by Clayton Masterman
Photo by Andrew Scott
It is easy to think of memory as a cognitive process, but like everything in our brain it depends on physiological processes to function. New research has revealed that diabetes can have physiological effects that are severely detrimental to memory. Diabetes comes in two forms, both of which have been linked with the degradation of mental processes. Type 1 diabetes occurs because the body fails to create enough insulin, and type 2 occurs because the body’s cells are unable to use the insulin correctly. Insulin is a hormone secreted by the pancreas that helps cells absorb glucose and create energy. In diabetes blood sugar levels become too high and various complications arise.
Recent studies have shown that both types of diabetes are having an impact on cognitive abilities and memory. Sometimes a diabetic patient can experience diabetic ketoacidosis, which occurs when the body reaches a state where it burns fat for energy instead of sugar. This can have severe complications, the worst of which being a coma. According to a recent study children that have gone through diabetic ketoacidosis perform worse on memory tests than other children. This research was based on children with type 1 diabetes, but these results aren’t isolated to this form of the disease.
A study performed by Dr. Tali Cukierman-Yaffe found that diabetics are 1.5 times more likely to experience a decline in cognitive performance and 1.6 times more likely to experience dementia than individuals without diabetes. This is complicated by the fact that diabetes is an intensive disease to manage; patients must remain constantly vigilant. If a treatment cycle begins to get off course, things quickly get out of control.
The reason for these effects is not entirely understood. Several studies have examined the influence of other factors such as stress and determined that they increase the risk of mental decline in patients, but that they are not the sole cause. Other studies are pointing to cardiovascular damage caused by diabetes as a mechanism for cognitive decline, leading to a form of dementia similar to pure vascular dementia. (Biessels et al, 2005) Until the cause is confirmed and a treatment is developed, patients are left with little hope of a way to prevent these issues from occurring. The only real recommendation that exists is for patients to keep on their treatments to ensure that blood sugar levels remain at normal levels. New cases must be diagnosed immediately to make sure treatment begins as soon as possible. Hopefully soon we’ll confirm the cause of this problem and be able to combat it more effectively.
References:
New York Times, “Diabetes Background”. Retrieved March 29, from
http://health.nytimes.com/health/guides/disease/diabetes/background.html
University of California – Davis (2009, October 19). Diabetic Episodes Affect Kids’ Memory. ScienceDaily. Retrieved March 2, 2010, from http://www.sciencedaily.com /releases/2009/10/091019134718.htm
Tel Aviv University (2009, March 12). Diabetes Linked To Cognitive Deterioration. ScienceDaily. Retrieved March 2, 2010, from http://www.sciencedaily.com /releases/2009/03/090305121659.htm
University of Edinburgh (2010, February 27). Stress raises risk of mental decline in older diabetics, study shows. ScienceDaily. Retrieved March 2, 2010, from
http://www.sciencedaily.com/releases/2010/02/100222100807.htm
Biessels, Geert Jan. Staekenbord, Salka. Brunner, Eric. Brayne, Carol. Scheltens, Philip. (2005). “Risk of dementia in diabetes mellitus: a systematic review”. The Lancet Neurology, Volume 5 (Issue 1). Pages 64-74.
This post addresses a very interesting complication that could develop as the result of poor blood sugar control. It seems that we have all heard the story about someone’s Great Aunt Gertrude or Cousin Betty who has had her foot amputated or is on dialysis because she had “a touch of the sugar.” But no one has every heard that Billy or Suzy has memory issues because he or she has diabetes. The thing is, nothing could have been done to prevent Great Aunt Gertrude or Cousin Betty’s complications except for diligent control of their blood glucose levels; and, I believe the same is true for Billy and Suzy. The medical community only knows that blood sugar levels as close to the normal range of 80-120 mg/dl are the best possible defense to ward off complications. Therefore, I found it interesting that researchers would like to learn more to “combat this problem effectively.” Whether memory deterioration stems from poor blood sugar control or stress the two possible factors go hand in hand. Like the author noted controlling blood sugar levels requires extreme diligence; there is not a formula to follow to control blood sugar levels.
Comment by Stephanie Stone — February 12, 2012 @ 11:26 am
Given some studies suggest that diabetes hurts cognitive functions via cardiovascular damage, wouldn’t specific exercises and physical therapy treatments geared towards improving the cardiovascular system help?
Comment by Jon Lee — February 21, 2012 @ 12:53 pm
I’m curious about the subject groups in the studies cited. Did they all have the same severity of diabetes? And were they all being treated, or managing their diabetes? Meaning, did diabetics who were properly following their treatment and eating the recommended diet experience the same decline in cognitive functioning as those who were not? Since Type II diabetes is in part caused by diet, would we see similar trends in people who are not diabetic but have a very poor diet?
