Neuroendocrine Findings Associated With Depression

The hypothalamic-pituitary-adrenal HPA axis mediates the ability of an organism to respond to threats, including stress. Interestingly, the determining characteristics of stressors which provoke depression in humans namely entrapment, humiliation, and loss provoke animal models of depression. Following exposure to a stressor, the hypothalamus releases corticotrophin-releasing hormone CRH which in turn stimulates the release of adrenocorticotrophic hormone ACTH by the anterior pituitary gland....

Spinal Cord Involvement In Diabetic Neuropathy

Previously considered a disease of the peripheral nervous system PNS , there is mounting evidence to support concomitant involvement of the CNS in diabetic neuropathy. Involvement of the spinal cord has been reported in post-mortem studies, which demonstrated axonal loss, gliosis, and demyeli-nation within the spinal cord 2-6 . However, many of these studies did not examine patients with diabetic neuropathy specifically therefore, it is not possible to conclude whether these changes were due to...

Relationship Between Depression And Cognitive Impairment

Certain symptoms of cognitive impairment psychomotor retardation, loss of affect, concentration, and memory difficulties are frequent among persons with depression and other mood disorders, and prevalence of both cognitive impairment and depression increases significantly with age 73 . People with depression have been shown to perform worse on tests of cognitive performance and neuropsychological measures than non-depressed persons 73 . Similar to the relationship between diabetes and...

Prediabetes And Cognition Prediabetic Stages

Global Atrophy The Brain

The progression from normal glucose tolerance to type 2 diabetes is a gradual process which generally proceeds unnoticed. In most cases, the very first changes in insulin and glucose metabolism already occur years before type 2 diabetes is actually diagnosed. Essential to type 2 diabetes is the reduction of insulin sensitivity in the tissue, referred to as insulin resistance 35 see Chapter 2 . Insulin resistance results in a compensatory increase in insulin secretion of the pancreas and...

Introduction

Pontine Reticular Hyperintensities

Dementia is one of the most widely feared age-related neurological diseases, and together with stroke, it is the only neurological disease listed in the ten most important causes of disease burden in developed countries 1 . The life-time risk of any dementia has been estimated to be more than 1 in 5 for women and 1 in 6 for men 2 . Worldwide, about 24 million people have dementia, with 4.6 million new cases of dementia every year 3 . The term dementia encompasses the spectrum of clinical...

How Does Hyperglycemia Affect The Ischemic Brain

Although an accumulating number of studies have convincingly demonstrated an association between hyperglycemia and poor outcome after stroke, it remains controversial whether this association is causal, i.e., hyper-glycemia is actually causing poor outcome. Hyperglycemia could also be epiphenomenal to a more pronounced stress reaction with higher levels of blood glucose in more severe stroke. Indeed, higher levels of glucose have been associated with more severe stroke 7, 7375 . On the other...

Diagnosis And Ancillary Investigations

Diabetic Foot Drawing

A diagnosis of dementia is preferentially made in a multidisciplinary setting, based on clinical criteria 4, 5 . These criteria include the presence of multiple cognitive deficits leading to a significant impairment in social and occupational functioning and a significant decline from a previous level of functioning. The clinical challenge is to define the aetiological diagnosis in an early phase, based on criteria such as those reviewed on the previous pages. This is crucial with regard to...

Etiology And Precipitating Factors

Glucose levels rise in the setting of relative insulin deficiency. The low levels of circulating insulin prevent lipolysis, ketogenesis, and ketoacidosis 62 but are unable to suppress hyperglycemia, glucosuria, and water losses. Levels of counter-regulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone are elevated, increasing gluconeogenic substrates, gluconeogenesis, and glycogenolysis. Meanwhile, glucose utilization is decreased. Glucose levels rise, leading to...

And Groups

Normal Distribution Performance Level

Neuropsychological assessment is more than just administering a number of tests in a patient. Although each test is presented and scored in a standardized manner, raw test results do not have any meaning. Only few tests measure functions at a ceiling level, allowing immediate interpretation. However, ceiling effects in test performance often result in a lack of sensitivity. Subtle impairments are easily missed, resulting in a high proportion of false-negative cases people classified as...

Therapeutic Interventions In Dkarelated Cerebral Edema

Children should be monitored closely including hourly vitals, capillary blood glucose monitoring, and frequent neurological observations 1 . Laboratory testing every 2-4 h should include electrolytes, urea, hematocrit, blood glucose, and blood gases 1 . In more severe cases, electrolytes and glucose may need to be monitored more closely. If cerebral edema is suspected, treatment should begin immediately by reducing intravenous fluid administration 1, 57 and by providing supportive care....

