Diabetes, depression, and cognitive disorders

Abstract

The interactions between diabetes and the mind are complex; physical illness increases the risk of a number of psychiatric disorders, while mental illness and its treatment also alter the risks of diabetes and worsen both acute metabolic and long-term outcomes of diabetes. The prevalence of depression is approximately 1.5–2-fold higher in people with diabetes compared with the general population. Approximately 10% of people with diabetes will have a formal diagnosis of depression and around a quarter have significant depressive symptoms. Microvascular and macrovascular complications and treatment with insulin are associated with higher rates of depressive symptoms. The underlying mechanisms are multifactorial and include genetic and environmental factors as well as disease and treatment effects. The presence of depression adversely affects diabetes outcomes; quality of life and glycemic control are worsened, while the rates of microvascular and macrovascular complications and mortality are increased in people with depression. Screening for depression in people with diabetes and prompt treatment, where necessary, are recommended. Diabetes has modest effects on certain aspects of cognition, including general intelligence, psychomotor speed, and mental flexibility, particularly when diagnosed in children under the age of 7 years. Diabetes increases the risk of vascular dementia and Alzheimer’s disease, even after adjustment for traditional cardiovascular risk factors. Approximately 1 in 15 cases of dementia is attributable to diabetes. Insulin directly affects β-amyloid formation. Dementia impedes the person with diabetes’ ability to self-manage their diabetes and mandates a change in glycemic targets and management strategies.