Vascular dementia is a term given to a group of conditions caused by blood supply issues to the brain . It can affect anywhere from the smallest blood vessels delivering the oxygen and nutrients to the larger vessels that could block the entire region ’ s supply . The most common cause of vascular dementia , and the related distress to the person living with the condition , are discreet episodes of small blood clots blocking off regions and memories at a time .
There are other types of dementia not linked to diabetes or sugar control . These include Lewy Body disease associated with Parkinson ’ s disease-like symptoms often accompanied by changes in perception , sleep difficulties or hallucinations , even loss of personality .
Living with dementia
Dementia and diabetes often present with difficulties performing self-care tasks : adhering to eating patterns or medication plans become increasingly difficult , and with more erratic sugar control , severe hypoglycaemia becomes up to four-fold more common .
A vicious cycle of dementia has arrived : the increased risk of malnutrition and dehydration leading to worsening diabetes control causes , in turn , the progression of dementia . Caregivers for patients with diabetes and dementia will face extraordinary challenges to manage both conditions , especially in those individuals who develop behaviour changes .
Practical management
Even if hyperglycaemia and cognitive dysfunction are connected , tight sugar control does not prevent a decline in mental function once cognitive impairment begins . Therefore , prevention is critical as preventing or effectively managing diabetes is one of the most important things to reduce dementia risk and protect the brain .
A healthy diet rich in olive oil and green vegetables , exercise , and weight control ( and stopping smoking !) is the first steps combined with blood pressure control to reduce the risk of vascular dementia . The use of statins ( cholesterol treatment ) reduces brain inflammation , leading to Alzheimer ’ s dementia . Nevertheless , older adults unable to exercise at the recommended levels benefit from even modest physical activity increases .
Once cognitive impairment ensues , an individualised HbA1c target can be set as high as 8.5 %. Allowing even higher values would increase the risk of infection , urinary incontinence or progression of dementia , whereas too low increase the risk of hypoglycaemia . Importantly , achieving tight sugar control without the risk of hypoglycaemia , with diet alone or drugs with a very low risk for hypoglycemia ( such as gliptins ) is not detrimental but may instead provide additional benefits in the longer term .
Summary
People with diabetes are more likely to survive into their old age and experience premature frailty syndrome and dementia , one of the most feared complications of frailty . The impact of diabetes on the brain takes 10 years to manifest in reduced mental function .
Once cognitive impairment ensues , there is little that can be done to prevent it . However , one can prevent dementia by good glycaemic , blood pressure and lipid control earlier in life .
A vicious cycle of dementia has arrived : the increased risk of malnutrition and dehydration leading to worsening diabetes control causes , in turn , the progression of dementia .
18