Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hyperhomocysteinemia (HHCY) is a consequence of disturbed methionine metabolism. It results from enzyme and/or vitamin deficiency. Epidemiological and clinical studies have proven HHCY to be an independent risk factor for atherosclerotic cardiovascular diseases, stroke, peripheral arterial occlusive disease and venous thrombosis. Trials in progress may clarify the "causality" of high homocysteine (HCY) concentrations and will assess the value of HCY lowering therapy. HHCY is also seen as a risk factor for neurodegenerative diseases such as cognitive impairment, dementia, Alzheimer's disease, and also for depression. There is a high prevalence of HHCY as a syndrome of vitamin shortage in elderly subjects, which strongly increases with advancing age. Elderly people have a high frequency of vitamin B12 deficiency which is more reliably diagnosed by measurement of serum methylmalonic acid and holotranscobalamin II, the metabolically active B12 fraction, than by total serum vitamin B12. Subjects who follow a strict vegetarian diet also have a high prevalence of HHCY caused by vitamin B12 deficiency. For prevention of neurological damages an early diagnosis of vitamin B12 deficiency is important. Furthermore, HHCY is a factor in the pathogenesis of neural tube defects and preeclampsia. HCY should be measured in patients with a history of atherothrombotic vessel diseases, in patients with diabetes or hyperlipidemia, in renal patients, in adipose subjects, in elderly people, in vegetarians, in postmenopausal women, and in early pregnancy.
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PMID:Hyperhomocysteinemia: a new risk factor for degenerative diseases. 1238 6

Diabetes-related cognitive dysfunction has been recognized for many years in humans, but the pathogenesis of this condition is poorly understood. Evidence from animal studies suggests that altered function of the blood-brain barrier (BBB) could be a potential cause contributing to this disease. This study aimed to investigate whether the permeability of the BBB is affected in the brains of persons with diabetes mellitus (DM). On postmortem prefrontal and temporal cortex of diabetic patients and controls, immunohistochemical stainings were carried out using specific antibodies against three proteins (PAL-E, IgG and albumin), which are considered as markers for the vascular permeability status of the BBB. Rare or no PAL-E staining was found in the capillaries of the prefrontal and temporal cortex parenchyma, in both DM and control materials. IgG and albumin were localized in and directly around blood vessel walls in the prefrontal and temporal cortex. No obvious differences in the staining pattern of IgG and albumin were observed between brain samples of persons with DM and controls. This study suggests that the BBB in diabetic patients is well maintained.
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PMID:Blood-brain barrier integrity is unaltered in human brain cortex with diabetes mellitus. 1241 15

Dementia of the Alzheimer type (DAT) and vascular dementia (VaD) are the two major subtypes of dementia. In our epidemiological study of DAT in an Arab community in Wadi Ara, Israel, we found a high prevalence of late onset DAT. Illiteracy, smoking, diabetes mellitus (DM) and hypertension are very frequent in Wadi Ara. These factors led us to study the prevalence of VaD and various risk factors in this population. All people aged 60 years or older (n=823) in a defined region were examined for identification of DAT and VaD (DSM-IV criteria), using clinical examinations and a semi-structured questionnaire for detecting cognitive dysfunction. We identified 49 demented patients (29 males) fulfilling criteria of VaD with a prevalence rate of 49/823 (5.9%), compared to 168/823 (20.5%) for DAT. All had suffered from strokes. Male gender and hypertension were more common among VaD cases. Illiteracy was significantly more common among VaD patients than among healthy subjects (79.6% vs. 40.2%, P=0.001) but less common than among DAT patients (94.6%, P=0.001). Thus, our results show that VaD constitutes about 22% of the total dementia population in Wadi Ara. We confirm the association between VaD, illiteracy and hypertension. Smoking and gender do not represent risk factors for VaD in this population. While suggestive, DM is not a statistically significant risk factor for VaD.
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PMID:Vascular dementia among elderly Arabs in Wadi Ara. 1241 60

Numerous considerations affect the diagnosis and management of overactive bladder (OAB) in older patients, including neurologic and cardiovascular disorders, musculoskeletal conditions, diabetes, and psychiatric disorders. Older patients are commonly prescribed multiple medications, and many medications can contribute to OAB symptoms and/or interact with drug treatment for OAB. In addition to chronic illnesses and related medications, several factors outside the lower urinary tract can play an important part in managing OAB in older patients. These factors include mobility disorders, cognitive impairment, bowel habits, and fluid intake. Moreover, OAB often does not occur in isolation in the geriatric population. Estrogen deficiency and sphincter weakness in women, prostatic enlargement and obstruction in men, and impaired bladder contractility in both sexes are common and can have prominent effects on management. The diagnostic evaluation of geriatric patients with OAB can usually be accomplished with a basic assessment, without more invasive and expensive procedures. Treatment depends on numerous factors, ranging from comorbidities and functional status to transportation, finances, and patient and caregiver preferences. Adverse effects of bladder-relaxant medications can be bothersome and exacerbate existing conditions common in older patients (eg, constipation, glaucoma, gastroesophageal reflux, and dementia). Setting realistic goals for treatment and communicating them clearly to older patients and their caregivers are crucial for patient satisfaction. There are myriad opportunities for research designed to improve the management of OAB in the geriatric population.
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PMID:Geriatric considerations in the diagnosis and management of overactive bladder. 1249 54