Epidemiology

Several studies report T1D incidence numbers of 0.1-36.8 100,000 subjects worldwide 2 . Above the age of 15 years ketoacidosis at presentation occurs on average in 10 of the population in children ketoacidosis at presentation is more frequent 3, 4 . Overall, publications report a male predominance 1.8 male female ratio and a seasonal pattern with higher incidence in November through March in European countries. Worldwide, the incidence of T1D is higher in more developed countries 1, 2, 4-6 ....

Inder Nagra 4 Chorea

Dunger DB, Sperling MA, Acerini CL, et al. European Society for Paediatric Endocrinol-ogy Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics 2004 113 2 e133-e140. 2. Umpierrez GE, Woo W, Hagopian WA, et al. Immunogenetic analysis suggests different pathogenesis for obese and lean African-Americans with diabetic ketoacidosis. Diabetes care 1999 22 9 1517-1523. 3. Balasubramanyam A, Zern JW, Hyman DJ, Pavlik V. New...

Pathogenesis

Ominous Octet Diabetes

There are two underlying mechanism that lead to the onset of clinical T2D inadequate insulin action in target tissues insulin resistance and inadequate secretion from pancreatic -cells Fig. 1 14 . Insulin resistance arises prior to the onset of clinical disease, but predicts the development of diabetes 15-17 . Environmental factors, particularly obesity and a sedentary lifestyle, are important contributors to the development of diabetes, largely because of their effects on insulin sensitivity...

Glucose Levels And Lesion Volume

Stroke Hyperglycemia

If hyperglycemia is indeed casually related to poor outcome after stroke, one would expect a relation between higher levels of blood glucose and an increased lesion volume. In hemorrhagic stroke, only little is known about the association between glucose levels and the size of the hemorrhage or its evolution during the clinical course. The evidence is limited to experimental settings where it has been shown that hyperglycemia exacerbates brain edema and peri-hematomal cell death after...

Hyperglycemia Introduction

The current classification of diabetes in different subtypes is based on the defect s that causes hyperglycemia, namely, aberrant or deficient insulin secretion or insufficient insulin action 1 . Type 1 diabetes T1D originates from autoimmune-mediated destruction of the pancreatic P-cells that normally produce insulin, thus resulting in absolute insulin deficiency. Other types of pancreatic disease involving destruction of the P-cells, such as alcoholic pancreatitis, are classified otherwise....

Glucose Surge Postprandial

AMI acute myocardial infarction ICU intensive care unit CABG coronary artery bypass graft IV intravenous SC subcutaneous GIK glucose insulin potassium infusion n.r. not reported. AMI acute myocardial infarction ICU intensive care unit CABG coronary artery bypass graft IV intravenous SC subcutaneous GIK glucose insulin potassium infusion n.r. not reported. The same observations as for the target levels can be made concerning the duration glucose lowering treatment. Although from a...

Insulin In The Periphery And The

It has long been established that insulin plays a crucial role in peripheral energy regulation. In a tightly controlled system, plasma glucose levels are kept remarkably constant in healthy human beings. Carbohydrate consumption initiates a rise in plasma glucose levels, which in turn, stimulates insulin secretion by the pancreas. As blood glucose levels begin to fall, counter-regulatory hormones are secreted, and plasma glucose concentrations are returned to normal pre-prandial levels....

FMri And Painfuldpn

Acute Pain Imaging Fmri

The exact pathophysiological mechanisms of neuropathic pain remain unknown although based on experiments in animal models both peripheral and central mechanisms have been postulated 41 . However, there are no consistent differences in peripheral nerve morphological parameters between painful-DPN and painless-DPN. It is likely that the pathophysio-logical changes resulting in pain may in part lie elsewhere within the nervous system. Recent advances in neuroimaging methods have led to better...

What Is Fehm Hl Kern W Peters A 2006 The Selfish Brain Competition For Energy Resources. Prog Brain Res 153 129-140

Brands AMA, Biessels GJ, De Haan EHF, Kappelle LJ, Kessels RPC. The effects of type 1 diabetes on cognitive performance A meta-analysis. Diabetes Care 2005 28 726-735. 2. Kodl CT, Seaquist ER. Cognitive dysfunction and diabetes mellitus. Endocr Rev 2008 29 494-511. 3. Cohen, J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ Erlbaum, 1988. 4. Kahneman D. Attention and effort. Englewood Cliffs, NJ Prentice Hall Inc., 1973. 5. Park DC, Lautenschlager G, Hedden T,...

