The Neuropsychology of Diabetes
The human brain is a complex system that controls important functions such as our respiratory system, our thinking abilities, personality, and behaviour. The brain’s cerebral cortex is divided into lobes: temporal, parietal, occipital, and frontal. Dedicated lobes govern cognitive functions such as memory, language, spatial skills, planning reasoning, judgement, language, and personality. Subcortical regions, such as the basal ganglia, cerebellum, amygdala, hippocampus control functions such as motor movement, motor speed, fear response, and memory. The brain stem governs those systems that keep us alive such as the respiratory and cardiac systems. These are just a few of the many functions that are controlled by the human brain.
Given the significant role of the brain, it becomes clear why good brain health is critical.
It is widely understood that diabetes can affect the microvascular system of the eyes, organs such as the kidneys, peripheral nerves, heart, and vasculature.
Decades worth of research also shows that diabetes can have a negative impact on the brain.
Diabetes may result in brain shrinkage as a result of toxicity from high glucose levels. Indeed, magnetic resonance imaging (MRI) studies found that the longer a patient had the disease, the more brain volume loss occurred. Another perspective is that diabetes has an adverse effect on the brains vascular(i.e, blood flow) system, which puts individuals at a greater risk for stroke and Alzheimer’s disease. Thus, diabetes can affect the brain through volume loss and/or vascular changes.
When the brain is altered, be it through head injury, degenerative disorders, shrinkage, or vascular changes resulting from chronic diseases such as diabetes, we see a change in the way in which it performs its functions.
A number of studies have shown that patients with diabetes have cognitive deterioration in the areas of memory, attention, motor speed, and executive functions such as planning, reasoning, and cognitive speed. Persons with diabetes may find that they experiencing difficulty with remembering and following conversations, recalling names of people, and misplacing items. They may complain of not being able to focus as well as they used to or are slower at processing information. Such deficits can impede one’s ability to work and carryout activities of daily living. When one’s cognitive ability reaches a point of significant impairment, then a diagnosis of dementia might be given. Dementia is an umbrella term to describe significant impairment in cognitive functioning and behahviour.
It is important to note that as we age, we see a decline in many cognitive functions – it is a normal part of aging. However, the decline is greater among some persons with diabetes, particularly among those with poor glycemic control. This is true for persons type I and 2 diabetes.
With the risk of cognitive decline and dementia among persons with diabetes, a neuropsychological evaluation becomes an important component of diagnosis and treatment. Neuropsychology is a specialized subset of psychology that examines cognition, emotions, and behaviour following alterations to the brain. A neuropsychological evaluation will provide the client and care team with a cognitive, emotional, and behavioural profile.
Neuropsychology is non-invasive and utilizes standardized tests developed through clinical trials. The test scores of the client with diabetes will be compared statistically to the scores of thousands of others within the same age group. The results will indicate whether or not the client is within the average range or is impaired. Complicating factors such as stress, depression will be factored into to the results, as they too are associated with mild decline in cognitive ability on their own.
A neurocognitive profile will enable the medical care team to work with the client in a more efficient and effective way. If the client has problems with memory and attention, then the care team members will be able to recommend supports to help the client with issues such as remembering to take medication. They will also alter the way in which they convey verbal information to the client. Psychotherapists will be able to decide whether or not the client will benefit from talk therapy based on their cognitive profile.
The benefit of the neurocognitive profile for the client is that they will be empowered with information. They will have a full understanding of their capabilities and will be furnished with a range of strategies to support optimal cognitive functioning. The client will be able to secure and implement appropriate supports in the workplace and at home.
There are ways to optimize cognitive functioning for persons with diabetes. Adhering to the prescribed treatment regimen, which includes monitoring, diet, exercise, and regular checkups are critical for brain health. If a client is found to have mild to moderate challenges in some areas of cognition, then memory aids and strategies such as keeping note books, posting reminders in common areas like the refrigerator, using an alarm system on the phone to remind the client to take medication. There are also a number of self-directed strategies to assist with anchoring attention and enhancing memory. Verbalizing the steps of a given task will help reduce the “auto-pilot” feeling associated with poor attention.
Life can be challenging and managing a chronic condition can create additional stress and depression for some individuals. As such, to the best of one’s ability, keeping stress levels to a minimum through stress management techniques is highly recommended. Engaging in social activities and staying cognitively active through reading, cross-words are all effective ways to promote good brain health.
Toni Nicholls, PhD