Open access peer-reviewed chapter

Cognitive Dysfunction in Diabetes Mellitus

Written By

Faiz Ahmed Shaikh, K.C. Bhuvan, Thet Thet Htar, Manish Gupta and Yatinesh Kumari

Reviewed: 19 March 2019 Published: 24 October 2019

DOI: 10.5772/intechopen.85940

From the Edited Volume

Type 2 Diabetes - From Pathophysiology to Modern Management

Edited by Mira Siderova

Chapter metrics overview

1,179 Chapter Downloads

View Full Metrics


People with diabetes mellitus type 2 will have higher rate of cognitive impairment than people that do not. Besides that, the effect of diabetes on the normal mental functions is often disregarded. This may be due to a lack of signs and standard assessment technique to measure the cognitive function of the diabetes patient. Hyperglycaemia which is common in people with diabetes has been associated with an increase in the possibility of developing Alzheimer’s disease and vascular dementia in the both general public and people with cognitive impairment. It has been estimated that an individual with diabetes mellitus is 1.5 times more likely to experience cognitive dysfunction and dementia than a normal healthy individual. Alleviation of microvascular complications and hypoglycaemia is the key in treatment of DM to prevent cognitive decline.


  • diabetes
  • cognition
  • age
  • glucose impairment
  • HbA1c

1. Introduction

According to the International Diabetes Federation, diabetes is one of the largest global health emergencies of the twenty-first century and is the top 10 causes of death globally [1]. Diabetes mellitus (DM) is a disease in which the human body cannot produce sufficient amount of insulin and fails to respond to the hormone insulin that will result to the abnormal increase of glucose level in the blood circulation resulting in hyperglycaemia [2]. It is a complex metabolic disorder which can damage multiple organs in the human body [3]. DM affects or even burdens individual and communities with huge economic cost and leads to a decrease in overall productivity [4]. The complications of DM, especially type 2, can be enhanced by comorbidities such as hypertension, stroke, etc. [5]. Diabetes is the leading problem of kidney failure, lower-limb amputation and also blindness among adults [6]. In Malaysia, diabetes is one of the main public health problems and is closely related to avoidable and premature death [7].

The World Health Organization (WHO) divides the DM into two major categories which are insulin-dependent diabetes mellitus (IDDM) or type 1 diabetes mellitus and non-insulin-dependent diabetes mellitus (NIDDM) or type 2 diabetes mellitus [8]. Approximately 90% of all diabetes cases in both developed and developing countries are NIDDM and can be found mostly in people more than 30 years old [9]. In type 1 DM, the pancreas cannot produce insulin, and the body has to completely rely on the synthetic insulin to reduce the glucose in the blood. Type 1 DM is common in children, teenager as well as young adult [10]. DM can lead to complications such as diabetic nephropathy, diabetic retinopathy, ischaemic heart disease and many more [11]. The number of people with type 2 DM is increasing in every country with 79% of people with DM living in low- and middle-income countries [12].

1.1 Global and Malaysian scenario of type 2 DM

Some 425 million people worldwide, or 8.8% of adults, are estimated to have diabetes [13]. About 79% lives in low- and middle-income countries. If these trends continue, by 2045, some 629 million people will have diabetes [13]. The estimated population of Malaysia in 2018 is 32.4 million [14]. There were almost 3.49 million cases of diabetes in Malaysia in 2017 [15]. The percentage of population aged 15–64 years old (working age) increases from 69.6% in 2017 to 69.7% in 2018. The percentage of 65 years and over (old age) population increases from 6.3 to 6.5% for the same period [14]. The number of deaths was divided into two groups of ages which are age between 30 and 69 years old as well as ages more than 70 years old. For example, the number of diabetes deaths for female ages more than 70 years old was 1260 people compared to 1070 for males [13].


