Depression in type 1 diabetes in children: natural history and correlates

The combination of diabetes and depression in children and adolescents is largely unstudied. The purpose of this article is to review the literature on the natural history and correlates of comorbid diabetes and depression in children and adolescents. Children with diabetes have a two-fold greater prevalence of depression, and adolescents up to three-fold greater, than youth without diabetes. Correlates of depression and diabetes include gender, poorer metabolic control, and family behaviors. Very little is known about treatment in these youth, and more studies are indicated.     

Depression in vascular dementia

OBJECTIVE: To study the presence of different dimensions of depression in subjects with vascular dementia. BACKGROUND: After a stroke, cognitive, affective and behavioural disturbances are common. It has been suggested that the nature of affective symptomatology can help to differentiate organic from psychological depression. METHODS: Cognitive and affective symptoms were assessed in 78 stroke patients and a principal component analysis was performed on these symptoms. Also, a discriminant analysis was carried out to establish the contribution of different symptoms on the diagnosis 'depressive disorder' and 'dementia'. RESULTS: (1) Principal component analysis revealed three distinct sub-syndromes: one with predominantly mood symptoms, one with essentially psychomotor symptoms, and one with vegetative symptoms; (2) mood, psychomotor and vegetative symptoms were all independently and strongly related to a diagnosis of major depressive disorder according to DSM-III-R criteria; (3) the psychomotor factor was also firmly associated with dementia; and (4) discriminant analysis gave further support for our conclusion that some of the depressive features, in particular the psychomotor factor, are at least partly related to the organic brain damage from stroke. CONCLUSION: The results indicate that different dimensions of depression could be discerned in a group of stroke patients and that the symptom profile of depression in these patients can be affected by the presence of dementia.     

Depression in dementia sufferers

A large number of studies concerning depression in dementia sufferers have appeared in the literature over the last few years and have added to our knowledge considerably. The prevalence rate of concurrent depression and dementia among clinical samples is approximately 20% with lower rates in the community. There is relatively little information available regarding patients in nursing homes, which is a priority for research along with the study of milder depression. Although there have been a number of interesting developments regarding possible neurochemical associations of depression among these patients, there has been little study of psychosocial factors. The symptoms of depression are similar to those seen in patients without cognitive impairment. Concurrent depression creates considerable excess disability. More information is required about the natural course of these disorders and treatment strategies.     

Predictors of cognitive impairment in type 1 diabetes

A decline in cognitive function has been reported in type 1 diabetes, but its relation to different disease factors such as hypoglycemic events and peripheral neuropathy is controversial. The objective of the present study was to identify factors that are important for cognitive impairment in type 1 diabetes. A cross-sectional study was performed in adult patients (N=150) with type 1 diabetes (duration 26.6+/-11.4 years). Function in different cognitive domains was evaluated by the same trained examiner, in order to eliminate inter-rater variability. Peripheral nerve function was tested quantitatively. Predictors of cognitive impairment were identified using multiple regression analysis. The major finding was that long diabetes duration and young age of diabetes onset were the strongest predictors of low scores in psychomotor speed, memory, processing speed, attention, working memory, verbal ability, general intelligence, executive functions and a low global score. The number of previous hypoglycemic events had no defined effect upon cognitive functioning. Other significant predictors were low compound muscle action potential (CMAP) (for visual perception-organization), old age (for visual-spatial ability), short stature, high BMI and hypertension. Presence of retinopathy and long-term metabolic control correlated with nerve conduction defects, but not with cognitive impairment. Although a history of hypoglycemic events was not a predictor of cognitive impairment, we cannot exclude the possibility that the influence of young age of diabetes onset depends on the effect of hypoglycemic events early in life. The clinical relationships of cognitive impairment differ from those of peripheral neuropathy, indicating a different pathogenesis. The influence of diabetes duration, BMI, height, age and CMAP may suggest that loss of the neuroprotective effects of insulin or insulin-like growth factors plays a role.     

Depression in subjects with and without dementia: a comparison using GMS-AGECAT.

OBJECTIVE: To compare depression in subjects with and without dementia, adjusting for possible confounders. BACKGROUND: The results of comparisons of depression between subjects with and without dementia are inconclusive. Probably confounders play a role. METHODS: Ninety-one subjects with DSM-III-R dementia and 110 controls without dementia were recruited from homes for the elderly using an identical procedure. The prevalences of AGECAT depressive syndromes, subsyndromes and factors of depressive symptoms were compared adjusting for possible confounders. RESULTS: (1) Both groups had similar prevalences of AGECAT depressive syndromes, subsyndromes and overall rates of depressive symptoms; (2) subjects with dementia had significantly more 'motivation symptoms'; and (3) there was a trend to a lower prevalence of 'mood symptoms' in subjects with dementia. These results refer to a sample of institutionalised elderly subjects. It is not clear to what extent they can be generalised to subjects living in the community. CONCLUSION: The results indicate that it is not AGECAT (sub)syndrome measures of depression but the profile of depressive symptomatology which is affected by dementia.     