Cognitive defects have been reported in type 1 diabetes mellitus with possible correlation to recurrent episodes of hypoglycemia. The purpose of the present study was to identify signs of brain dysfunction with quantitative EEG in adults with insulin-dependent (type 1) diabetes. Patients (n = 49) with type 1 diabetes and controls (n = 51) were recruited. All patients had good glycemic control, no diabetic polyneuropathy and a minor history of severe hypoglycaemia. EEG was recorded for 15 min following a standardized protocol, power spectra were obtained from 236-584 s of artefact-free EEG from each subject and EEG was repeated in diabetic patients after 3 and 9 months. The most pronounced finding was a loss of fast oscillations (alpha, beta and gamma activity) in both posterior temporal regions, with p< 0.001 for beta and p< 0.05 or 0.01 for alpha and gamma activity in the diabetes patients. A decrease in beta activity was also present bilaterally in the anterior temporal and occipital regions (p< 0.05 or 0.01). The alpha peak frequency was lower in patients than in controls, with reductions bilaterally in the temporo-central regions (p< 0.01). These changes were not found to correlate to a previous history of hypoglycaemia. The alpha and beta power showed a high test-retest reliability at both 3 and 9 months (0.88-0.92). The focal decrease in temporal lobe fast activity suggests that these brain regions are preferentially affected by type 1 diabetes. This abnormality may be related to the mechanism underlying the cognitive dysfunction described in diabetes.
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PMID:Loss of temporal lobe beta power in young adults with type 1 diabetes mellitus. 1249 51

Patients suffering from diabetes mellitus and depressive patients show a hyperactivity of the hypothalamic-pituitary-adrenocortical axis (HPA-axis) with hypercortisolemia. Hypercortisolemia is associated with cognitive dysfunction. These neuroendocrinological disturbances can cause an insulin resistance syndrome which complicates the regulation of blood glucose. Cognitive and depressive disorders in patients with diabetes mellitus might be associated with a hyperactivity of the HPA-axis. By normalising the HPA-axis both disorders could be improved. In addition, one can expect that antidepressive treatment with normalization of the HPA-axis could improve the metabolic situation and cognitive dysfunction. There is need for further research to study the associations between depression, diabetes mellitus and cognitive dysfunction.
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PMID:[The HPA-axis as a possible link between depression, diabetes mellitus and cognitive dysfunction]. 1252 32

Previous studies have shown that recurrent severe hypoglycaemia can cause long-term cognitive impairment in children with type-1 diabetes, but the results are controversial, possibly due to the heterogeneity of samples and lack of comprehensive neuropsychological assessments of children. The aim of this study was to assess the effects of diabetes and severe hypoglycaemia on the neurocognitive functioning of children with a standardized, wide age-range neuropsychological test battery designed for the assessment of children. Eleven children with diabetes and a history of severe hypoglycaemia, 10 children with diabetes without a history of severe hypoglycaemia, and 10 healthy control children (a total of 31 children: 14 males and 17 females, age range 5 years 6 months to 11 years 11 months, mean 9 years 4 months, SD 1 year 11 months) were studied using the Wechsler Intelligence Scale for Children-Revised (WISC-R) and the NEPSY, a Developmental Neuropsychological Assessment. The NEPSY assessed development in attention and executive functions, language, sensorimotor functions, visuospatial processing, and learning and memory. Children with a history of severe hypoglycaemia had more neuropsychological impairments, more learning difficulties (as reported by parents), and needed more part-time special education than those in the other groups. Significant differences were found in verbal short-term memory and phonological processing. Results suggest that severe hypoglycaemia is a risk factor for learning due to deficits in auditory-verbal functioning.
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PMID:Neurocognitive functioning in children with type-1 diabetes with and without episodes of severe hypoglycaemia. 1264 28

