STUDY OF ASSOCIATION BETWEEN COGNITIVE IMPAIRMENT AND GLYCEMIC CONTROL IN TYPE 2 DIABETES PATIENT AND MOCA (MONTREAL COGNITIVE ASSESSMENT) AS A PREDICTIVE TOOL FOR GLYCEMIC CONTROL IN DIABETIC PATIENTS WITH COGNITIVE IMPAIRMENT: A CROSS-SECTIONAL STUDY

UMA BHOSALE; NEHA DHARAP; ATHARV GADAVE

doi:10.22159/ijcpr.2025v17i3.55061

Authors

UMA BHOSALE Department of Pharmacology, SKNMC, Narhe (Ambegaon) Pune-41, India https://orcid.org/0000-0001-5300-0619
NEHA DHARAP SKNMC and GH, Narhe (Ambegaon) Pune-41, India https://orcid.org/0000-0001-5300-0619
ATHARV GADAVE SKNMC and GH, Narhe (Ambegaon) Pune-41, India https://orcid.org/0000-0001-5300-0619

DOI:

https://doi.org/10.22159/ijcpr.2025v17i3.55061

Keywords:

MoCA, Glycemic control, Cognitive decline

Abstract

Objective: India has the second highest number of type 2 diabetes mellitus (T2DM) cases, with several known complications, including heart disease, stroke, hypertension, atherosclerosis, neuropathy etc. In a considerable number of diabetics, cognitive impairment is found. This prevalent complication is an alarming one. There has been insufficient research data to conclusively comment on cognitive impairment in diabetic patients with poor glycemic control. This study was therefore designed to assess the cognitive impairment using MoCA test (Montreal Cognitive Assessment) and its association with glycemic control in T2DM and utility of MoCA test as a predictive tool for glycemic control in patients with cognitive decline over period of time.

Methods: 30 points MoCA test was conducted in 150 T2DM patients.

Results: In present study, significant cognitive impairment (MoCA score<26) was found in diabetic patients with HbA1c % >7.5 and a resounding majority of diabetic patient also showed cognitive impairment with greater preponderance towards the uneducated subjects and those with co-morbid conditions.

Conclusion: The diabetics with strict glycemic control have lesser incidence of cognitive impairment over period of time. MoCA test could be used as early predictive tool for glycemic control in patients with cognitive decline.

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References

Kinattingal N, Mehdi S, Undela K, Wani SU, Almuqbil M, Alshehri S. Prevalence of cognitive decline in type 2 diabetes mellitus patients: a real-world cross-sectional study in Mysuru India. J Pers Med. 2023;13(3):524. doi: 10.3390/jpm13030524, PMID 36983706.

Kravitz E, Schmeidler J, Schnaider Beeri M. Type 2 diabetes and cognitive compromise: potential roles of diabetes-related therapies. Endocrinol Metab Clin North Am. 2013;42(3):489-501. doi: 10.1016/j.ecl.2013.05.009, PMID 24011882.

Sheen YJ, Sheu WH. Association between hypoglycemia and dementia in patients with type 2 diabetes. Diabetes Res Clin Pract. 2016;116:279-87. doi: 10.1016/j.diabres.2016.04.004, PMID 27321346.

Areosa Sastre A, Vernooij RW, Gonzalez Colaco Harmand M, Martinez G. Effect of the treatment of type 2 diabetes mellitus on the development of cognitive impairment and dementia. Cochrane Database Syst Rev. 2017;6(6):CD003804. doi: 10.1002/14651858.CD003804.pub2, PMID 28617932.

Gregg EW, Brown A. Cognitive and physical disabilities and aging-related complications of diabetes. Clin Diabetes. 2003;21(3):113-8. doi: 10.2337/diaclin.21.3.113.

Biessels GJ, Van Der Heide LP, Kamal A, Bleys RL, Gispen WH. Ageing and diabetes: implications for brain function. Eur J Pharmacol. 2002;441(1-2):1-14. doi: 10.1016/s0014-2999(02)01486-3, PMID 12007915.

Duarte AI, Candeias E, Correia SC, Santos RX, Carvalho C, Cardoso S. Crosstalk between diabetes and brain: glucagon-like peptide-1 mimetics as a promising therapy against neurodegeneration. Biochim Biophys Acta. 2013;1832(4):527-41. doi: 10.1016/j.bbadis.2013.01.008, PMID 23314196.

Pasquier F, Boulogne A, Leys D, Fontaine P. Diabetes mellitus and dementia. Diabetes Metab. 2006;32(5 Pt 1):403-14. doi: 10.1016/s1262-3636(07)70298-7, PMID 17110895.

Shanik MH, XU Y, Skrha J, Dankner R, Zick Y, Roth J. Insulin resistance and hyperinsulinemia: is hyperinsulinemia the cart or the horse? Diabetes Care. 2008;31 Suppl 2:S262-8. doi: 10.2337/dc08-s264, PMID 18227495.