Depression in dementia: a comparative and validation study of four brief scales in the elderly Chinese

AIM: The study aimed to determine: (i) the diagnostic accuracy of four brief depression scales, the Geriatric Depression Scale (GDS), Even Briefer Assessment Scale for Depression (EBAS DEP), Single Question and Cornell Scale for Depression in Dementia (Cornell) in an elderly Chinese population with varying dementia severity; and (ii) which scale had the best diagnostic performance. METHOD: All four scales were administered to 88 elderly outpatients with dementia: 66 without and 22 with depression. Receiver Operating Characteristic (ROC) analysis was used to establish the optimal cut-off scores of the GDS, EBAS DEP and Cornell scales. The patients' dementia-severity was dichotomously categorized into mild and moderate-severe dementia, and the above analysis was repeated in both these groups to look at changes in the scales' diagnostic performance as dementia advances. RESULTS: The best diagnostic scale for detecting depression in dementia was the Cornell scale. Its optimal cut-off score was 6/7 (sensitivity 91.7%, specificity 80.0%) in the mild dementia group and 12/13 (sensitivity 70.0%, specificity 87.0%) in the more advanced dementia group. The optimal cut-off scores of the GDS and EBAS DEP also shifted to higher values when moving from the mild to the more advanced dementia groups, indicating the increasing difficulty on all these scales to detect depression with worsening cognitive impairment. The Single Question, however, was more robust with much less changes in its diagnostic parameters in both dementia cohorts: sensitivity 58.3%, specificity 90.0% for mild dementia, and 60.0 and 84.8%, respectively, for more advanced dementia. CONCLUSION: An efficient strategy to diagnose depression in dementia amongst elderly Chinese patients is to administer the Single Question followed by, when necessary, the Cornell scale.     

2型糖尿病并发脑梗死危险因素临床分析

目的探讨2型糖尿病并发脑梗死的危险因素。方法随机选取120例患者,分为2型糖尿病并发脑梗死者组(A组)和单纯2型糖尿病组(B组),每组60例。对所入选患者测量空腹血糖(FBG)、空腹胰岛素(FBI)、血流变、甘油三酯(TG)、血胆固醇(TCHO)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL),测量身高、体质量、血压,计算腹围指数(IBM)和胰岛素敏感指数(ISI),对所得结果进行分析。结果 2型糖尿病并发脑梗死患者其空腹血糖、甘油三酯、胆固醇、低密度脂蛋白、腹围指数、血压均高于单纯2型糖尿病者,而高密度脂蛋白、胰岛素敏感指数低于后者。结论高血压、高血糖、肥胖、高黏血症、高血脂、胰岛素抵抗是2型糖尿病并发脑梗死的危险因素。     

Impact of physical activity on heart rate variability in children with type 1 diabetes

Objective Children with type 1 diabetes are usually associated with cardiovascular autonomic neuropathy. The present study explored the influence of physical activity on their autonomic nervous function by measuring the heart rate variability (HRV). Materials and methods A total of 93 type 1 diabetic children and 107 healthy control subjects were enrolled. The Physical Activity Questionnaire for Children (PAQ-C) was adopted to determine the physical activity level as low, moderate, or high activity. HRV was determined by frequency analysis and measured in both resting and active states. Results Children with type 1 diabetes had significantly lower HRV than that of healthy control subjects in resting state but not in active state. The decreased HRV in diabetic children was observed only in subjects with low physical activity. The HRV in diabetic children with moderate to high physical activity, however, was not different from that of their healthy controls. Conclusions Diabetic children should be encouraged to engage in physical activity with more intensity, which can benefit their autonomic nervous function. Nevertheless, the potential risk of vigorous activity still needs our concern.     

Cognition in type 2 diabetes: Association with vascular risk factors, complications of diabetes and depression

Background

The role of variables like duration of diabetes, diabetic control and microvascular complications in the causation of cognitive decline in patients with type 2 diabetes is not well studied. The contribution of hypertension to the cognitive decline in nondemented diabetic patients is unclear.

Aims:

We wanted to see if cognition in patients with type 2 diabetes is associated with the duration of diabetes, control of diabetes, complications of diabetes, vascular risk factors, or depression. We also looked at association of noncompliance with cognition, and depression.

Settings and Design:

We recruited ambulant patients with type 2 diabetes who are 55 years or more in age from the weekly diabetic clinic. We excluded patients with past history of stroke.

Methods and Material:

We selected the time taken for the Trial A test, delayed recall on ten-word list from Consortium to Establish a Registry for Alzheimer''s Disease (CERAD), Rowland Universal Dementia Assessment Scale (RUDAS) and Centre for Epidemiologic Studies Depression scale (CES-D) screening instrument to assess these patients.

