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Cognitive Performance, Psychological Well-Being, and Brain Magnetic Resonance Imaging in Older Patients With Type 1 Diabetes

¹ Department of Neurology, University Medical Center, Utrecht, the Netherlands
² Neuropsychology, Zuwe Hofpoort Hospital/Regional Psychiatric Center, Woerden, the Netherlands
³ Helmholtz Instituut, Utrecht University, Utrecht, the Netherlands
⁴ Department of Internal Medicine, Groene Hart Hospital, Gouda, the Netherlands
⁵ Department of Neurology, Zuwe Hofpoort Hospital, Woerden, the Netherlands
⁶ Department of Internal Medicine, Zuwe Hofpoort Hospital, Woerden, the Netherlands

Address correspondence and reprint requests to Augustina M.A. Brands, Neuropsychology, Zuwe Hofpoort, Blekerijlaan 3, 3447 AC Woerden, Netherlands. E-mail: i.brands{at}altrecht.nl

Abbreviations: BCR, bicaudate ratio; BDI-II, Beck Depression Inventory-II; BFR, bifrontal ratio; CFT, Complex Figure Test; DWML, deep white-matter lesion; MRI, magnetic resonance imaging; PWML, periventricular white-matter lesion; WAIS-III, Wechsler Adult Intelligence Scale, third edition; WML, white-matter lesion

Modest cognitive impairment has been reported in young-adult patients with type 1 diabetes. In older patients with type 2 diabetes, cognitive impairments are more pronounced, which might be due to age but also to differential effects of type 1 diabetes and type 2 diabetes on the brain. This study therefore assessed cognitive performance and magnetic resonance imaging (MRI) of the brain in older type 1 diabetic patients. Forty type 1 diabetic patients (age >50 years) and 40 age-matched control subjects were included. Neuropsychological assessment included all major cognitive domains, and psychological well-being was assessed with questionnaires. Atrophy, white-matter abnormalities, and infarcts were rated on MRI scans. Type 1 diabetic patients performed slightly (effect sizes <0.4) worse on cognitive tasks, but only "speed of information processing" reached statistical significance. No significant between-group differences were found on any of the MRI parameters. Type 1 diabetic patients tended to report more cognitive and depressive problems than control subjects, but this did not correlate with the performance on cognitive tests. We conclude that cognition in older type 1 diabetic patients is only mildly disturbed. Chronic exposure to hyperglycemia is in itself, even at older age, apparently not sufficient to have considerable impact on the brain.

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