2. Cognitive function

Cognitive function can be defined as mental process (cerebral activities) that lead to the gaining of knowledge which allows people to carry out their daily life activities [16]. Cognitive functions are mainly related to remembering, solving problems, making decision and understanding the language, problems or even issues like personal issues and health issues, focus, attention and others [2]. It also can be defined as memory which is tested by the stimuli either spoken or presented using another talking format or talking memory [17]. Moreover, it can be related to the large spectrum of cognitive capability among the middle- and old-aged group of people, which are having dementia as well as maintaining normal physiological function [18].

2.1 Relationship of cognitive function with type 2 DM

Cognitive impairment is a type of disorder which has not been studied and explored as the complications of DM. At the same time, the association of DM with cognition is well acknowledged. The meta-analysis shows small to moderate performance decline in persons with diabetes relative to nondiabetic controls in each domain examined. The motor function is largely affected, while attention/concentration is affected minimally [19]. Another study shows that people with type 2 DM will have higher rate of cognitive impairment than people that do not have DM [20]. Besides that, the effect of diabetes on the normal mental functions is often disregarded. This may be due to lack of signs and standard assessment technique to measure the cognitive function of the diabetes patient [21]. Hyperglycaemia which is common in people with diabetes has been associated with an increase in the possibility of developing Alzheimer’s disease and vascular dementia in both the general public and people with cognitive impairment [22]. It has been estimated that an individual with DM is 1.5 times more likely to experience cognitive dysfunction and dementia than a normal healthy individual [23].

Elderly people who are more than 65-year-old will have more than 20% chances to be diagnosed with both DM and impaired cognitive function [24]. Type 2 DM has been associated with few cognitive impairments such as decreases in psychomotor speed, processing speed, visual retention, attention, concentration and many more. It is understood that more significantly hyperglycaemia, vascular disease, hypoglycaemia and insulin resistance affect cognitive decline, but the exact pathophysiological mechanisms not of cognitive decline in diabetes are unclear [3]. The causes of cognitive decline in diabetes may be the direct effect of the chronic hyperglycaemia on the brain regions, blood lipid, blood pressure, hypoglycaemia and others [25].

2.2 Duration of DM and cognitive impairment

Several studies have studied about the linkage of DM with cognitive decline in elderly population. A perspective (over 20 years) cohort study in the USA with mid-age (mean age 58) diabetic patient reported that DM in the midlife was related to a significant increase in cognitive impairment. This study included 13,351 black and white adults aged 48–67 years old, and their cognitive function was examined using three cognitive tests, which are the delayed-word-recall test (DWRT), the digit substitution test (DSST) of Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the word fluency test (WFT). The study also reported that a patient with poorly controlled DM might have bigger cognitive disorder than well-controlled ones and longer duration of DM will have increased chances of late-life cognitive disorder [26].

A cross-sectional study was conducted on 57 patients having type 2 DM. The result shows that patients with type 2 DM had low grades in the cognitive testing and poor performance in different cognitive function tasks which include the verbal relations, visual reasoning, short-term memory test and many more. Cognitive function is impaired more with the untreated DM patient than the treated group [25]. Cognitive dysfunction is nonlinearly related to the duration of diabetes. However, cognitive decline is more prominent when the duration of DM is more than 5 years and presence of hypertension which further increases the risk of cognitive impairment [21]. The patients having diabetes showed poor performance in the tests of recent memory, repetition and attention, as compared to the control group and DM, and the people with long history of DM are more at risk of cognitive decline [27]. It is concluded that cognitive function of diabetes type 2 patients should frequently be tested. This is because the duration of disease can be related with the decrease in cognitive function. As duration increases, impairment also increases [28].

2.3 Influence of age and cognitive impairment

A prospective study is done to observe and determine the impact of DM on the cognitive function impairment in the oldest of the old participants. The study was conducted using prospective population method. They have chosen approximately 599 participants with the respond rate of 87% with the age ranges from 85 to 90 years old. The memory function test does not show any differences between both diabetic and nondiabetic participants. Cognitive function of diabetic participants is affected when the time and speed test has been conducted [29].

