The Additive Effects of Type 2 Diabetes Mellitus on Neurobehavioral Functioning of Patients Diagnosed with Myocardial Infarction

By Rafique, Rafia; Anjum, Afifa et al. | Journal of Behavioural Sciences, May 1, 2016 | Go to article overview

The Additive Effects of Type 2 Diabetes Mellitus on Neurobehavioral Functioning of Patients Diagnosed with Myocardial Infarction


Rafique, Rafia, Anjum, Afifa, Amer, Lubna, Journal of Behavioural Sciences


The neurobehavioral sequel of cardiovascular conditions is well-documented and can have a devastating impact on individuals' quality of life. The growing interest in the field of neurobehavior has led investigators and researchers to examine neurobehavioral deficit as related to brain deficits in a wide variety of medical conditions including cardiac diseases (Kang et al., 1991). Diabetes affects the central nervous system, leading to cognitive decline among patients with type 2 diabetes (Gispen & Biessels, 2000). Research endorses a strong association of diabetes with increased risk of dementia, including Alzheimer's disease and vascular dementia (Biessels, De Leeuw, Lindeboom, Barkhof, & Scheltens, 2006). Case-control studies indicated cognitive impairment affecting verbal memory and processing speed, although the results were not found to associate with nonverbal memory and executive functioning (Awad, Gagnon, & Messier, 2004). Not all studies have suggested these cognitive impairments. Differences in methods and study designs such as demographic and diabetic characteristics have made some results inconclusive. Inconsistencies may also be due to differences in the control of confounding factors.

Cardiac dysrhythmias or MI can decrease cardiac output, which may in turn result in decreased cerebral perfusion resulting in disrupted functions like visual perceptual disabilities. Moreover, attention, memory, language and executive control can also be affected (Rockwood, Dobbs, Rule, Howlett, & Black, 1992). Vascular risk factors, such as cardiovascular and cerebrovascular diseases, hypertension, dyslipidemia, and cigarette smoking, as well as psychological distress and lifestyle factors including alcohol consumption, have been suggested to influence cognitive functions. However, the relation between these factors and neurobehavioral functioning has not been examined in detail. Age is also an important demographic factor for cognitive impairment in type 2 diabetes. The characteristics of diminished neurobehavioral functioning in diabetes, resemble the pattern of cognitive decline described in normal aging (Tisserand & Jolles, 2003). Several studies indicated accelerated brain aging caused by diabetes mellitus (Brands et al., 2007), and thus assessing broad neurobehavioral aspects and providing descriptive evaluations, after controlling for confounding factors such as age, are necessary. Few studies have evaluated the neurobehavioral functions of diabetes in patients with relatively poor glycemic control (Yeung, Fischer, & Dixon, 2009). We performed neurobehavioral tests on hospitalized patients with poorly controlled diabetes and examined the neurobehavioral characteristics of patients with poor glycemic control.

Most research carried out on CHD patients has investigated neurobehavioral functioning in patients with coronary artery bypass graft (CABG) surgery (Daniel & Mark, 2002; Dupuis et al., 1999) and those involved in cardiac rehabilitation programmes (Moser et al., 1999). Patients undergoing cardiac rehabilitation demonstrate worse neurobehavioral performance compared to control subjects, with relative deficits in the domains of memory and verbal fluency (Biessels, Deary, & Ryan, 2008; Moser et al., 1999). Dementia and cognitive decline in type 2 diabetes and prediabetic stages (Biessels, Strachan, Visseren, Kappelle & Whitmer, 2014) and cognitive decline in older people with type 2 diabetes have been endorsed (Feinkohl, Aung, & Keller, 2014). Dupuis et al. (1999) endorsed the fact that patients having undergone CABG, as well as those diagnosed with diabetes mellitus, have an elevated risk of manifesting mild cognitive deficits. Verbal fluency, logical verbal memory, and attention/concentration appear to recover in pre- and post-CABG surgery patients, and no decline in neurobehavioral functioning was found through the battery of tests administered 6 months post-operatively. …

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