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A recent study suggests that it is not the presence of diabetes that poses a risk for cognitive decline as much as it is living with uncontrolled or poorly managed diabetes that puts one at risk for a decline in cognition. High blood sugar, obesity, high blood pressure and high cholesterol and insulin resistance are all complications of poorly managed diabetes and all can lead to problems with cognition.

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Early assessment of diabetes associated cognitive impairment and memory loss can prevent or, at the very least, delay the devastating effects associated with declines in memory and thought processes.

A decline in memory can occur in only two years after diagnosis and is frequently insidious in onset.

What Are the Mechanisms for Cognitive Decline?

The most frequent mechanism cited for early cognitive decline is related to inflammation. We know that obesity is an inflammatory condition, so obesity aggravates an already inflammatory condition. High blood pressure and lipids as well as blood sugar impede blood flow of oxygen to the brain thus aggravating an already tenuous situation with regards to adequate blood flow and oxygenation. Insulin resistance is also a contributor to the metabolic milieu that leads to memory deterioration.


What Can Be Done?

For now, better monitoring at both community and primary care settings for inflammatory conditions and implementing effective care plans with frequent follow-up would be a start.  Early identification of cognitive impairment and memory loss allows for timely prevention and better prognosis for patients and those who care for them.

Monitoring performance on daily activities, memory, gait speed in older adults with diabetes may point to a decline in ability to regulate blood flow in the brain.

The ability to maintain balance and posture while walking can be noted.

For older adults with diabetes it is important to maintain healthy lifestyles and to minimize fluctuations in blood sugar in addition to following their medication regimen consistently.

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The management of diabetes requires a high degree of daily maintenance tasks, healthy eating, activity, taking medications, foot care, etc. and all require a degree of cognitive performance. Cognitive impairment is a common, underdiagnosed complication of diabetes that can interfere with the ability to adequately perform required daily self-management behaviors.

Early detection and treatment of obesity, high blood pressure, high lipids, and insulin resistance may delay onset of cognitive problems. Community and primary intervention programs can be implemented to assist those with growing dementia in holding on to cognitive abilities through brain games or other thought-provoking challenges and activities.

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