Comment by Adrienne L — February 26, 2012 @ 10:51 am
When thinking about the effects of physiological disorders on mental health, it is important to remember that neurons are cells. Neurons, like all our other cells, metabolize glucose in order to function, so it is no surprise that diabetes affects cognitive performance. Normally, the body reacts to hypoglycemia (low blood sugar levels) by taking measures that slow the onset of further hypoglycemia. In people with diabetes (types 1 and 2), however, these regulatory mechanisms are damaged*. The impaired state of the cells of people with diabetes makes it more difficult for those cells to perform regulatory processes. This makes it all the more difficult for diabetics to prevent further decline.
*Tesfaye, N. and Seaquist, E. R. (2010), Neuroendocrine responses to hypoglycemia. Annals of the New York Academy of Sciences, 1212: 12–28. doi: 10.1111/j.1749-6632.2010.05820.x
Comment by Sarah Yanuck — February 26, 2012 @ 3:08 pm
Though there are many unexplored issues regarding cognitive degeneration and diabetes, one conclusion that has been shared among studies I’ve browsed about the subject is that the insulin resistance seen in diabetes patients can have serious and long term neurological effects. Insulin is an important signal chemical for the prefrontal cortex, responsible in part for helping individuals make decisions and predict future rewards or punishments, as well as the hippocampus, involved in long term memory. The effect of insulin resistance is not only the chronic stress put on individuals, but of reduction in hippocampal function and repair. Alvarez et al. (2009) has found that in mice with type I diabetes, hippocampus cells die faster and proliferate at slower rates than in those without insulin resistance. The study also found that the mice suffered degeneration in both memory and learning tests, and not only that, had markers of oxidative stress and aging in multiple parts of the hippocampi, and even displayed a higher latency in the escape response. Further research must be done to understand exactly how insulin levels modulate neurological function, but signs depression of not only prefrontal cortex and hippocampus activity seem to underscore how potent the effects of diabetes can be.
Alvarez, E. O., Beauquis, J., Revsin, Y., Banzan, A.M., Roig, P., De Nicola, A.F., Saravia, F. (2009) Cognitive dysfunction and hippocampal changes in experimental type 1 diabetes. Behavioral Brain Research 198(1) 224-230.
Comment by Alex Lee — February 26, 2012 @ 9:00 pm
I find this article particularly interesting because a close family member of mine was diagnosed with type I diabetes three years ago. Clearly, his memory has declined since his diagnosis. I always have tracked his slower physiological processing to the physical fatigue caused by his unstable blood sugar. However, the more serious cognitive effects of the inevitable physical fatigue, especially for patients with type I diabetes, are often overlooked. This article does a fantastic job highlighting these, such as experiencing a diabetic ketoacidosis and coma. If this post were to be extended, I would be interested to learn what type of treatments would be specially useful for patients with slower physiological processing.
Comment by Hannah Van Demark — February 26, 2012 @ 10:28 pm
It is interesting to note the numerous side effects that may be implicated with diabetes. It seems like a key aspect in diabetes that may be associated with memory loss, is related to the levels of insulin that run through the body, specifically the brain. The lack of insulin and the inability to make use of it, is the problem brought about by diabetes and may also be the culprit as to why patients experience memory loss. A study conducted which observed the effects that insulin had on the brain when performing memory functions, found that a lack of insulin contributed to a shortage of brain water which led to cerebral dehydration. Dehydration in the brain impairs short term memory function and affects one’s ability to recall long term memory due to the fact that the brain needs to be hydrated to function properly. With the effects of insulin and its relationship with diabetes and contributions to water loss, it’s important to consider how the lack of this hormone may contribute to a loss in memory.
Source: Šerbedžija, Predrag; Madl, James E.; Ishii, Douglas N.. Brain Research 1303 (Nov 25, 2009): 179-194.
Comment by Marvin Ponce — February 29, 2012 @ 8:40 pm
Diabetes is a disease that effects 8.3 percent of people in the United States. Diabetes not only complicates the life of the carrier, but increases their chance of other complications. One of these is diabetic ketoacidosis. This is a very serious medical condition that effects the patients body and brain. It makes sense though that since one of the complications of diabetic ketoacidosis is a coma, that it would have some effect on other brain functions as well.When in a coma the patient can not be awakened, and does not respond to stimuli that would usually wake the patient up. If diabetic ketoacidosis has the ability to send a diabetic into such a severe state as a coma, it only makes sense that it would effect the brain in other ways as well. DKA has several other side effects such as, confusion, lethargy, dry mouth, abdominal pain, and more. It is no surprise that some of these side effects involve thought processes, or the ability to make decisions. Diabetics are constantly fighting DKA off, which leads me to believe that their their brain my be constantly occupied with something else possibly lowering their ability to create new memories.This could also lead to other serious mental illnesses, such as dementia later in life.