Hyperglycemia Causing Cardiac Conduction Defect

Hypoglycemia Schematic Diagram

Adapted from MacCuish 36 , with permission of Edward Arnold Publishers Adapted from MacCuish 36 , with permission of Edward Arnold Publishers hypoglycemia, a continuous intravenous infusion of dextrose and frequent oral feeding will be required. When hypoglycemic coma does not respond to intravenous dextrose, neuroimaging must be performed urgently to look for cerebral edema, a recognized complication of severe hypoglycemia that is associated with a high mortality, and to exclude other...

Novel Treatment Strategies For Alzheimers Disease

In this final section, we will discuss three novel treatment strategies for Alzheimer's disease and for its prodromal stage, mild cognitive impairment Table 1 . The three strategies have a common thesis that improving insulin sensitivity will have a beneficial effect on patients with memory loss. Novel therapeutic strategies for Alzheimer's disease and mild cognitive Raises brain insulin levels Increases brain insulin without affecting plasma activity glucose or insulin levels Modulates Aft...

Biomedical Risk Factors

Three types of diabetes-related biomedical variables have been linked to the appearance of neurocognitive anomalies in children with diabetes moderately severe episodes of hypoglycemia, ketoacidosis, and chronic hyperglycemia. our understanding of these associations remains imperfect, unfortunately, because so few studies have adequately ascertained those biomedical variables in pediatric samples. Rather than capturing most, or even a representative number, of those events over the course of...

Peroxisome Proliferatoractivated Receptor Ppary Agonists And Treatment Of Alzheimers Disease

Drugs of the PPAR-y class have been approved by the FDA to treat T2DM for approximately a decade. Members of this class currently in clinical use include rosiglitazone and pioglitazone. They are ligand-activated nuclear transcription factors that improve insulin sensitivity. PPAR-y, expressed in adipocytes, regulates adipogenesis and increases the uptake of fatty acids into adipocytes. Thus, PPAR-y agonists reduce the burden of fatty acid uptake for striated muscles, which likely explains their...

Assessment Of Cognitive Function

Corsi Block Weschler

In assessing cognitive deficits, two important questions must be answered. Firstly, the question is whether an individual patient, or a patient group, has cognitive dysfunction compared to a reference group. Secondly, we need to look at the pattern of impairment whether selective deficits of one or more cognitive processes - or domains - exist. By establishing this pattern of cognitive deficits, we can subsequently relate this information to cerebral dysfunction in general or specific brain...

Brain Mr Spectroscopy In

Findings from the spinal cord studies described above suggest that the metabolic insult of diabetes has a generalised effect on the whole nervous system and has made us question whether the brain too may be involved. Anatomical studies have demonstrated that the ascending sensory pathways of the spinal cord terminate within the thalamus before high-order sensory projections are sent to the cortex 11 . Recent studies have shown that the thalamus does not merely act as a sensory relay station but...

Lifestyle

Patients are encouraged to maintain an active lifestyle and to exercise. They should receive advice on how to modify insulin dosage according to the amount and duration of exercise to avoid related hypoglycemia and potential late hypoglycemia at night. Vigorous exercise can deteriorate severe hypertension, retinopathy, and autonomic neuropathy and should be avoided without previous medical consultation 51 . Patients with normal body weight do not have dietary restrictions with respect to...

Post Thrombolysis Ct

Patients with ischemic stroke usually present with focal neurological deficit of sudden onset. Occasionally a more gradually or stepwise onset can be found, especially in patients with a hemodynamic origin of cerebral ischemia. Common deficits include dysphasia, dysarthria, hemianopia, weakness, ataxia, sensory loss, and cognitive disorders such as spatial neglect 9 . Symptoms are unilateral except in some patients with posterior circulation stroke. Most patients remain alert. Mild-to-moderate...

Hyperglycemia in Acute Stroke

Background Stroke Stroke and Hyperglycemia Hyperglycemia After Stroke Etiology of Hyperglycemia in Acute Ischemic Stroke Admission Hyperglycemia and Clinical Outcome After Stroke Glucose Levels and Lesion Volume How Does Hyperglycemia Affect the Ischemic Brain Treatment of Hyperglycemia Conclusions Recommendations References Hyperglycemia is frequently found 40-60 after all kinds of stroke and it has been related to increased lesion size and poor clinical outcome. In this chapter, we will...

