The Cross-Sectional Association of Cognition With Diabetic Peripheral and Autonomic Neuropathy–the Grade Study

Authors

Joshua I Barzilay
Alokananda Ghosh
Rodica Pop Busui
Andrew Ahmann
Ashok Balasubramanyam
Mary Ann Banerji
Robert M Cohen
Jennifer Green
Faramarz Ismail-Beigi
Catherine L Martin
Elizabeth Seaquist
José A Luchsinger
GRADE Research Group

Publication Date

12-1-2021

Journal

Journal of Diabetes and its Complications

DOI

10.1016/j.jdiacomp.2021.108047

PMID

34556408

PMCID

PMC8608739

PubMedCentral® Posted Date

12-1-2022

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Aged, Autonomic Nervous System Diseases, Cardiovascular Diseases, Cognition, Cognition Disorders, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Diabetic Neuropathies, Female, Humans, Male, Middle Aged, Peripheral Nervous System Diseases, diabetes, cognitive tests, diabetic peripheral neuropathy, cardiovascular autonomic neuropathy

Abstract

BACKGROUND: Studies examining whether measures of cognition are related to the presence of diabetic peripheral neuropathy (DPN) and/or cardiovascular autonomic neuropathy (CAN) are lacking, as are data regarding factors potentially explaining such associations.

METHODS: Participants were from the Glycemia Reduction Approaches in Diabetes Study (GRADE) that examined 5047 middle-aged people with type 2 diabetes of(memory) were assessed with the Spanish English Verbal Learning Test; frontal executive function and processing speed with the Digit Symbol Substitution Test; and ability to concentrate and organize data with word and animal fluency tests. DPN was assessed with the Michigan Neuropathy Screening Instrument and CAN by indices of heart rate variability (standard deviation of normal beat to beat variation [SDNN] and root mean square of successive differences [RMSSD]).

RESULTS: DPN was significantly inversely related to measures of immediate recall and processing speed. The percent of cognitive variation explained by DPN was small. Tests of CAN had an inconsistent or absent association with measures of cognition. Higher waist circumference and urine albumin creatinine (UACR) levels were the strongest correlates in the relationship between DPN and cognitive impairment.

CONCLUSION: DPN, but not CAN, is cross-sectionally associated with lower performance in measures of cognition in people with type 2 diabetes of <10 years of known duration. Greater waist circumference and UACR were important variables in this association. The mechanisms underlying the cross-sectional association of DPN with cognitive impairment are unknown.

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