The results of another research show that diabetic patients more than 65 years old have higher chances to be associated with impaired cognitive function [24]. Besides that, one more study was conducted that is related to assessing the status of cognitive function in people that have DM. The chosen patients were assessed by using MMSE and 3MS (the modified mini-mental state examination). The scores for both assessments were 30 and 100, respectively. At the same time, the relationships of age, gender and duration of diabetes and HbA1c among the DM with 3MS will also be assessed. The results of this study were diabetic patients have lower MMSE and 3MS than nondiabetic patients. This mean cognitive function will be reduced as the age increases and when having DM [30].

The uncontrolled DM which is one of the risk factors for cognitive impairment and dementia especially in Alzheimer patients. Therefore, controlling DM can reduce the possibility to get cognitive impairment and Alzheimer disease [5].

2.4 Association between duration of DM and age towards cognitive impairment

According to a homogenous cohort study on the community-dwelling women in 11 US states. This study focusses on women that live in the community which are on their own compared to living in nursing or old folk home. The result of this research was participants (women) with type 2 DM had lower mean score in all the tests conducted than women without DM. At the same time, when duration has been diagnosed with DM and insufficiency in pharmacological treatment, it can worsen or cause increment in cognitive impairment. One of the limitations for this research is self-reporting regarding diabetes diagnosis [31].

Meanwhile, another study was done regarding the cognitive impairment in diabetic patients with special references to age of onset, duration and also control of diabetes. The study was conducted in diabetic patients that came to the medicine inpatient and outpatient departments and diabetic clinic of SSKM Hospital, India. It is used to calculate the mean effect of sugar control after a 6-month period. The result of this study was cognitive impairment has a relationship with diabetes. The cognitive function that usually affected were recognition, fluency and immediate memory power of the patients. Control of DM can help in improving cognitive function of the patients. Other habits such as smoking, poor control of sugar intake as well as life style can enhance the effect of cognitive impairment [32].

A cross-sectional study was conducted which is related to prevalence and predictors of cognitive dysfunction in type 2 DM population of Punjab, India. The study involves 516 type 2 DM participants that attended the endocrinology outpatient department of the Government Medical College and Hospital, Patiala, Punjab, India. The result of this study shows that many of diabetic participants that are living in Punjab, India, remain undiagnosed with cognitive impairment during their life. Cognitive impairment in diabetic participants is independently influenced by duration of diabetes, age of the patients and other complications besides diabetes such as hypertension and others [33].

2.5 HbA1c control and cognitive decline

HbA1c is recommended to be used to identify the people at risk of developing diabetes as well as to diagnose diabetes. It is the most important biomarker for the management of blood glucose control in individuals with already diagnosed diabetes [34]. It is also a strong predictor for ensuing diabetes, because it incorporates the average blood glucose level over the last 2–3 months [35] and has better reliability than fasting or postprandial blood glucose test [36]. The cohort studies conducted in middle-aged populations show that the cognitive decline in people with diabetes is significantly faster than those with normal blood glucose levels [26, 37]. The study also reported that there is no significant difference in cognitive decline in people with prediabetes than in those with normal blood glucose levels [13]. On the contrary, the other study reported significantly faster cognitive decline among people with prediabetes than those with normal HbA1c levels [26]. The longitudinal study done reported significant longitudinal associations between HbA1c levels, diabetes status and long-term cognitive decline [38].


3. Cognitive deficits in patients with type 1 and type 2 DM

The cognitive domains that were negatively affected have been identified in patients with type 1 and type 2 DM with strong supporting data (Table 1).

Type 1 DM Type 2 DM
Slowing of information processing [39, 40, 41, 42]
Psychomotor efficiency [39, 40, 44]
Attention [42]
Visuoconstruction [42]
Psychomotor speed [43]
Working memory [45, 46]
Verbal memory [47]
Immediate recall
Delayed recall [31]
Executive function [43, 45, 46]

Table 1.

Cognitive domains affected by type 1 and type 2 DM (with strong supporting data).