Descending Pain Modulation

Descending Pain Inhibitory System

Nociceptive inputs are subjected to modulation by the descending pain modulatory systems prior to arrival at higher cortical centres. This well-characterised functional anatomical network regulates nociceptive processing, largely within the dorsal horn, to produce either facilitation prono-ciceptive or inhibition antinociceptive Fig. 9 53 . The brain regions involved in this descending modulation include the frontal lobe, anterior cin-gulate cortex, insula, amygdala, hypothalamus,...

Christopher M Ryan PhD

Methodological Considerations School Performance Identifying Neurocognitive Phenotypes Biomedical Risk Factors Pathophysiological Models Are We There Yet Future Directions References Diabetes has a marked effect on brain function and structure in children and adolescents. As a group, diabetic children are more likely to perform more poorly than their nondiabetic peers in the classroom and earn lower scores on measures of academic achievement and verbal intelligence. Specialized...

Scheltens Scale

Scheltens Grading Hippocampal Atrophy

A score of 0-4 is given separately for the left and right side. f increase decrease. A score of 0-4 is given separately for the left and right side. f increase decrease. Fig. 4. Examples of scores on medial temporal lobe atrophy visual rating scale on coronal T1-weighted coronal MRI scans. Fig. 4. Examples of scores on medial temporal lobe atrophy visual rating scale on coronal T1-weighted coronal MRI scans. atrophy in subjects with amnestic MCI is associated with a diagnosis of dementia at...

Cerebral Edema In Dka Risk Factors

Epidemiologic studies have identified several risk factors for cerebral edema in DKA. Younger age 31 and newly diagnosed diabetes both potentially increase risk of cerebral edema in DKA 6, 31, 35 . Additionally, patients presenting with longer duration of symptoms are at increased risk 26 , which may be related to severity of DKA 28 . Other risk factors have been identified in retrospective case-controlled studies. A complete list of risk factors associated with cerebral edema in DKA is shown...

Need For Improving Diabetes Care References

Type 2 diabetes T2D is the most common form of diabetes, a metabolic disorder characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Early diagnosis of T2D and the high-risk category of pre-diabetes may help reduce the associated public health and clinical burden. Available diagnostic strategies include fasting plasma glucose, oral glucose tolerance test, and casual plasma glucose in the presence of symptoms of hyper-glycemia. Potential use of...

Esther van den Berg Yael D Reijmer and Geert Jan Biessels

Diabetes Pre-Diabetes and Cognition Brain Imaging in Type 2 Diabetes Determinants and Mechanisms Treatment Opportunities Implications for Clinical Care Conclusions and Directions This chapter addresses the effects of type 2 diabetes mellitus on cognitive functioning. It covers the nature and severity of cognitive decrements in relation to diabetes and pre-diabetic stages. Possible risk factors and pathophysiological mechanisms, such as vascular risk factors, hypoglycemia and hyperglycemia,...

Choreiform Movements

Chorea or ballismus has been observed in the hyperosmolar hyperglycemic state 76 . In a report of HHS patients presenting with chorea, the mean age was 71.1 years and had a 2 1 ratio of women to men 76 . In patients with HHS, choreiform movements are often but not always unilateral and occur concurrent with or shortly after the episode of hyperglycemia 77 . Diabetes is usually newly diagnosed in these patients and develops subacutely over days to months 77 . In states of hyperglycemia,...

Cerebral Edema In Dka Pathophysiology

Potential causes of DKA-related cerebral edema include 1 generation of inflammatory mediators 43, 44 2 disruption of cell membrane ion transport and aquaporin channels 45-47 3 generation of intracellular organic osmolytes and subsequent osmotic imbalance 48 and 4 changes in cerebral blood flow 49 . Inflammatory mediators may cause cerebral edema. Studies have demonstrated that inflammatory mediators can disrupt endothelial cells of the blood-brain barrier BBB 43 . Routes for penetration include...

School Performance

As a group, diabetic children earn somewhat lower grades in school as compared to their nondiabetic classmates, are more likely to fail or repeat a grade, perform more poorly on formal tests of academic achievement, and have lower IQ scores, particularly on tests of verbal intelligence. The most compelling evidence for a link between diabetes and poorer school outcomes has been provided by a swedish population-based register study involving 5,159 children who developed diabetes between July...

