Working memory impairment relationships with visfatin and body composition indices in patients with type 2 diabetes mellitus
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1
King Saud University, Saudi Arabia
Objectives: Diabetes Mellitus is associated with a higher incidence of neurobehavioral symptoms, fatigue and cognitive impairment, in the form of longer reaction times and impaired spatial planning. However, to see the independent effect of diabetes on cognitive impairment by controlling the confounding effect of fatigue and mini mental state needs further studies. Therefore we hypothesized that there are some missing links and controversies in the relation between cognitive impairment in T2DM and its relationship with body composition indices & adipokine visfatin.
Methods: This pilot observational case-control study was conducted at the Department of Physiology, College of Medicine and King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. We used a validated standardized Mini-mental State Examination (MMSE), Fatigue Severity Scale (FSS) and a Visual Analogue Fatigue Scale (VAFS) as screening tests before neurocognitive assessments. All subjects were matched for MMSE, FSS & VAFS scores. We excluded the diabetics with high FSS and VAFS scores and lower MMSE scores, to match them with the control subjects. After screening of 103 subjects the final selection included 65 participants (31 patients with T2DM and 34 healthy controls). Clinical and demographic characteristics were measured for each participant. Cognitive functions were evaluated by Cambridge Neuropsychological Automated Battery (CANTAB) to assess executive functions and memory. The test paradigms used were Stop Signal Task (SST) and Intra-Extra Dimensional Set Shift (IED). Blood samples were collected to measure visfatin, fasting blood glucose (FBG) and HbA1c levels. Body composition was analysed by bioelectrical impedance analysis (BIA) using Body Composition Analyzer (Type BC-418 MA, TANITA Corporation Japan). The bioimpedance analyzer uses eight points of tactile electrodes (contact at the hands and feet). The technique uses multiple frequencies to measure total body water, fats and fat free mass in total and its segmental distribution in trunk and limbs.
Results: Patients with T2DM showed higher visfatin levels and significantly impaired cognitive functions compared to healthy control individuals in Stop Signal Reaction Time (SSRT) Last half, SST Median Correct Reaction Time on GO trials, Stop Signal Delay (SST SSD) 50% last half and SST Direction errors on stop and go trials in SST task (Figure 1). It was observed that Stop Signal Task Stop Signal Reaction Time (SST SSRT) Last half (p=0.03), Stop Signal Task Median Correct Reaction Time on GO trials (p=0.0012), Stop Signal Task Stop Signal Delay (SST SSD) 50% last half and (p=0.02), Stop Signal Task Direction Errors on STOP and GO trials (p=0.04) were significantly delayed in diabetic patients compared to the controls, while the difference for Stop Signal Task proportion of successful stops in the last half (p=0.24) was not significant between the two groups. The SSP length was significantly lower in diabetics compared to control subjects indicating impaired working memory capacity (p=0.02). The correlation between visfatin levels and cognitive functions was not statistically significant. However, visceral adiposity correlated inversely with IED task for total errors, SST Median and SST SSD Last Half.
Conclusions: Patients with T2DM have cognitive impairments, in the form of longer reaction times in flexibility of attention and impulse control alongwith impaired working memory, compared to matched control subjects. Moreover, visceral adiposity may be related to pathophysiology of cognitive impairments in these patients.
Significant Outcomes: Compared to healthy subjects patients with T2DM had significant delay in response time to SST and decrease in SSP length time paradigm. IED, SST & SSP paradigms assesses the flexibility of attention, impulse control and working memory capacity respectively. Visceral adiposity correlated significantly with impairment in cognitive functions including IED & SST tasks, while no relationship was observed with SSP. Serum adipokine visfatin levels did not correlate significantly with any neuro cognitive tests.
Limitations: The limitations of our study were that we had relatively small sample size and its cross sectional design. Moreover, only three cognitive paradigms were assessed although CANTAB battery contains about 25 tasks.
Acknowledgements
We would also like to thank Hadeel Adel Al-Sulimani**, Hibah Mishaal Al-Kadhi**, Mody Abdulrahman Al-Marshad**, Reem Nasser Al-Rakaf**, Shatha Ali Al-Shanqeeti**, Yara Yousef Al-Salloum** for their cooperation and assistance.
References
References:
[1] About Alzheimer’s Disease: Mild Cognitive Impairment [Internet]. National Institute on Aging. [cited 2015 May 5]. Available from: http://www.nia.nih.gov/alzheimers/topics/mild-cognitive-impairment
[2]-Messier C. Impact of impaired glucose tolerance and type 2 diabetes on cognitive aging. Neurobiol Aging. 2005 Dec 1;26(1):26–30.
[3]Umegaki H, Hayashi T, Nomura H, et al. Cognitive dysfunction: an emerging concept of a new diabetic complication in the elderly. Geriatr Gerontol Int. 2013 Jan;13(1):28–34.
[4]-Lasselin J, Layé S, Barreau J-B, et al. Fatigue and cognitive symptoms in patients with diabetes: relationship with disease phenotype and insulin treatment. Psychoneuroendocrinology. 2012 Sep;37(9):1468–78.
Keywords:
type 2 diabetes mellitus,
Waist/hip ratio,
Cognitive Function,
Fatigue,
working memory
Conference:
2nd International Conference on Educational Neuroscience, Abu Dhabi, United Arab Emirates, 5 Mar - 6 Mar, 2017.
Presentation Type:
Poster Presentation
Topic:
Educational Neuroscience
Citation:
Habib
SS,
Bashir
S,
Iqbal
M,
Al Regaiey
K and
Al Jeraisy
S
(2017). Working memory impairment relationships with visfatin and body composition indices in patients with type 2 diabetes mellitus.
Conference Abstract:
2nd International Conference on Educational Neuroscience.
doi: 10.3389/conf.fnhum.2017.222.00037
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Received:
11 Jan 2017;
Published Online:
11 Dec 2017.
*
Correspondence:
Prof. Syed S Habib, King Saud University, Riyadh, Saudi Arabia, shahidhabib44@hotmail.com