The cognitive domains that were negatively affected have been identified in patients with type 1 and type 2 DM with less supporting data (Table 2).

Type 1 DM Type 2 DM
Memory [44]
Motor speed [41, 49, 50, 51]
Vocabulary [44, 52, 53, 54]
General intelligence [53, 54]
Visual perception
Motor strength [51]
Executive function [49, 57]
Verbal fluency [43, 48]
Complex motor function [43]
Processing speed [47]
Attention [55]
Depression [45, 56]

Table 2.

Cognitive domains affected by type 1 and type 2 DM (with less supporting data).

3.1 Physiological pathways linking diabetes and cognition

The link between diabetes and cognitive impairment was first reported in 1922 [58]. The exact physiologic pathways linking the two conditions remain unclear. The hypothetical mechanisms include which is related to cerebrovascular complications, neuronal glucose processing and frequent episodes of hypoglycaemia [3, 59, 60]. The diabetic patients are more prone to develop comorbid cardiovascular disease, which is itself predictive of cognitive decline through cerebrovascular events and other pathways [61].

3.2 Treatment strategy

There are some complications of type 2 DM that affect the brain; it is believed that diabetes treatment may have beneficial effects on cognition. Three different trials reported that intensive glycaemic control alleviate microvascular complications but does not alleviate macrovascular complications in geriatric patients with long-duration of type 2 diabetes and high cardiovascular risk [62, 63, 64]. The intensive treatment of type 2 DM leads to hypoglycaemia which may contribute to cognitive decline and eliminate the benefits of intensive treatment [63, 65, 66]. Hypoglycaemia is more common in intensive glycaemic control than in standard glycaemic control [67].


4. Conclusion

DM is an important risk factor along with other diabetic complications for cognitive decline, which leads to loss of independence and nonadherence to medication and results in high healthcare cost. It is still controversial how early the age of cognitive impairment is, although there is enough documented links between diabetes and cognitive function. The standard glycaemic control is better than intensive glycaemic control in the prevention of cognitive decline. The challenge for treatment is to maintain the cognitive function by reduction of hypoglycaemic events.


Conflict of interest

There is no conflict of interest among the authors.


