Mild to moderate cognitive decrements are a well-known phenomenon associated with diabetes mellitus. In this review, we provide an overview of the cognitive consequences of type 1 and type 2 diabetes ...based on hallmark studies that follow patients over an extended period of time. In patients with type 1 diabetes, cognitive dysfunction appears soon after diagnosis and can be found in individuals of any age. The magnitude of these effects is generally modest, although their severity is especially pronounced in those with early onset type 1 diabetes (diagnosis before 7 years of age) or those who have developed microvascular disease, such as proliferative retinopathy. Rates of type 2 diabetes have increased dramatically over the past 20 years, in part driven by the world-wide epidemic of obesity, and this form of diabetes is appearing at a progressively younger age. Again, cognition may be disrupted, particularly in those who are in poorer glycemic control, and there is some evidence to suggest that with increasing diabetes duration, the rate of cognitive decline is accelerated and the risk of dementia is increased significantly.
Anxiety symptoms (AS) are exacerbated in healthcare workers (HCWs) during the COVID-19 pandemic. Spirituality is known to protect against AS in the general population and it is a construct that ...differs from religion. It can be assessed using structured questionnaires. A validated questionnaire disclosed three spirituality dimensions: peace, meaning, and faith. In HCWs we investigated the predictors of chronic anxiety (pre-COVID-19 and during the pandemic) and acute anxiety (only during the pandemic), including spirituality in the model. Then, we verified which spirituality dimensions predicted chronic and acute anxiety. Lastly, we studied group differences between the mean scores of these spirituality dimensions.
The study was carried out in a Brazilian Hospital. HCWs (n = 118) were assessed for spirituality at a single time-point. They were also asked about AS that had started pre-COVID-19 and persisted during the pandemic (chronic anxiety), and AS that had started only during the pandemic (acute anxiety). The subjects without chronic anxiety were subdivided into two other groups: acute anxiety and without chronic and acute anxiety. Forward stepwise logistic regressions were used to find the significant AS predictors. First, the model considered sex, age, religious affiliation, and spirituality. Then, the analysis were performed considering only the three spirituality dimensions. Group means differences in the spirituality dimensions were compared using univariate ANCOVAS followed by T-tests.
Spirituality was the most realible predictor of chronic (OR = 0.818; 95%CI:0.752-0.890; p<0.001) and acute anxiety (OR = 0.727; 95%CI:0.601-0.881; p = 0.001). Peace alone predicted chronic anxiety (OR = 0.619; 95%CI:0.516-0.744; p<0.001) while for acute anxiety both peace (OR:0.517; 95%CI:0.340-0.787; p = 0.002), and faith (OR:0.674; 95%CI:0.509-0.892; p = 0.006) significantly contributed to the model. Faith was significantly higher in subjects without AS.
Higher spirituality protected against chronic and acute anxiety. Faith and peace spirituality dimensions conferred protection against acute anxiety during the pandemic.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aim
To assess the effects of Roux‐en‐Y gastric bypass surgery (RYGB)‐related changes in glucagon‐like peptide‐1 (GLP‐1) on cerebral resting‐state functioning in obese women.
Materials and Methods
In ...nine obese females aged 40‐54 years in the fasted state, we studied the effects of RYGB and GLP‐1 on five a priori selected networks implicated in food‐ and reward‐related processes as well as environment monitoring (default mode, right frontoparietal, basal ganglia, insula/anterior cingulate and anterior cingulate/orbitofrontal networks).
Results
Before surgery, GLP‐1 receptor blockade (using exendin9‐39) was associated with increased right caudate nucleus (basal ganglia network) and decreased right middle frontal (right frontoparietal network) connectivity compared with placebo. RYGB resulted in decreased right orbitofrontal (insula/anterior cingulate network) connectivity. In the default mode network, after surgery, GLP‐1 receptor blockade had a larger effect on connectivity in this region than GLP‐1 receptor blockade before RYGB (all PFWE < .05). Results remained similar after correction for changes in body weight. Default mode and right frontoparietal network connectivity changes were related to changes in body mass index and food scores after RYGB.
Conclusions
These findings suggest GLP‐1 involvement in resting‐state networks related to food and reward processes and monitoring of the internal and external environment, pointing to a potential role for GLP‐1–induced changes in resting‐state connectivity in RYGB‐mediated weight loss and appetite control.