Statistical Analysis Used:

We utilized mean, standard deviation, Chi-square test and Pearson''s correlation for statistical analysis. We considered P < 0.05 to be significant.

Results:

RUDAS scores inversely correlated (r = −0.360) with CES-D scores (P = 0.002). Scores of the screening instrument for depression, the CES-D was associated with the duration of diabetes mellitus (P = 0.018), fasting blood glucose (P = 0.029) as well as with 2-hour post prandial blood glucose (P = 0.017).

Conclusions:

There is correlation between depression and global cognitive score. Depression seems to be associated with duration of diabetes and control of diabetes.     

2型糖尿病无症状脑梗死相关危险因素探讨

目的探讨2型糖尿病(DM)有无症状性脑梗死(SCI)危险因素。方法对217例2型糖尿病患者根据临床资料分两组,即DM有SCI组,DM无SCI组。应用多元logistic分析,对DM有SCI常见危险因素讨论分析。结果 217例2型DM中131例(60.4%)有SCI,86例(39.6%)无SCI。结论 2型糖尿病有SCI与年龄、收缩压、颈动脉内膜-中膜厚度(IMT)、动脉粥样硬化斑块的数量与性质有显著相关性。积极治疗糖尿病是防治脑卒中重要手段。     

Olfactory dysfunction in dementia of Alzheimer's type and vascular dementia

Background: Olfactory function in vascular dementia has not been extensively investigated to date. We studied olfactory function in vascular dementia (VD) and dementia of Alzheimer's type (DAT). Methods: We studied olfactory functioning in 12 patients suffering from dementia of Alzheimer's type, 11 patients with vascular dementia and 30 normal subjects. For these subjects we examined a 12‐item version of the Pennsylvania smell identification test and mini‐mental state examinations. These three groups were matched for age, sex and educational level. Results: Although the dementia scores were comparable in the DAT and VD groups, the smell identifications were low in DAT patients compared with VD patients and normal control subjects. Conclusions: These results suggest that the smell identification test may be useful in differential diagnosis between DAT and VD patients     

Alexithymia as a risk factor for type 2 diabetes mellitus in the metabolic syndrome: a cross-sectional study

Alexithymia is a clinical trait consisting of diminished introspective and interoceptive capacities that has been shown to implicate elevated autonomic outflow and to bias for hypertension. To estimate relative risk associated with alexithymia in the metabolic syndrome (MetS), we conducted a cross-sectional analysis of patients with manifest type 2 diabetes mellitus (T2DM) or familial diabetes risk (N=101; 67 females; age 45.6±13.96) in a nationwide sampled treatment cohort for MetS in the Ukrainian governmental health care system. Laboratory data of single components of the MetS according to International Diabetes Federation Consensus were dependent measures in multivariable regression models with self-reported alexithymia severity (TAS-20) and socio-demographic data. TAS-20 as the sole surviving psychometric predictor for T2DM in the simplest regression equation provided the best model fit: OR 1.073, Z=19.04, (95%CIs 1.065–1.081). For microalbuminuria, the best fitting model was OR 1.030, Z=3.49 (95%CIs 1.013–1.048). TAS-20 predicted also triglyceride level at Wald-χ²=1299.27, Z=36.05 (95%CIs 0.052–0.058) and blood pressure maximum at Wald-χ²=2309.05, Z=48.05 (95%CIs 2.402–2.606). Our results show that alexithymia severity contributes to MetS by covarying with several of its single components, and that it may be a substantial concurrent indicator of T2DM and cardiovascular risks in MetS.     

Eating disorders in young women with type 1 diabetes mellitus

Research findings from the past decade regarding the association of type 1 diabetes mellitus and eating disorders are critically reviewed in this paper. Although there has been much debate regarding the specificity of this association, a recent large multisite case-controlled study demonstrated that the prevalence rates of both full syndrome and subthreshold eating disorders among adolescent and young adult women with diabetes are twice as high as in their nondiabetic peers. Further, a 4-year follow-up study showed that disordered eating behavior in young women with diabetes often persists and is associated with a threefold increase in the risk of diabetic retinopathy. These eating disturbances tend to be associated with impaired family functioning and with poor diabetes management. Health care professionals should maintain a high index of suspicion for the presence of an eating disturbance among young women with diabetes, particularly among those with persistently poor metabolic control and/or weight and shape concerns. Screening for such disturbances should begin during the prepubertal period among girls with diabetes. A brief psychoeducational intervention leads to a reduction in disturbed eating attitudes and behavior but is not sufficient to improve metabolic control. More intensive treatment approaches, which should include a family-based component, may be needed to improve metabolic control. The evaluation of these and other treatment approaches is indicated in view of the serious short- and long-term health risks associated with eating disorders in young women with diabetes.