  1. 1. Atlas ID. Brussels, Belgium: International diabetes federation; 2013. International Diabetes Federation (IDF). 2017
  2. 2. Tomar S. Impact of neurobiofeedback therapy on cognitive impairment among type-2 diabetes mellitus patients. Delhi Psychiatry Journal. 2012;15(2):287-293
  3. 3. Kodl CT, Seaquist ER. Cognitive dysfunction and diabetes mellitus. Endocrine Reviews. 2008;29(4):494-511
  4. 4. Mafauzy M, Hussein Z, Chan S. The status of diabetes control in Malaysia: Results of DiabCare 2008. The Medical Journal of Malaysia. 2011;66(3):175-181
  5. 5. Rajeshkanna N, Valli S, Thuvaragah P. Relation between diabetes mellitus type 2 and cognitive impairment: A predictor of alzheimer's disease. International Journal of Medical Research & Health Sciences. 2014;3(4):903-910
  6. 6. Control CfD, Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. Atlanta, GA: US department of health and human services, centers for disease control and prevention; 2011;201(1)
  7. 7. Feisul M, Azmi S. National Diabetes Registry Report, Volume 1, 2009-2012. Kuala Lumpur: Ministry of Health Malaysia. p. 2013
  8. 8. Organization WH. Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO consultation. In: Part 1, Diagnosis and Classification of Diabetes Mellitus. Geneva: World health organization; 1999
  9. 9. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice. 2010;87(1):4-14
  10. 10. Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes through the life span: A position statement of the American diabetes association. Diabetes Care. 2014;37(7):2034-2054
  11. 11. Mafauzy M. Diabetes control and complications in public hospitals in Malaysia. Medical Journal of Malaysia. 2006;61(4):477
  12. 12. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Research and Clinical Practice. 2011;94(3):311-321
  13. 13. Ogurtsova K, da Rocha Fernandes J, Huang Y, Linnenkamp U, Guariguata L, Cho N, et al. IDF diabetes atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Research and Clinical Practice. 2017;128:40-50
  14. 14. Malaysia DoS. Population and Housing Census of Malaysia. Putrajaya: Department of Statistics Malaysia; 2010
  15. 15. Forces ID. International Diabetes Federation Diabetes Atlas. Brussels, Belgium: International Diabetes Federation; 2015
  16. 16. Bandura A. Social cognitive theory: An agentic perspective. Annual Review of Psychology. 2001;52(1):1-26
  17. 17. Cosway R, Strachan M, Dougall A, Frier B, Deary I. Cognitive function and information processing in type 2 diabetes. Diabetic Medicine. 2001;18(10):803-810
  18. 18. Huppert FA, Gardener E, McWilliams B. Cognitive function. In: Retirement, Health and Relationships of the Older Population in England. London, UK: The Institute for Fiscal Studies; 2004. pp. 217-242
  19. 19. 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. Journal of the International Neuropsychological Society. 2014;20(3):278-291
  20. 20. Cukierman T, Gerstein H, Williamson J. Cognitive decline and dementia in diabetes—Systematic overview of prospective observational studies. Diabetologia. 2005;48(12):2460-2469
  21. 21. Hazari MAH, Reddy BR, Uzma N, Kumar BS. Cognitive impairment in type 2 diabetes mellitus. International Journal of Diabetes Mellitus. 2015;3(1):19-24
  22. 22. Feinkohl I, Price JF, Strachan MW, Frier BM. The impact of diabetes on cognitive decline: Potential vascular, metabolic, and psychosocial risk factors. Alzheimer's Research & Therapy. 2015;7(1):46
  23. 23. Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME, et al. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: The action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care. 2009;32(2):221-226
  24. 24. Rodríguez-Sánchez E, Mora-Simón S, Patino-Alonso MC, Pérez-Arechaederra D, Recio-Rodríguez JI, Gómez-Marcos MA, et al. Cognitive impairment and dependence of patients with diabetes older than 65 years old in an urban area (DERIVA study). BMC Geriatrics. 2016;16(1):33
  25. 25. Hamed SA, Youssef A, Elserogy Y, Herdan O, Abd-Elaal R, Metwaly N, et al. Cognitive function in patients with type 2 diabetes mellitus: Relationship to stress hormone (cortisol). Journal of Neurology and Neuroscience. 2013;4:3