Objective
Cognitive impairments in type 1 diabetes may result from hyperglycemia‐associated cerebral microangiopathy. We aimed to identify cerebral microangiopathy and skin microvascular ...dysfunction—as a surrogate marker for generalized microvascular function—as predictors of cognitive performance over time.
Methods
In this prospective cohort study, 25 type 1 diabetes patients with proliferative retinopathy and 25 matched healthy controls underwent neurocognitive testing at baseline and after follow‐up (3.8 ± 0.8 years). At baseline, 1.5‐T cerebral magnetic resonance imaging was used to detect WML and cerebral microbleeds. Skin capillary perfusion was assessed by means of capillary microscopy.
Results
In type 1 diabetes patients, but not in healthy controls, the presence of WML (ß = −0.419; P = 0.037) as well as lower skin capillary perfusion (baseline: ß = 0.753; P < 0.001; peak hyperemia: ß = 0.743; P = 0.001; venous occlusion: ß = 0.675; P = 0.003; capillary recruitment: ß = 0.549; P = 0.022) at baseline was associated with lower cognitive performance over time, independent of age, sex, HbA1c, and severe hypoglycemia. The relationship between WML and lower cognitive performance was significantly reduced after adjusting for capillary perfusion.
Conclusions
These data fit the hypothesis that cerebral microangiopathy is a manifestation of generalized microvascular dysfunction, leading to lower cognitive performance.
Background
The aim of the present study was to determine trajectories of cognitive and cortical changes over time in middle‐aged patients with type 1 diabetes mellitus (T1DM) and proliferative ...retinopathy.
Methods
Twenty‐five patients and 25 controls underwent neuropsychological assessment and neuroimaging twice in a mean (±SD) of 3.56 ± 0.65 and 3.94 ± 0.91 years, respectively (P = 0.098). Cognitive assessment included the domains of general cognitive ability, memory, information processing speed, executive functions, attention, and motor and psychomotor speed. Symmetrized percentage change in local cortical thickness, surface area, and volume was determined using the FreeSurfer 6 vertex‐wise general linear model method. Analyses were performed uncorrected and corrected for baseline systolic blood pressure and depressive symptoms.
Results
In patients versus controls, accelerated executive function decline was accompanied by, but not related to, lower left frontal and temporal surface area, left parietal and right frontal thickness, and bilateral frontal and right posterior cingulate volume (family‐wise error FWE‐corrected P < 0.05 for all). In patients, lower executive performance was related to loss of right precuneus surface area (PFWE = 0.005). Higher HbA1c during follow‐up was related to executive function decline (r = −0.509, P = 0.016) and loss of left hemisphere surface area (rcorrected analysis = −0.555, P = 0.007).
Conclusions
After 3.5 years of follow‐up, middle‐aged T1DM patients with proliferative retinopathy, mild focal changes in executive functions, and cortical structure were found, which may indicate accelerated aging.
摘要
背景
本研究旨在有合并增殖性视网膜病变的中年1型糖尿病(T1DM)患者中测定认知功能与脑皮质随时间变化的轨迹。
方法
本研究共纳入25名患者与25名对照组受试者, 接受2次神经心理评估以及神经影像学检查, 平均随访时间分别为3.56 ± 0.65与3.94 ± 0.91年(P = 0.098)。认知评估包括一般认知能力、记忆、信息处理速度、执行功能、注意力、运动以及精神活动速度。采用FreeSurfer 6 vertex‐wise一般线性模型法测定局部皮质厚度、表面积以及体积的对称百分比变化。校正基线收缩压以及抑郁症状, 在校正前及校正后都进行了分析。
结果
与对照组受试者相比, 伴随着左额叶与颞叶表面积、左顶叶与右额叶厚度、双侧额叶与右后扣带回的体积,T1DM患者的执行功能加速下降, 但没有相关性(校正族系误差family‐wise error,FWE后所有P < 0.05)。患者的执行功能较差与右楔前叶表面积减少相关(PFWE = 0.005)。随访期间HbA1c越高与执行功能越差(r = ‐0.509,P = 0.016)以及左半球表面积越小相关(r校正后分析 = ‐0.555,P = 0.007)。
结论
经过3.5年的随访, 发现合并增殖性视网膜病变的中年T1DM患者执行功能以及皮质结构都出现了轻度的局灶性变化, 这可能意味着加速的老龄化。
Highlights
In middle‐aged type 1 diabetes mellitus patients with proliferative retinopathy at baseline, executive function performance showed a moderate decline over 3.5 years.
