Healthcare sciences have achieved great feats in increasing longevity, decreasing neonatal mortality and significantly reducing or eliminating the impact of infectious diseases. At the same time, chronic non-communicable diseases (CNCD; related and preventable conditions of type II diabetes, hypertension, coronary artery disease and stroke) have become important and ever-rising causes of morbidity and mortality around the world. On a daily basis, as an academic neuropsychologist, I see first-hand the nefarious effect that CNCD has on the brains of my patients.CNCD, especially diabetes, and its relation to brain health is not often something people put together. Yet it is the common denominator of many diseases that can cause permanent and irreversible damage to the brain and forever alter cognitive skills. The brain, although being an exquisitely tuned organ, is very sensitive to the amount of sugar, or glucose, it receives as fuel. Whether it is individuals with type 1 (T1DM) or type 2 (T2DM) diabetes, high blood sugar levels of uncontrolled diabetes and the low blood glucose that, in certain occasions, comes with the treatment of diabetes, can affect brain health.Indeed, numerous studies have shown mild to moderate reductions in cognitive function in both T1DM and T2DM patients1,2,3,4,5,6. In addition, T2DM has also been associated with a 50% increase risk of dementia5. What happens in these circumstances is that diabetes increases the risk of damage to blood vessels over time, including damage to the small blood vessels in the brain. This accumulated injury to small blood vessels over the years causes damage to the brain’s white matter.White matter is the brain structure that I describe to my patients as vast highways in the brain. They interconnect brain areas, allowing them to talk to each other by sending messages back and forth. When these are damaged, the brain finds it harder to communicate with other areas. If we imagine each damaged blood vessel as a traffic accident on the “white matter highway,” one can rightly come to the conclusion that messages dispatched from part A will take longer to arrive at part B.Functionally, in someone’s day to day life, that obstruction in cerebral intercommunication translates to slower thinking skills, difficulties paying attention, issues with sustained concentration and a limited ability to use working memory skills. The latter is what people may refer to as short-term memory, and that which allows us to hold onto information for a short period of time while we decide what to do with it and how to process it. As a result of these changes in thinking skills, people tend to find it more difficult to assimilate new information during conversation, or find it harder to retrieve the right information in a timely manner, often needing prompts to jog their memory.The constellation of cognitive syndromes that is described above is commonly seen in diabetes-associated cognitive decline7 and in the mild stages is often labelled as vascular mild cognitive impairment (vMCI). If nothing is done to manage diabetes, we often see the emergence of associated conditions such as hypertension, high cholesterol and obesity, which exacerbate further the risk of cardiovascular and cerebrovascular disease. Over the long-term, this can cause vMCI to progress to vascular dementia and/or Alzheimer’s disease8, and increases the likelihood of suffering from a stroke.The Global Foundation for Community Health (GFCH) and its revolutionary 5-2035 vision aims to significantly decrease diabetes through community empowerment and frugal innovation. With its forward-thinking approach to revisiting the management of diabetes in local communities, it aims to make treatment and education around CNCD readily available to all. By raising awareness of these core concepts, the GFCH aims to promote better health habits with the ultimate goal of a reduction in medical complications related to CNCDs, such as reduced risk of cognitive decline and dementia.Let’s come together as a nation and curb diabetes through the 5-2035 Vision as a model for the world!References
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Gaudieri PA, Chen R, Greer TF, Holmes CS. Cognitive function in children with type 1 diabetes: a meta-analysis. Diabetes Care. 2008 Sep; 31(9):1892-7.
Arbelaez AM, Semenkovich K, Hershey T. Glycemic extremes in youth with T1DM: the structural and functional integrity of the developing brain. Pediatr Diabetes. 2013 Dec; 14(8):541-53.
Palta P, Schneider AL, Biessels GJ, Touradji P, Hill-Briggs F. Magnitude of cognitive dysfunction in adults with type 2 diabetes: a meta-analysis of six cognitive domains and the most frequently reported neuropsychological tests within domains. J Int Neuropsychol Soc. 2014 Mar; 20(3):278-91.
Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. 2006 Jan; 5(1):64-74.
van den Berg E, Kloppenborg RP, Kessels RP, Kappelle LJ, Biessels GJ. Type 2 diabetes mellitus, hypertension, dyslipidemia and obesity: A systematic comparison of their impact on cognition. Biochim Biophys Acta. 2009 May; 1792(5):470-81.
Mijnhout GS, Scheltens P, Diamant M, Biessels GJ, Wessels AM, Simsek S, Snoek FJ, Heine RJ. Diabetic encephalopathy: A concept in need of a definition. Diabetologia. 2006 Jun; 49(6):1447-8.
Moheet A, Mangia S, Seaquist ER. Impact of diabetes on cognitive function and brain structure. Ann N Y Acad Sci. 2015 Sep;1353:60-71.