  26. 26. Rawlings AM, Sharrett AR, Schneider AL, Coresh J, Albert M, Couper D, et al. Diabetes in midlife and cognitive change over 20 years: A cohort study. Annals of Internal Medicine. 2014;161(11):785-793
  27. 27. Kalar MU, Mujeeb E, Pervez S, Lalani Z, Raza B, Batool A, et al. Assessment of cognitive status in type 2 diabetes. International Journal of Collaborative Research on Internal Medicine & Public Health. 2014;6(8):235
  28. 28. Alencar RC, Cobas RA, Gomes MB. Assessment of cognitive status in patients with type 2 diabetes through the mini-mental status examination: A cross-sectional study. Diabetology and Metabolic Syndrome. 2010;2(1):10
  29. 29. Van den Berg E, De Craen A, Biessels G, Gussekloo J, Westendorp R. The impact of diabetes mellitus on cognitive decline in the oldest of the old: A prospective population-based study. Diabetologia. 2006;49(9):2015-2023
  30. 30. Shuba N. Assessment of the cognitive status in diabetes mellitus. Journal of Clinical and Diagnostic Research: JCDR. 2012;6(10):1658
  31. 31. Grodstein F, Chen J, Wilson RS, Manson JE. Type 2 diabetes and cognitive function in community-dwelling elderly women. Diabetes Care. 2001;24(6):1060-1065
  32. 32. Mukherjee P, Mazumdar S, Goswami S, Bhowmik J, Chakroborty S, Mukhopadhyay S, et al. Cognitive dysfunction in diabetic patients with special reference to age of onset, duration and control of diabetes. Activitas Nervosa Superior. 2012;54(1-2):67-75
  33. 33. Khullar S, Kaur G, Dhillon H, Sharma R, Mehta K, Singh M, et al. The prevalence and predictors of cognitive impairment in type 2 diabetic population of Punjab, India. Journal of Social Health and Diabetes. 2017;5(1):47
  34. 34. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Supplement 1):S62-S69
  35. 35. Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J, et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. The New England Journal of Medicine. 2010;362(9):800-811
  36. 36. Selvin E, Crainiceanu CM, Brancati FL, Coresh J. Short-term variability in measures of glycemia and implications for the classification of diabetes. Archives of Internal Medicine. 2007;167(14):1545-1551
  37. 37. Tuligenga RH, Dugravot A, Tabák AG, Elbaz A, Brunner EJ, Kivimäki M, et al. Midlife type 2 diabetes and poor glycaemic control as risk factors for cognitive decline in early old age: A post-hoc analysis of the Whitehall II cohort study. The Lancet Diabetes & Endocrinology. 2014;2(3):228-235
  38. 38. Zheng F, Yan L, Yang Z, Zhong B, Xie W. HbA 1c, diabetes and cognitive decline: The english longitudinal study of ageing. Diabetologia. 2018;61(4):839-848
  39. 39. Brands AM, Kessels RP, Hoogma RP, Henselmans JM, van der Beek Boter JW, Kappelle LJ, et al. Cognitive performance, psychological well-being, and brain magnetic resonance imaging in older patients with type 1 diabetes. Diabetes. 2006;55(6):1800-1806
  40. 40. Ryan CM, Geckle MO, Orchard TJ. Cognitive efficiency declines over time in adults with type 1 diabetes: Effects of micro-and macrovascular complications. Diabetologia. 2003;46(7):940-948
  41. 41. Ryan CM, Williams TM, Finegold DN, Orchard TJ. Cognitive dysfunction in adults with type 1 (insulin-dependent) diabetes mellitus of long duration: Effects of recurrent hypoglycaemia and other chronic complications. Diabetologia. 1993;36(4):329-334
  42. 42. Wessels AM, Rombouts SA, Remijnse PL, Boom Y, Scheltens P, Barkhof F, et al. Cognitive performance in type 1 diabetes patients is associated with cerebral white matter volume. Diabetologia. 2007;50(8):1763-1769
  43. 43. Reaven GM, Thompson LW, Nahum D, Haskins E. Relationship between hyperglycemia and cognitive function in older NIDDM patients. Diabetes Care. 1990;13(1):16-21
  44. 44. Weinger K, Jacobson AM, Musen G, Lyoo IK, Ryan CM, Jimerson DC, et al. The effects of type 1 diabetes on cerebral white matter. Diabetologia. 2008;51(3):417-425
  45. 45. Munshi M, Grande L, Hayes M, Ayres D, Suhl E, Capelson R, et al. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care. 2006;29(8):1794-1799
  46. 46. Perlmuter LC, Hakami MK, Hodgson-Harrington C, Ginsberg J, Katz J, Singer DE, et al. Decreased cognitive function in aging non-insulin-dependent diabetic patients. The American Journal of Medicine. 1984 Dec 1;77(6):1043-1048
