Review
Copyright ©The Author(s) 2023.
World J Diabetes. Feb 15, 2023; 14(2): 92-109
Published online Feb 15, 2023. doi: 10.4239/wjd.v14.i2.92
Table 1 Risk factors for cognitive decline in diabetes mellitus
Risk factors for cognitive decline in diabetes mellitus
Age > 60 yrAtherosclerotic cardiovascular disease
Presence of ApoE ε4 alleleUncontrolled hypertension
Long duration of diabetesProteinuria
Poor glycaemic control/high HbA1cDyslipidaemia
Higher fasting glucose levelsPhysical inactivity
Recurrent hypoglycaemic episodesUnhealthy diet
Severe insulin resistanceDepression
Table 2 Landmark randomized controlled trials looking at the benefits of clinical management of modifiable risk factors in diabetes and cognitive dysfunction
Intervention/ treatment
Study characteristics & benefit(s) of treatment/intervention group
Ref.
Treatment with antihypertensives acting on renin angiotensin axisBetter executive function, processing speed, verbal memory and composite score compared to those treated with other antihypertensivesWharton et al[105], 2022
Intensive BP and lipid control compared to standard treatment (ACCORD trial)Intense BP control and lipid reduction had no effects on cognitive decline. Moreover, total brain volume was found to be less with intense BP control (systolic BP < 120 mm Hg) than standard treatment after 40 moWilliamson et al[107], 2014
Liraglutide therapy for T2DMActivation of different cerebral areas with improved memory, attention, and better scores in all cognitive function testsLi et al[112], 2021
Intense vs standard BP control (SPRINT trial)Intense BP control was not associated with improvements in memory or processing speed compared to standard BP reductionRapp et al[113], 2020
10 yr of ILI vs standard care (Look AHEAD trial)ILI resulted in better odds for emergence of: Decision-making inability (OR = 0.851) and problem solving inability (OR = 0.694) in those without these baseline complaintsEspeland et al[114], 2018
Finnish diabetes prevention studyMiddle-aged overweight participants with impaired glucose tolerance showed better cognitive performance with low total fat & saturated fat intake, and frequent physical activities compared to standard lifestyleLehtisalo et al[115], 2016