Neurological Complications In

Neurological complications in the hyperglycemic hyperosmolar state present as a spectrum of abnormalities and can range from lucidity to confusion or lethargy to complete coma. Other neurological manifestations, including hemiparesis, hemianopsia, chorea, and partial motor or generalized seizure activity, have also been described 14, 64 . The most common and classic clinical presentation in the hyperglycemic hyperosmolar state is an altered sensorium 14 . Varying degrees of mental status...

Mri Findings In Type Diabetes

Diabetes White Matter Lesion

As discussed in the previous sections, neurocognitive research suggests that type 1 diabetes is primarily associated with psychomotor slowing and reductions in mental efficiency. This pattern is more consistent with damage to the brain's white matter than with grey-matter abnormalities. Unfortunately, the relation between cognitive impairments and structural changes in the brain is a topic that has not yet been investigated in sufficient detail in patients with type 1 diabetes. The combined...

Bgat Hypoglycemia

American Diabetes Association Workgroup on Hypoglycemia. Defining and reporting hypoglycemia in diabetes. Diabetes Care 2005 28 1245-1249. 2. The Diabetes Control and Complications Trial Research Group. Hypoglycemia in the Diabetes Control and Complications Trial. Diabetes 1997 46 271-286. 3. Deary IJ. Symptoms of hypoglycaemia and effects on mental performance and emotions. In Hypoglycaemia in Clinical Diabetes, Second edition . Frier BM, Fisher M, eds. Chichester John Wiley amp Sons 2007...

Abduljalil Et Al. 2008 Eur J Pharmacol

Neuropsychological consequences and correlates of diabetes in childhood. In Holmes CS, ed. Neuropsychological and Behavioral Aspects of Diabetes. New York, NY Springer-Verlag, 1989 58-84. 2. Desrocher M, Rovet J. Neurocognitive correlates of type 1 diabetes in childhood. Child Neuropsychol 2004 10 36-52. 3. Rovet JF. Diabetes. In Yeates KW, Ris MD, Taylor HG, eds. Pediatric Neuropsychology Research, Theory, and Practice. New York, NY Guilford Press, 2000 336-365. 4. Northam EA,...

Hyperglycemic Hyperosmolar State Definition and Epidemiology

The hyperosmolar hyperglycemic state HHS is also an acute complication that may occur in patients with diabetes mellitus. It is seen primarily in patients with T2DM and has previously been referred to as hyperglycemic hyperosmolar non-ketotic coma or hyperglycemic hyperosmolar non-ketotic state 13 . HHS is marked by profound dehydration and hyper-glycemia and often by some degree of neurological impairment. The term hyperglycemic hyperosmolar state is used because 1 ketosis may be present and 2...

Psychiatric Comorbidity In Diabetes Mellitus Is There A Relationship With Cognitive Impairment

The prevalence of psychiatric disorders, in particular depression and anxiety disorders which are known to have a negative effect on cognition 28, 29 , is increased in type 1 diabetes. In a recent meta-analysis, odds ratios and prevalence of depression were estimated for both type 1 and type 2 diabetes, from 42 studies having a combined sample size of 21,351 subjects 30 . The main conclusion is that diabetes doubles the odds ratio. A difference in the prevalence of depression in type 1 compared...

Insulin And Dementia

Thus far, we have examined the relationship between insulin and normal memory, and now we turn to the relationship between insulin and dementia. As we have seen, diabetes increases the risk for both cognitive decline and dementia. It is important to keep in mind that T2DM represents both abnormal glycemic regulation and abnormal insulin activity. This section will examine the relationship between Alzheimer's disease, the most common form of dementia among older adults, and insulin...

Dkarelated Cerebral Edema Prognosis

Type Cerebral Edema

Increased intracranial pressure with cerebral edema has been recognized as the leading cause of morbidity and mortality in pediatric patients with DKA 59 . Mortality from DKA-related cerebral edema in children is high, up to 90 26, 31, 33, 35, 60 and accounts for 60-90 of the mortality seen in DKA 28, 31, 35 . DKA-related cerebral edema also accounts for a Fig. 2. Treatment guidelines for DKA. Fig. 2. Treatment guidelines for DKA. high percentage of morbidity since many patients are left with...

Cognitive Performance In Older People With Type Diabetes

Studies addressing cognition in type 1 diabetes predominantly examined cognition in children or young to middle-aged adults. However, it could be hypothesised that the cognitive effects of type 1 diabetes might be more pronounced in older individuals. A recent study compared the cognitive performance in 40 patients with type 1 diabetes with a mean age of 60 years with 40 age- and education-matched controls. Also, cognitive performance was related to measures of psychological well-being and...