TY - JOUR
T1 - The use of insulin pump therapy in diabetes mellitus type 1 and its relation to cognitive performance, psychological well-being and brain MRI
AU - Brands, Augustina M.A.
AU - Hoogma, Roel P.L.M.
AU - Kessels, Roy P.C.
AU - Henselmans, Johanna M.L.
AU - Van Der Beek Boter, Johanna W.
AU - Jaap Kappelle, L.
AU - De Haan, Edward H.F.
AU - Biessels, Geert Jan
PY - 2006/12/1
Y1 - 2006/12/1
N2 - Background. Diabetes mellitus (DM) is a common metabolic disease. Although cognition in older patients with type 1 diabetes (DM1) appears to be only mildly disturbed compared to non-diabetic controls, it may be that specific subgroups of DM1 patients, such as those with worse metabolic control, have a higher risk for cognitive decline. Patients with continuous subcutaneous insulin infusion (CSII) differ from patients on a multiple daily injection (MDI) regime in several important metabolic parameters. The present observational study therefore aimed to compare cognition, psychological wellbeing and brain MRI between older patients with DM1 with and without CSII. Material and methods. For this project we enrolled 40 patients with DM1 (52-77 years, mean duration DM 34 years), of whom 19 were receiving CSII (mean duration: 6.5 ± 3.5 years) and 21 were on MDI. Neuropsychological assessment covered five major cognitive domains. Psychological well-being was assessed by the Symptom Checklist (SCL)-90-R and the Beck Depression Inventory (BDI). Atrophy, white-matter abnormalities (WML) and infarcts were rated on MRI scans. Results. Patients with and without CSII did not differ on neuropsychological measures. Patients with CSII had significantly higher scores on the BDI-II and better MRI ratings on cortical atrophy measures, but not on the other MRI measures. Conclusions. CSII seems to be associated with better MRI ratings, without better cognitive performance. It could be worthwhile to compare CSII with other treatment regimes in a longitudinal randomized controlled trial.
AB - Background. Diabetes mellitus (DM) is a common metabolic disease. Although cognition in older patients with type 1 diabetes (DM1) appears to be only mildly disturbed compared to non-diabetic controls, it may be that specific subgroups of DM1 patients, such as those with worse metabolic control, have a higher risk for cognitive decline. Patients with continuous subcutaneous insulin infusion (CSII) differ from patients on a multiple daily injection (MDI) regime in several important metabolic parameters. The present observational study therefore aimed to compare cognition, psychological wellbeing and brain MRI between older patients with DM1 with and without CSII. Material and methods. For this project we enrolled 40 patients with DM1 (52-77 years, mean duration DM 34 years), of whom 19 were receiving CSII (mean duration: 6.5 ± 3.5 years) and 21 were on MDI. Neuropsychological assessment covered five major cognitive domains. Psychological well-being was assessed by the Symptom Checklist (SCL)-90-R and the Beck Depression Inventory (BDI). Atrophy, white-matter abnormalities (WML) and infarcts were rated on MRI scans. Results. Patients with and without CSII did not differ on neuropsychological measures. Patients with CSII had significantly higher scores on the BDI-II and better MRI ratings on cortical atrophy measures, but not on the other MRI measures. Conclusions. CSII seems to be associated with better MRI ratings, without better cognitive performance. It could be worthwhile to compare CSII with other treatment regimes in a longitudinal randomized controlled trial.
KW - Ageing
KW - Atrophy
KW - CSII
KW - Depression
KW - Hyperglycaemia
KW - Neuropsychological assessment
UR - http://www.scopus.com/inward/record.url?scp=84865393502&partnerID=8YFLogxK
M3 - Article
AN - SCOPUS:84865393502
SN - 1730-7503
VL - 4
SP - 140
EP - 152
JO - Acta Neuropsychologica
JF - Acta Neuropsychologica
IS - 3
ER -