Dr Araz Rawshani

Diabetes and dementia

Contents

Diabetes increases the risk of dementia

Dementia affects 50 million people worldwide. Dementia means that changes occur in the brain and these changes lead to a deterioration in memory and ability to plan and carry out everyday tasks. Dementia also leads to difficulties in speaking, difficulties with time perception and less ability to orient. Many people with dementia also become anxious, depressed, and sometimes personality changes occur. Dementia is a severe disease.

There are over 100 diseases and conditions that can cause dementia. Approximately 60 -70% of all cases of dementia are caused by Alzheimer’s disease. This disease causes the cells of the brain to gradually die. The second most common form of dementia is vascular dementia and it is due to atherosclerosis and clots in the vessels of the brain. When the vessels of the brain become atherosclerotic or clogged, it leads to oxygen deficiency in the brain and the lack of oxygen damages the cells in the brain.

In recent years, people with diabetes (type 2 diabetes) have an increased risk of dementia. Initially, it was believed that this was Alzheimer’s disease, but recent research shows that people with diabetes have a special type of dementia. The number of people at risk of dementia and risk factors for dementia remains to be investigated. Research is underway in this area. 3

Type 2 diabetes and dementia: diabetic dementia

The relationship between diabetes and dementia has been noticed in recent years. More and more studies have shown that dementia is much more common if you have diabetes and now dementia is actually regarded as a complication of diabetes. Current knowledge suggests that people with diabetes have a type of dementia reminiscent of “vascular dementia”, but with some unique features.

People with type 2 diabetes experience dementia earlier in life and have more pronounced symptoms.4

The brain (after death) of people with diabetes and dementia has been examined and noted that these people have more small infarcts in the brain and worse blood supply to the brain tissue. Earlier it was said that Alzheimer’s disease was more common among people with type 2 diabetes but nowadays it is considered that the form of dementia most often affected by type 2 diabetes forms its own type of dementia and is mostly similar to vascular dementia. Today, scientists have begun to use the term “diabetic dementia” for this type of dementia.

There are a wide range of explanations for diabetic dementia and the main ones seem to be the following:

  • High blood sugar is harmful to both the brain tissue and the blood vessels that supply the brain tissue with blood. Therefore, high sugar can lead to damage to the term of the brain.
  • People with diabetes have a significantly higher risk of getting infarcts in the brain tissue (this is called stroke). The absolute majority of these infarcts are very small and do not have to give any symptoms when they occur. Such infarcts are more common among people with type 2 diabetes.
  • People with type 2 diabetes more often have heart rhythm disturbances, especially atrial fibrillation, which can lead to small blood clots being sent up to the brain and cause small infarcts (strokes).
  • People with diabetes more often have low blood clots. Blood sugar (hypoglycaemia) which can lead to damage to the brain if it occurs too many times.
  • People with type 2 diabetes have a higher risk of falling and when you hit the head, brain cells can be damaged both acutely and in term.
  • Hypocampus is an area of the brain that is very important for our memory. Insulin is needed in order for the hypocampus to absorb glucose (sugar) and thus function normally. People with insulin resistance (as seen in type 2 diabetes and metabolic syndrome) have impaired ability to absorb glucose in the hypocampus.
  • People with type 2 diabetes have a higher risk of getting hypothyroidism and lack of vitamin B12, which also worsens brain capacity (cognitive ability, cognition).

We still have much to learn about diabetic dementia, especially as regards the risk of people with type 1 diabetes. Since diabetic dementia appears to have much in common with vascular dementia, current treatment recommendations should also reduce the risk of diabetic dementia. Current treatment, namely, is aimed at preventing damage to the vessels and heart.

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