Characteristics of type 1 diabetic patients with psychoorganic syndrome

BACKGROUND: The term “diabetic encephalopathy” or psychoorganic syndrome (POS) of diabetic origin) does not appear in current classifications of diabetic complications but is eventually used by researchers and physicians. However, evidence for its existence has been scarce and contradictory.

AIM: To identify epidemiological, anamnestic, clinical and psychological characteristics of POS in young patients with T1DM and to assess its possible association with factors specific and non-specific for diabetes.

METHODS: This single center, cross-sectional study consecutively enrolled T1DM in-patients aged 18 to 45 years with >1 year diabetes curation, without exclusion criteria (pregnancy, conditions hindering testing, and comorbidities that could cause organic brain damage). The clinical diagnosis of POS was made by a psychiatrist. In addition to clinical and laboratory examinations, cognitive functions (MMSE, Roshchina-Balashova-Korsakova scales, Wechsler, proofreading, and digit span tests) and emotional/personality characteristics (Multiple Minnesota Personality Inventory [MMPI] and CES-D depression scale) were assessed. In the univariate analysis, differences between patients with and without POS were tested with Mann-Whitney and χ2 tests. Multivariate regression analysis was performed to identify characteristics independently associated with POS.

RESULTS: The study consecutively recruited 122 patients with T1DM (60 men) aged 18 to 40 years with diabetes duration of 1 to 27 years, age of onset 1 to 32 years, and glycated hemoglobin (HbA_1c) level of 9.5±2.5% (range, 5.1 to 20.6%). POS was clinically diagnosed in 30 patients (24.6%). In the univariate analysis, patients with POS, compared to those without POS, were older, had higher prevalence of diabetic retinopathy, past history of severe hypoglycemia, arterial hypertension (AH), current depression, and a more pronounced decline in cognitive functions (mainly working memory, attention, visospatial skills, analysis and synthesis, generalization, and speed of task completion). There were no differences in sex ratio, age of onset and duration of diabetes, HbA_1c levels, and past history of diabetic ketoacidosis. Among the possible etiologies in the POS group compared to the non-POS group, severe infections (13.3 and 0%, p=0.003), prenatal injuries (60.7 and 43%, p=0.006), and controlled AH (33.3 and 13%, p=0.012) were more common. The biggest difference between-group was found for a combination of factors unrelated to diabetes (63.3 and 28.3%, p=0.001), especially brain trauma, alcohol abuse, perinatal injuries, severe infections, and AH. The multivariate analysis confirmed the significance of the combination of non-diabetic brain damaging factors in POS etiology (odds ratio [OR] 1.8, 95%CI 1.0–3.1, p=0.043), and revealed independent associations of POS with depression, diastolic blood pressure, and an inverse association with occupational mental complexity (OR 0.7, 95%CI 0.4–1.0, p=0.076). The multivariate regression did not confirm an independent association of POS with any of the potential diabetes-related factors of brain damage.

CONCLUSION: The results obtained do not confirm the specific diabetic etiology of POS in T1DM and probably allow considering POS (encephalopathy) in patients with T1DM to be rather a multicausative comorbid condition of mostly exogenous origin.

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