  47. 47. Messier C. Impact of impaired glucose tolerance and type 2 diabetes on cognitive aging. Neurobiology of Aging. 2005;26(1):26-30
  48. 48. Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K. Change in cognitive function by glucose tolerance status in older adults: A 4-year prospective study of the Rancho Bernardo study cohort. Archives of Internal Medicine. 2004;164(12):1327-1333
  49. 49. Hershey T, Bhargava N, Sadler M, White NH, Craft S. Conventional versus intensive diabetes therapy in children with type 1 diabetes: Effects on memory and motor speed. Diabetes Care. 1999;22(8):1318-1324
  50. 50. Ryan CM. Neurobehavioral complications of type I diabetes: Examination of possible risk factors. Diabetes Care. 1988;11(1):86-93
  51. 51. Skenazy JA, Bigler ED. Neuropsychological findings in diabetes mellitus. Journal of Clinical Psychology. 1984;40(1):246-258
  52. 52. Hershey T, Craft S, Bhargava N, White NH. Memory and insulin dependent diabetes mellitus (IDDM): Effects of childhood onset and severe hypoglycemia. Journal of the International Neuropsychological Society. 1997;3(6):509-520
  53. 53. Northam EA, Anderson PJ, Werther GA, Warne GL, Adler RG, Andrewes D. Neuropsychological complications of IDDM in children 2 years after disease onset. Diabetes Care. 1998;21(3):379-384
  54. 54. Schoenle EJ, Schoenle D, Molinari L, Largo RH. Impaired intellectual development in children with type I diabetes: Association with HbA1 c, age at diagnosis and sex. Diabetologia. 2002;45(1):108-114
  55. 55. Fontbonne A, Berr C, Ducimetière P, Alpérovitch A. Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: Results of the epidemiology of vascular aging study. Diabetes Care. 2001;24(2):366-370
  56. 56. Bruce DG, Casey GP, Grange V, Clarnette RC, Almeida OP, Foster JK, et al. Cognitive impairment, physical disability and depressive symptoms in older diabetic patients: The fremantle cognition in diabetes study. Diabetes Research and Clinical Practice. 2003;61(1):59-67
  57. 57. Northam EA, Anderson PJ, Jacobs R, Hughes M, Warne GL, Werther GA. Neuropsychological profiles of children with type 1 diabetes 6 years after disease onset. Diabetes Care. 2001;24(9):1541-1546
  58. 58. Miles WR, Root HF. Psychologic tests applied to diabetic patients. Archives of Internal Medicine. 1922;30(6):767-777
  59. 59. Awad N, Gagnon M, Messier C. The relationship between impaired glucose tolerance, type 2 diabetes, and cognitive function. Journal of Clinical and Experimental Neuropsychology. 2004;26(8):1044-1080
  60. 60. Stolk RP, Breteler MM, Ott A, Pols HA, Lamberts SW, Grobbee DE, et al. Insulin and cognitive function in an elderly population: The Rotterdam study. Diabetes Care. 1997;20(5):792-795
  61. 61. Leritz EC, McGlinchey RE, Kellison I, Rudolph JL, Milberg WP. Cardiovascular disease risk factors and cognition in the elderly. Current Cardiovascular Risk Reports. 2011;5(5):407
  62. 62. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. The New England Journal of Medicine. 2008;358(24):2545-2559
  63. 63. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. The New England Journal of Medicine. 2008;358(24):2560-2572
  64. 64. Turnbull FM, Abraira C, Anderson RJ, et al. Diabetologia. 2009;52:2288. Available from:
  65. 65. Launer LJ, Miller ME, Williamson JD, Lazar RM, Gerstein HC, Murray AM, et al. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): A randomised open-label substudy. The Lancet Neurology. 2011;10(11):969-977
  66. 66. Cukierman-Yaffe T, Bosch J, Diaz R, Dyal L, Hancu N, Hildebrandt P, et al. Effects of basal insulin glargine and omega-3 fatty acid on cognitive decline and probable cognitive impairment in people with dysglycaemia: A substudy of the ORIGIN trial. The Lancet Diabetes & Endocrinology. 2014;2:562-572
  67. 67. Chatterjee S, Sharma A, Lichstein E, Mukherjee D. Intensive glucose control in diabetics with an acute myocardial infarction does not improve mortality and increases risk of hypoglycemia-a meta-regression analysis. Current Vascular Pharmacology. 2013;11(1):100-104

Written By

Faiz Ahmed Shaikh, K.C. Bhuvan, Thet Thet Htar, Manish Gupta and Yatinesh Kumari

Reviewed: 19 March 2019 Published: 24 October 2019