Cognitive impairment and dementia: a new challenge in our practice

Abstract

The intersection of diabetes mellitus (DM) and cognitive impairment presents a significant challenge in clinical practice. With the increasing prevalence of DM and its impact on the aging population, it is crucial to understand how this metabolic disease can influence the development of cognitive disorders and dementia.

Various studies have highlighted a strong association between type 2 DM and cognitive impairment. Chronic hyperglycemia and insulin resistance are factors that contribute to cerebrovascular dysfunction and neurodegeneration. Diabetes can accelerate the onset of mild cognitive impairment (MCI) and increase the risk of progression to dementia, including Alzheimer's disease and vascular dementia forms. MCI in people with diabetes is characterized by cognitive decline that does not significantly interfere with daily activities but may be a precursor to dementia. Early identification of MCI is crucial to implement interventions that can delay its progression. Neuropsychological assessment tools and neuroimaging biomarkers are essential for a precise and early diagnosis in this population. Managing dementia in patients with DM requires a comprehensive and multidisciplinary strategy. Pharmacological interventions, including aggressive and dynamic metabolic control, can offer benefits, although care must be taken to avoid hypoglycemia, which can worsen cognitive dysfunction. Concurrently, non-pharmacological therapies such as cognitive stimulation, regular physical exercise, and dietary intervention have shown positive effects on cognitive function and patients' quality of life.

Medical care for these patients should be coordinated by a multidisciplinary team that includes diabetologists/endocrinologists, neurologists, psychologists, geriatricians, and occupational therapists, among others. This holistic approach addresses both the metabolic and neurocognitive aspects of DM. Additionally, it is fundamental to involve caregivers and family members in the care process, providing education and emotional support to mitigate the caregiving burden.

In conclusion, cognitive impairment and dementia in patients with diabetes mellitus represent a growing challenge in advanced clinical practice. Early identification and the implementation of combined therapeutic strategies are essential to improve outcomes in this population. Continuous education and caregiver support play a crucial role in providing high-quality care.