This was mirrored by loss of frontal and parietal cortical structure.
Both changes were related to worse glycemic control during follow‐up.
Background and purpose
Temporal lobe epilepsy secondary to hippocampal sclerosis is related to epileptogenic networks rather than a focal epileptogenic source. Graph‐theoretical gray and white matter ...networks may help to identify alterations within these epileptogenic networks.
Methods
Twenty‐seven patients with hippocampal sclerosis and 14 controls underwent magnetic resonance imaging, including 3D‐T1, fluid‐attenuated inversion recovery, and diffusion tensor imaging. Subject‐specific structural gray and white matter network properties (normalized path length, clustering, and small‐worldness) were reconstructed. Group differences and differences between those with higher and lower seizure burden (<4 vs. ≥4 average monthly seizures in the last year) in network parameters were evaluated. Additionally, correlations between network properties and disease‐related variables were calculated.
Results
All patients with hippocampal sclerosis as one group did not have altered gray or white matter network properties (all p > .05). Patients with lower seizure burden had significantly lower gray matter small‐worldness and normalized clustering compared to controls and those with higher seizure burden (all p < .04). A higher number of monthly seizures was significantly associated with increased gray and white matter small‐worldness, indicating a more rigid network.
Conclusion
Overall, there were no differences in network properties in this group of patients with hippocampal sclerosis. However, patients with lower seizure burden had significantly lower gray matter network indices, indicating a more random organization. The correlation between higher monthly seizures and a more rigid network is driven by those with higher seizure burden, who presented a more rigid network compared to those with a lower seizure burden.
Temporal lobe epilepsy secondary to hippocampal sclerosis is related to abnormal epileptogenic networks, including multiple temporal and extra‐temporal structures, rather than a single focal epileptogenic source. This study aims to assess alterations within structural gray and white matter networks in patients with hippocampal sclerosis, through a graph theory analysis. In patients with hippocampal sclerosis, a more rigidly organized network (higher small‐worldness) was related to having more monthly seizures; also, patients with low seizure burden had significantly lower gray matter small‐worldness and normalized clustering compared to controls and those with high seizure burden.
Objective:
To investigate the association between diabetes mellitus (DM) and incidence of depressive episodes among men and women.
Methods:
Data were used from 12,730 participants (5866 men and 6864 ...women) at baseline (2008–2010) and follow-up 1 (2012–2014) of the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort of Brazilian civil servants. Participants were classified for diabetes using self-reported and clinical information, and evaluated for presence of depressive episodes by the Clinical Interview Schedule–Revised (CIS-R). Associations were estimated by means of logistic regression models (crude and adjusted for socio-demographic variables).
Results:
Women classified as with DM prior to the baseline were at 48% greater risk (95% confidence interval (CI) = 1.03–2.07) of depressive episodes in the crude model and 54% greater risk (95% CI = 1.06–2.19) in the final adjusted model compared to women classified as non-DM. No significant associations were observed for men. The regression models for duration of DM and incidence of depressive episodes (n = 2143 participants; 1160 men and 983 women) returned no significant associations.
Conclusion:
In women classified as with prior DM, the greater risk of depressive episodes suggests that more frequent screening for depression may be beneficial as part of a multi-factorial approach to care for DM.
We aimed to evaluate whether human immunodeficiency virus (HIV)-positive patients with and without clinically significant memory deficits and healthy control participants differ on in vivo hydrogen-1 ...magnetic resonance spectroscopy (H-MRS) in the posterior cingulate gyri.
In total, 21 HIV-positive patients with memory deficit (HIV+wMD) were compared with 15 HIV-positive patients without memory deficit (HIV+wOMD) and 22 sex-, age-, and education-matched control participants. Memory impairments were classified based on the participants' performance on the Rey Auditory Verbal Learning Test. Short echo time (30 ms), single-voxel H-MRS was performed using a 1.5-T magnetic resonance scanner.
The HIV+wMD and HIV+wOMD groups had higher choline/creatine ratio in the posterior cingulate gyri than the control group. There were no significant metabolite ratio differences between the HIV+wMD and HIV+wOMD groups.
HIV-positive patients with and without memory deficits had significantly higher choline/creatine ratios than controls in the posterior cingulate gyri, which may reflect cerebral inflammation, altered cell membrane metabolism, microgliosis, and/or astrocytosis.
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