A study published in Stroke showed that after adjusting for age, sex, and level of education, individuals with type 2 diabetes vs normal fasting blood sugar levels after a stroke had worse cognitive performance 3 to 6 months later. Cognitive tests included memory, attention, processing speed, language, visuospatial function, mental flexibility, and executive functioning. Of note, people who had prediabetes after a stroke did not have significantly different scores on cognitive testing compared with those who had normal blood sugar levels after stroke.
These correlations were present after controlling for type of stroke, ethnicity, hypertension, smoking, previous stroke, abnormal heart rhythm and body mass index. Researchers combined data from 1,601 individuals with stroke (mean age 66; 63% male; 70% Asian; 26% Caucasian; 2.6% African American) who participated in 1 of 7 international studies from 6 countries. Almost all had ischemic stroke and a variety of cognitive functions were assessed at 3 to 6 months after the stroke. Fasting blood sugar levels were measured at hospital admission and medical histories were used to define the presence of type 2 diabetes and prediabetes.
“The deficits we found in all areas of cognitive function highlight the importance of assessing the capacity for self-care in individuals with type 2 diabetes following a stroke,” said Jess Lo, MSc, lead author of the study and research associate at UNSW Sydney’s Centre for Healthy Brain Ageing (CHeBA), in Kensington, Australia.
“We need to ensure that stroke survivors have the mental competency to manage the complex and intertwined tasks to effectively treat type 2 diabetes, which can include measuring glucose levels multiple times a day, managing glucose monitoring devices, adjusting medication doses, self-administering insulin or other medications, and understanding food labels and portion sizes to adjust what is eaten at each meal or snack.”
“Type 2 diabetes increases the risk of stroke and has been associated with cognitive impairment and may increase dementia risk. That’s why type 2 diabetes is another important target in the prevention of dementia, and the focus should be on early treatment for prediabetes to delay or prevent the progression to type 2 diabetes,” said Perminder Sachdev, MD, PhD, senior author of the study and Scientia professor at UNSW Sydney’s Centre for Healthy Brain Aging (CHeBA) in Kensington, Australia.
“In this study, we wanted to know if stroke patients with prediabetes also have worse cognitive function compared with stroke patients without prediabetes or diabetes,” Sachdev said. “This is important because prediabetes is very common, and individuals can have prediabetes for several years before progressing to type 2 diabetes. Early and aggressive treatment of prediabetes can delay or prevent type 2 diabetes. If we target the treatment of prediabetes, could this prevent the development of dementia in some individuals?” said Sachdev.
Karissa N. Arca, MD, and Amaal J. Starling, MD
Leeann B. Burton, MD, and Amanda C. Guidon, MD
Paul M. Elsbernd, MD; Kathryn J. Lago, DO; Tatjana P. Calvano, DO; and John H. Sladky, MD