Comment by Alex Snyder — March 1, 2012 @ 4:36 pm
I found this article interesting because a friend who I used to hang out with a lot suffers from type 1 diabetes and, being sloppy with his medication and lifestyle, has been hospitalized a few times for diabetic ketoacidosis (DKA) throughout his early teens. I did more reading on the link between DKA and cognitive decline and found out that there is a concern that the current accepted methods for intensive treatment of DKA might be tied to cognitive impairment. These treatments involve the use of intravenous fluids and insulin to correct the fluid and glucose balance, which some researchers believe are administered too aggressively at patients’ expense. Some data even suggests that these methods increase the risk of a cerebral edema in patients (http://emj.bmj.com/content/21/2/141.full), which can lead to severe brain damage. Studies on this issue so far seem to have gone either way, however, and there doesn’t seem to be any final word out yet. For instance, this study (http://care.diabetesjournals.org/content/31/10/1933.full) found no connection between DKA treatment and cognitive decline.
Comment by Ben Chin — March 12, 2012 @ 4:30 pm
Very interesting article. I would have never thought that having a disease that primarily affects blood sugar could have adverse effects on memory in individuals. It seems as though these DKA episodes and diabetes in general has an effect on memory. But, I would like to take another approach and say that people who are genetically more prone to diabetes NOT consequently have worse memory capabilities. Diabetes is a very interesting disease that ( I hope) should be cured within my life time. It would be interesting to test whether such memory damage caused by DKA episodes is permanent even without diabetes affecting the individual. Also, it would be interesting to investigate a newborn who is at high risk for Type 1 Diabetes and give them the “cure” for diabetes… and still test their cognitive memory abilities.
Comment by Evan Kamber — May 4, 2012 @ 12:02 pm
The potential damage to a diabetic’s cognitive functions makes an already challenging disease even more difficult to deal with. Children suffering from diabetes must be especially at risk of diabetic ketoacidosis, because it is harder for them to keep track of sugar in the things they eat and their parents can’t keep a constant watch on them. Even if someone makes it through ketoacidosis, they still might have to deal with serious damage to their mental performance, which is obviously significantly detrimental. These studies just make it even more apparent that diabetics have to constantly pay attention to the foods they eat and their blood sugar levels, if the physical dangers weren’t enough to begin with.
Comment by Brian O'Connor — October 8, 2012 @ 7:34 pm
It surprised me that diabetes can affect memory and brain functions. However, as comment 4 points out, I just need to remember that neurons are cells too. What we eat directly affects out entire body, which is why our food choices are so important. What we eat fuels us, and if your body has a deficiency and cannot handle sugar, or another food for that matter, that needs to be accounted for. When I was a camp counselor this summer, one of my campers had a strong case of diabetes. She was fourteen and used an insulin pump. While she may have thought she was in control of her disease because she manipulated her insulin pump often, she had probably the worst eating habits I could imagine for a diabetic. Every meal we would try to convince her to eat less carbohydrates and more vegetables, but she refused. She also refused to participate in camp activities involving exercise. One night, her blood sugar levels were so high that she needed to be sent home. It is upsetting to think that her poor choices as a teenager will effect her brain growth, memory, and life very directly in the future.
Comment by Sarah Muskin — November 27, 2012 @ 4:32 pm
My grandfather was diagnosed with Type 1 diabetes, and throughout the latter parts of his life he struggled to keep healthy. It certainly didn’t help that he also developed a cardiovascular disease later on. It also didn’t help that he still loved to eat sweets. A lot of sweets. My grandmother would always yell at him for sneaking in a popsicle after dinner or having a dessert for lunch. But reading this article, it makes me think more about his declining memory towards the last few years of his life. He was no Cam Jansen when he was younger, but I definitely noticed that he was forgetting a lot more when I was in my early teens. More recently, my grandfather showed some sure signs of cognitive decline. I wonder if this was indeed linked to his diabetes, or was another disease entirely that affected his memory while his diabetes and cardiovascular disease attacked other parts of his body.