We sought to assess whether epilepsy is associated with a higher risk of emotional reactions to frustrating stimuli, aggressive behavior, apathy, and depression, and whether these psychiatric patterns are specific to the epileptic condition. The study population consisted of referral patients 17 years and older with idiopathic or cryptogenic epilepsy (i.e., epilepsy not caused by a detectable brain lesion) without significant cognitive dysfunction. A first control was selected for each patient among patients with insulin-dependent diabetes and a second among normal blood donors. Aggressiveness in response to stressful stimuli was assessed with the Picture Frustration Study (PFS). Depression was tested by the Beck Depression Inventory. The Aggressive Behavior Scale (assessing irritability and rumination) and the Apathy Scale were also used. Odds Ratios (ORs) with 95% Confidence Intervals (95% CI) were used as the risk measure. Statistical analysis included between-group comparisons. In patients with epilepsy, the test scores were correlated to the main demographic (age, sex, education, marital status, and occupation) and clinical features (seizure types, disease duration, seizure control, and treatments). The sample included 55 patients with epilepsy, 56 diabetics, and 59 normal individuals. Patients with epilepsy and the two control groups had similar PFS scores and similar aggressiveness. Scores were also similar for the Aggressive Behavior and Apathy Scales, with similar numbers of individuals with aggressive conduct and excess rumination. Patients with epilepsy had higher depression scores. Moderate to severe depression was present in 9 cases (diabetes, 2; blood donors, 1) (P=0.004). Relative to blood donors, the OR for moderate to severe depression (95% CI) was 2.1 (0.1-61.7) for diabetes and 11.3 (1.4-247.8) for epilepsy. No significant correlation was detectable between test scores and patient and disease characteristics.
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PMID:Emotional and affective disturbances in patients with epilepsy. 1266 6

Although clinical experience has suggested for more than two decades that OSA is associated with impairment of cognition, emotional state, and quality of life and that treatment with nasal CPAP produces significant improvements in these areas, sound empirical evidence to support this view, especially regarding treatment outcome, has been lacking. More recent investigations have begun to provide this support from randomized, adequately controlled studies. These assessments suggest that some degree of cognitive dysfunction is associated with OSA. The effects are most apparent in the severe cases, whereas results in mild cases are more equivocal. Reported impairments include global intellectual dysfunction and deficits in vigilance, alertness, concentration, short- and long-term memory, and executive and motor function. Considerable discrepancy exists across studies with respect to type and degree of dysfunction, however. Disturbances in general intellectual function and executive function show strongest correlations with measures of hypoxemia. Not unexpectedly, alterations in vigilance, alertness, and, to some extent, memory seem to correlate more with measures of sleep disruption. Although many inadequately controlled investigations have demonstrated reversibility of most or all of these deficits with effective treatment, more recent placebo-controlled studies have raised doubts regarding whether the observed changes are truly a function of treatment. This issue requires further systematic exploration with adequate controls and step-wise analysis of treatment duration effects. A similar set of considerations exists with respect to the relationship between psychological disturbance, primarily depression, and OSA. Although several studies suggest significant depression in these patients, the results are mixed. Placebo-controlled treatment trials fail to demonstrate consistently a difference in mood improvement between active treatment groups and controls, although several methodologic considerations suggest that these results should be interpreted with caution. Numerous investigations leave little doubt about the issue of quality of life impairment among persons with OSA. Further characterization of impairment, particularly in areas specific to this population, will provide clearer understanding of the problem. Preliminary investigations of treatment response in controlled studies indicate significantly greater improvement of quality of life in response to CPAP. Although patients with OSA commonly report disturbances in cognitive and psychological function and general quality of life, the increased rates of obesity, hypertension, diabetes, cardiovascular disease, medication use, and related psychosocial complications present a host of potential etiologies that might explain the impairments noted. There can be little doubt that these covariants do, in some cases, contribute to neuropsychological dysfunctions. It is essential that future studies continue to define those disturbances that are specific to OSA, the relationship between levels of severity and impairment, the role of treatment in reversing these dysfunctions, and the correlation between test results and significant day-to-day social and occupational functional impairment.
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PMID:Neuropsychological impairment and quality of life in obstructive sleep apnea. 1280 Jul 82

Vascular dementia is the second most common type of dementia. The subcortical ischaemic form (SIVD) frequently causes cognitive impairment and dementia in elderly people. SIVD results from small-vessel disease, which produces either arteriolar occlusion and lacunes or widespread incomplete infarction of white matter due to critical stenosis of medullary arterioles and hypoperfusion (Binswanger's disease). Symptoms include motor and cognitive dysexecutive slowing, forgetfulness, dysarthria, mood changes, urinary symptoms, and short-stepped gait. These manifestations probably result from ischaemic interruption of parallel circuits from the prefrontal cortex to the basal ganglia and corresponding thalamocortical connections. Brain imaging (computed tomography and magnetic resonance imaging) is essential for correct diagnosis. The main risk factors are advanced age, hypertension, diabetes, smoking, hyperhomocysteinaemia, hyperfibrinogenaemia, and other conditions that can cause brain hypoperfusion such as obstructive sleep apnoea, congestive heart failure, cardiac arrhythmias, and orthostatic hypotension. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL)and some forms of cerebral amyloid angiopathy have a genetic basis. Treatment is symptomatic and prevention requires control of treatable risk factors.
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PMID:Subcortical ischaemic vascular dementia. 1284 65


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