Dementia in diabetes is usually a progressive decline in intellectual functioning. Memory loss is a frequent symptom of dementia.
What Causes Dementia in Diabetes
Narrowing of the brain vessels is the underlying cause for intellectual decline and memory loss in a majority of diabetic patients.
Transient ischemic attacks (TIAs), also known as mini-strokes, take place due to transient cessation of blood circulation to a certain part of the brain. Multiple mini-strokes over a period of time lead to the death of brain cells and, eventually, a person starts experiencing a decline in intellectual function and lapses in memory. This is known as multi-infarct dementia or vascular dementia, the most common cause for memory loss in diabetic patients.
Of course, the underlying cause for narrowing of the blood vessels is Insulin Resistance Syndrome. And once again, diabetes, high blood pressure, cholesterol disorder, and abdominal obesity are the main components of Insulin Resistance Syndrome.
In a large clinical study (1), involving 10,963 people, researchers assessed changes in cognitive function over a six-year interval. Diabetes and hypertension were found to be the strongest predictors of decline in intellectual functioning, even as early as at the age of forty-seven.
In another study (2), researchers looked at the impact of ingesting 50 grams of rapidly absorbing carbohydrates (one half of a bagel and white grape juice) on the memory of diabetic patients. They found a positive correlation between carbohydrate intake and poor memory in these patients. In addition, overall poor control of diabetes was associated with a decline in memory.
If you don’t aggressively treat the underlying disease that caused a stroke in the first place, how can you prevent further strokes and their consequences, such as memory loss? Quite often, these patients are misdiagnosed with Alzheimer’s disease.
Another common problem is when patients suffer a heart attack, undergo heart bypass surgery or angioplasty, and they are not properly evaluated or treated for the risk factors for stroke. Remember, if you have narrowing of the blood vessels in your heart, you probably also have narrowing of the blood vessels in your brain, and probably every where in the entire body.
Anyone who has memory loss, a stroke (even a minor stroke), a heart attack, coronary angioplasty, or heart bypass surgery should be evaluated for risk factors for narrowing of the blood vessels. These risk factors include hypertension, cholesterol disorder, and diabetes or pre-diabetes.
Other Causes Of Dementia in Diabetes
Besides vascular dementia, some of the other causes for memory loss or dementia include an underactive thyroid, vitamin B12 deficiency, depression, subdural hematoma, AIDS, and syphilis.
Out of these causes, an underactive thyroid, depression and vitamin B12 deficiency are the most common disorders, which can be easily diagnosed and treated. A low level of vitamin B12 is common in elderly diabetic individuals who are also on metformin. Vitamin B12 deficiency should be treated either with vitamin B12 injections or with vitamin B12 pills. (See chapter on vitamin B12 deficiency.)
Alzheimer’s dementia is a diagnosis of exclusion. That is, once all the treatable causes of dementia as mentioned above have been excluded, only then should a diagnosis of Alzheimer’s be made.
Diagnostic Testing For Dementia in Diabetes
- Two-hour oral glucose tolerance test to diagnose pre-diabetes or diabetes
- Cholesterol panel, which should include HDL, LDL, and triglycerides
- Ultrasound of carotid arteries to rule out narrowing of the neck arteries
- MRI of the brain to rule out any evidence of a recent or an old stroke
- A thyroid blood panel to diagnose an underactive thyroid
- A blood test for vitamin B12, syphilis, and AIDS
- Knopman D, et al. Atherosclerosis Risk in Communities (ARIC) cohort. Neurology 2001; 56:42–28.
- Greenwood CE, Kaplan RJ, et al. Carbohydrate induced memory impairment in adults with type 2 diabetes. Diabetes Care 2003; 26:1961–1966.
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