Comment by 105 student — December 2, 2012 @ 9:15 pm
“A study performed by Dr. Tali Cukierman-Yaffe found that diabetics are 1.5 times more likely to experience a decline in cognitive performance and 1.6 times more likely to experience dementia than individuals without diabetes.”
This kind of hits home for me. My grandmother has been living with diabetes for most of her adult life. And when she reached about 60, well… she just wasn’t the same person anymore. She has always been really irresponsible with maintaining her blood sugar levels, so she probably increased her own risk of developing dementia with her own refusal to eat properly. Still, even though it’s just important for a diabetic person’s overall life and health to eat right, I’m sure she had no idea she was increasing her chances of dementia; I certainly had no clue until I read this article that the two could even be related.
Comment by 105 student — December 5, 2012 @ 9:17 pm
While I was unaware that diabetes could interfere with cognitive functions, it did not surprise me. My father is diabetic along with his entire side of the family including both of his parents, aunts and uncles, cousins and his brother. I have seen the numerous side effects and complications that come with diabetes due the elevated sugar levels and elevated blood pressure such as eye floaters, foot pain, diabetic coma, stroke and amputation due to poor circulation (my grandmother was a bilateral amputee due to diabetes.) Diabetes affects so many parts of the body due to the close links blood sugar and blood sugar has to maintaining homeostasis that the fact that it affects the brain is not shocking. Though I have not noticed notable memory impairment in any of my relatives with diabetes, I can only imagine the frustration that they would experience due to memory impairment. As the use of insulin, diet and exercise can stave off many side effects, I am curious as to if the preventing cognitive impairment would also aided by diet, medication and exercise?
Comment by 105 Student — December 10, 2012 @ 10:15 pm
With regards to burning fat instead of sugar, how about when a runner “hits a wall”? Is it not that the diabetic is burning fat instead of sugar, but rather that the patient is burning fat instead of sugar while there is still sugar that can be burned floating around the body? Is it the presence of this excess sugar which leads to memory deficits? In that case, could it be possible to say that sugar shock, or intake of excessive amounts of sugar even for a regular person, might somehow lead to memory impairment since there is too much sugar in the body to be broken down quickly? Interesting stuff.
Comment by Alex Treitel — March 4, 2013 @ 1:05 am
This is an interesting article. I did not know that diabetes can have cognitive effects, but it does make sense, since diabetes is such a systemic and long term disease. Like many other commenters, this issue is of interest to me because a close friend of mine has diabetes. If the only treatment that exists for this symptom, keeping blood sugar at normal levels, that is not good enough. This is something that diabetics are already working to regulate. I wonder what other kinds of treatments can be made for this loss of memory capability? Memory loss and decrease in any cognitive function is so devastating, both for the patient and those who are close to them. So what kinda of things can be done? What kind of research is being done for treatments besides regulation of sugar levels?
Comment by psych 105 student — April 9, 2013 @ 10:59 pm
I think this is a good reminder that we should take our health seriously, as any disease can affect numerous systems in our bodies. Although diabetes is primarily a detriment to one’s blood sugar levels, the brain as well as the rest of the body make use of glucose, so it is reasonable to expect other kinds of problems as a result of diabetes. As others have said, the entire body is comprised of interconnected and interdependent systems. It’s also relevant that neurodegenerative disorders such as Huntingtin’s Disease have a severe effect on the motor phenotype. So, it works both ways; what happens to the brain affects the body and vice versa.
Comment by Joe Louie — April 13, 2013 @ 2:40 pm
I found this to be an interesting article, pointing out again the body/mind link. Is it possible that the reason these mental problems are more common in diabetics who’ve experienced ketoacidosis is that being forced to burn fat is bad for the brain? After all, the brain normally runs solely on glucose. Potentially, entering ketoacidosis either causes brain cells to simply starve, or forces them to use a “polluting” fuel that they are not equipped to handle safely.
Comment by Ben Hoffman — May 8, 2013 @ 7:55 pm
I found this article helpful and informative. I had never heard of a link between diabetes and cognitive function, but needless to say, it doesn’t surprise me. Many physiological problems interfere with cognition, so I wonder why I’ve never thought of it before. Often neurodegenerative disorders manifest themselves physically in the body as well. I have a few friends who have diabetes and over the years, I haven’t noticed any change to personality or cognitive performance in school. It is scary to know that something so common and seemingly unrelated to the brain can so greatly affect cognition and future risks of dementia. It begs the question, what other physiological problems are so directly related to cognitive performance, and what can we do to prevent them and ensure a healthy future? It seems that a healthy diet, exercise, and a healthy mental state fix or help many physical problems.
Comment by 105 student — May 20, 2013 @ 8:22 pm