Cognitive Impairment and Dementia in Older Adults with Type II Diabetes Mellitus BGS Amulree Prize Essay Submission

The number of older adults in our societies is rapidly increasing. As a consequence of such demographic change there is set to be a large increase in age related illnesses and syndromes. One such age-related illness which attracts a great deal of media and academic attention is dementia. Similarly, in accordance with rising obesity levels, Type 2 Diabetes Mellitus (T2DM) is also rapidly increasing in prevalence. Taken together, and in the context of better medical treatment of T2DM and its complications, older adults with T2DM are living longer with T2DM, which may itself present new issues and complications in the management and treatment of this cohort. At the intersection of ageing and obesity trends, there is a wealth of evidence to suggest that a diagnosis of T2DM places older adults at increased risk of cognitive impairment and dementia. The epidemiological and neuro-pathological evidence for this risk is reviewed in the present essay. The main pathophysiologial hypotheses gaining traction in the literature are reviewed and discussed, as are the effects of certain treatments to mitigate the cognitive impairment/dementia seen in older adults with T2DM. The main danger here is of a positive-feedback cycle, where cognitive impairment may result in poor control of T2DM, which may in turn lead to a deterioration in cognitive function in older adults with T2DM. The present essay, by way of literature review, addresses cognitive impairment and all-type dementia as unrecognised complications of T2DM. Such complications are of utmost importance in the context of population ageing and an increase in the number of older adults living with T2DM. Adam Dyer. School of Medicine, Trinity College Dublin BGS Amulree Essay Prize Submission