Diabetes mellitus in older persons with neurocognitive disorder: overtreatment prevalence and associated structural brain MRI findings.

Details

Serval ID
serval:BIB_46A998E9381F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Diabetes mellitus in older persons with neurocognitive disorder: overtreatment prevalence and associated structural brain MRI findings.
Journal
BMC geriatrics
Author(s)
Putallaz P., Seematter-Bagnoud L., Draganski B., Rouaud O., Krief H., Büla C.J.
ISSN
1471-2318 (Electronic)
ISSN-L
1471-2318
Publication state
Published
Issued date
14/05/2024
Peer-reviewed
Oui
Volume
24
Number
1
Pages
427
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Tight diabetes control is often applied in older persons with neurocognitive disorder resulting in increased hypoglycemic episodes but little is known about the pattern of brain injury in these overtreated patients. This study aims to: (a) quantify the prevalence of diabetes overtreatment in cognitively impaired older adults in a clinical population followed in an academic memory clinic (b) identify risk factors contributing to overtreatment; and (c) explore the association between diabetes overtreatment and specific brain region volume changes.
Retrospective study of older patients with type 2 diabetes and cognitive impairment who were diagnosed in a memory clinic from 2013 to 2020. Patients were classified into vulnerable and dependent according to their health profile. Overtreatment was defined when glycated hemoglobin was under 7% for vulnerable and 7.6% for dependent patients. Characteristics associated to overtreatment were examined in multivariable analysis. Grey matter volume in defined brain regions was measured from MRI using voxel-based morphometry and compared in patients over- vs. adequately treated.
Among 161 patients included (median age 76.8 years, range 60.8-93.3 years, 32.9% women), 29.8% were considered as adequately treated, 54.0% as overtreated, and 16.2% as undertreated. In multivariable analyses, no association was observed between diabetes overtreatment and age or the severity of cognitive impairment. Among patients with neuroimaging data (N = 71), associations between overtreatment and grey matter loss were observed in several brain regions. Specifically, significant reductions in grey matter were found in the caudate (adj β coeff: -0.217, 95%CI: [-0.416 to -0.018], p = .033), the precentral gyri (adj βcoeff:-0.277, 95%CI: [-0.482 to -0.073], p = .009), the superior frontal gyri (adj βcoeff: -0.244, 95%CI: [-0.458 to -0.030], p = .026), the calcarine cortex (adj βcoeff:-0.193, 95%CI: [-0.386 to -0.001], p = .049), the superior occipital gyri (adj βcoeff: -0.291, 95%CI: [-0.521 to -0.061], p = .014) and the inferior occipital gyri (adj βcoeff: -0.236, 95%CI: [-0.456 to - 0.015], p = .036).
A significant proportion of older patients with diabetes and neurocognitive disorder were subjected to excessively intensive treatment. The association identified with volume loss in several specific brain regions highlights the need to further investigate the potential cerebral damages associated with overtreatment and related hypoglycemia in larger sample.
Keywords
Humans, Aged, Male, Female, Retrospective Studies, Aged, 80 and over, Magnetic Resonance Imaging/methods, Diabetes Mellitus, Type 2/epidemiology, Diabetes Mellitus, Type 2/complications, Prevalence, Middle Aged, Overtreatment, Brain/diagnostic imaging, Brain/pathology, Neurocognitive Disorders/epidemiology, Cognitive Dysfunction/epidemiology, Risk Factors, Alzheimer’s disease, Cognitive impairment, Dementia, Diabetes mellitus, Hypoglycemia, Neuroimaging, Older patients, Voxel-based morphometry
Pubmed
Web of science
Open Access
Yes
Create date
16/05/2024 15:31
Last modification date
25/05/2024 7:13
Usage data