Matveeva MV, Samoilova YG, Zhukova Natali G, Rotkank Mariya A, Tolmachev Ivan V, Oleynik OA. Chapter 2. Sibat HF, Editor. Cognitive impairment in patients with diabetes mellitus. Cognitive disorders. 1st ed. Intech Open; 2018.

Sharma G, Parihar A, Talaiya T, Dubey K, Porwal B, Parihar MS. Cognitive impairments in type 2 diabetes risk factors and preventive strategies. J Basic Clin Physiol Pharmacol. 2020;31(2):20190105. doi: 10.1515/jbcpp-2019-0105, PMID 31967962.

Kaufman DM, Milstein MJ. Chapter 7. Dementia. In: Kaufman DM, Milstein MJ, editors. Kaufman’s clinical neurology for psychiatrists. 7th ed. Elsevier; 2013. p. 109-54. doi: 10.1016/B978-0-7234-3748-2.00007-4.

Alkhunizan M, Alkhenizan A, Basudan L. Prevalence of mild cognitive impairment and dementia in Saudi Arabia: a community-based study. Dement Geriatr Cogn Dis Extra. 2018;8(1):98-103. doi: 10.1159/000487231, PMID 29706986.

Naguib R, Soliman ES, Neimatallah FM, AlKhudhairy NS, AL Ghamdi AM, Almosa RS. Cognitive impairment among patients with diabetes in Saudi Arabia: a cross-sectional study. Middle East Curr Psychiatry. 2020;27(1):49. doi: 10.1186/s43045-020-00058-5.

Biessels GJ, Despa F. Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications. Nat Rev Endocrinol. 2018;14(10):591-604. doi: 10.1038/s41574-018-0048-7, PMID 30022099.

Saedi E, Gheini MR, Faiz F, Arami MA. Diabetes mellitus and cognitive impairments. World J Diabetes. 2016;7(17):412-22. doi: 10.4239/wjd.v7.i17.412, PMID 27660698.

Yerrapragada DB, Rao CR, Karunakaran K, Lee HS. Cognitive dysfunction among adults with type 2 diabetes mellitus in Karnataka India. Ochsner J. 2019;19(3):227-34. doi: 10.31486/toj.18.0160, PMID 31528133.

Palta P, Schneider AL, Biessels GJ, Touradji P, Hill Briggs F. Magnitude of cognitive dysfunction in adults with type 2 diabetes: a meta-analysis of six cognitive domains and the most frequently reported neuropsychological tests within domains. J Int Neuropsychol Soc. 2014;20(3):278-91. doi: 10.1017/S1355617713001483, PMID 24555960.

Spauwen PJ, Kohler S, Verhey FR, Stehouwer CD, Van Boxtel MP. Effects of type 2 diabetes on 12-year cognitive change: results from the maastricht aging study. Diabetes Care. 2013;36(6):1554-61. doi: 10.2337/dc12-0746, PMID 23275366.

Mori Y, Futamura A, Murakami H, Kohashi K, Hirano T, Kawamura M. Increased detection of mild cognitive impairment with type 2 diabetes mellitus using the Japanese version of the montreal cognitive assessment: a pilot study. Neurol Clin Neurosci. Japanese version. 2015;3(3):89-93. doi: 10.1111/ncn3.153.

Hishikawa N, Yamashita T, Deguchi K, Wada J, Shikata K, Makino H. Cognitive and affective functions in diabetic patients associated with diabetes-related factors, white matter abnormality and aging. Eur J Neurol. 2015;22(2):313-21. doi: 10.1111/ene.12568, PMID 25220803.

Zhong Y, Miao Y, Jia WP, Yan H, Wang BY, Jin J. Hyperinsulinemia insulin resistance and cognitive decline in older cohort. Biomed Environ Sci. 2012;25(1):8-14. doi: 10.3967/0895-3988.2012.01.002, PMID 22424621.

Zhao X, Han Q, LV Y, Sun L, Gang X, Wang G. Biomarkers for cognitive decline in patients with diabetes mellitus: evidence from clinical studies. Oncotarget. 2018;9(7):7710-26. doi: 10.18632/oncotarget.23284, PMID 29484146.

Moran C, Phan TG, Chen J, Blizzard L, Beare R, Venn A. Brain atrophy in type 2 diabetes: regional distribution and influence on cognition. Diabetes Care. 2013;36(12):4036-42. doi: 10.2337/dc13-0143, PMID 23939539.

Kooistra M, Geerlings MI, Mali WP, Vincken KL, Van Der Graaf Y, Biessels GJ. Diabetes mellitus and progression of vascular brain lesions and brain atrophy in patients with symptomatic atherosclerotic disease. The SMART-MR study. J Neurol Sci. 2013;332(1-2):69-74. doi: 10.1016/j.jns.2013.06.019, PMID 23835088.

West RK, Ravona Springer R, Schmeidler J, Leroith D, Koifman K, Guerrero Berroa E. The association of duration of type 2 diabetes with cognitive performance is modulated by long-term glycemic control. Am J Geriatr Psychiatry. 2014;22(10):1055-9. doi: 10.1016/j.jagp.2014.01.010, PMID 24534521.