Skip to main content Accessibility help
×
Home
Hostname: page-component-544b6db54f-bkjnw Total loading time: 0.266 Render date: 2021-10-17T12:05:20.246Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Cognitive Functioning in Young Children with Type 1 Diabetes

Published online by Cambridge University Press:  11 February 2014

M. Allison Cato
Affiliation:
Divsions of Neurology, Nemours Children's Clinic, Jacksonville, Florida
Nelly Mauras
Affiliation:
Division of Endocrinology, Nemours Children's Clinic, Jacksonville, Florida
Jodie Ambrosino
Affiliation:
Yale Children's Diabetes Program, Yale University, New Haven, Connecticut
Aiden Bondurant
Affiliation:
Department of Psychiatry, Washington University, St. Louis, Missouri
Amy L. Conrad
Affiliation:
Division of Pediatric Psychology, University of Iowa Children's Hospital, Iowa City, Iowa
Craig Kollman
Affiliation:
Jaeb Center for Health Research, Tampa, Florida
Peiyao Cheng
Affiliation:
Jaeb Center for Health Research, Tampa, Florida
Roy W. Beck
Affiliation:
Jaeb Center for Health Research, Tampa, Florida
Katrina J. Ruedy*
Affiliation:
Jaeb Center for Health Research, Tampa, Florida
Tandy Aye
Affiliation:
Department of Pediatric Endocrinology, Stanford University, Stanford, California
Allan L. Reiss
Affiliation:
Department of Radiology, Pediatrics, Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
Neil H. White
Affiliation:
Department of Pediatrics and Medicine, Washington University, St. Louis, Missouri
Tamara Hershey
Affiliation:
Departments of Psychiatry, Neurology and Radiology, Washington University, St. Louis, Missouri
*
Correspondence and reprint requests to: Katrina J. Ruedy, Jaeb Center for Health Research, 15310 Amberly Drive Suite 350, Tampa, FL 33647. E-mail: kruedy@jaeb.org

Abstract

The aim of this study was to assess cognitive functioning in children with type 1 diabetes (T1D) and examine whether glycemic history influences cognitive function. Neuropsychological evaluation of 216 children (healthy controls, n = 72; T1D, n = 144) ages 4–10 years across five DirecNet sites. Cognitive domains included IQ, Executive Functions, Learning and Memory, and Processing Speed. Behavioral, mood, parental IQ data, and T1D glycemic history since diagnosis were collected. The cohorts did not differ in age, gender or parent IQ. Median T1D duration was 2.5 years and average onset age was 4 years. After covarying age, gender, and parental IQ, the IQ and the Executive Functions domain scores trended lower (both p = .02, not statistically significant adjusting for multiple comparisons) with T1D relative to controls. Children with T1D were rated by parents as having more depressive and somatic symptoms (p < .001). Learning and memory (p = .46) and processing speed (p = .25) were similar. Trends in the data supported that the degree of hyperglycemia was associated with Executive Functions, and to a lesser extent, Child IQ and Learning and Memory. Differences in cognition are subtle in young children with T1D within 2 years of onset. Longitudinal evaluations will help determine whether these findings change or become more pronounced with time. (JINS, 2014, 20, 238–247)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

A full listing of the members of the study group is included in the acknowledgements.

References

Aye, T., Reiss, A.L., Kesler, S., Hoang, S., Drobny, J., Park, Y., Buckingham, B.A. (2011). The feasibility of detecting neuropsychologic and neuroanatomic effects of type 1 diabetes in young children. Diabetes Care, 34(7), 14581462.CrossRefGoogle ScholarPubMed
Barnea-Goraly, N., Raman, M., Mazaika, P., Marzelli, M., Hershery, T., Weinzimer, SA., Reiss, A.L. (2013). Alterations in white matter structure in young children with type 1 diabetes mellitus. Diabetes Care, [Epub ahead of print December 6, 2013, doi: 10.2337/dc13-1388].Google Scholar
Bjorgaas, M., Gimse, R., Vik, T., Sand, T. (1997). Cognitive function in type 1 diabetic children with and without episodes of severe hypoglycaemia. Acta Paediatrica, 86, 148153.CrossRefGoogle ScholarPubMed
Blasetti, A., Chiuri, R.M., Tocco, A.M., Giulio, C.D., Mattei, P.A., Ballone, E., Verrotti, A. (2011). The effect of recurrent severe hypoglycemia on cognitive performance in children with type 1 diabetes: A meta-analysis. Journal of Child Neurology, 26(11), 13831391.CrossRefGoogle ScholarPubMed
Bullmore, E., Sporns, O. (2012). The economy of brain network organization. Nature Reviews Neuroscience, 13(5), 336349.Google ScholarPubMed
Cohen, M.J. (1997). CMS: Children's memory scale. San Antonio, TX: The Psychological Corporation.Google Scholar
Connors, C.K. (1994). CPT: The Conners Continuous Performance Test. Toronto, Canada: Multi-Health Systems.Google Scholar
Diabetes Research in Children Network Study Group (2007). Continuous glucose monitoring in children with type 1 diabetes. Journal of Pediatrics, 151(4), 388393.CrossRefGoogle ScholarPubMed
Ferguson, S.C., Blane, A., Perros, P., McCrimmon, R.J., Best, J.J., Wardlaw, J., Frier, B.M. (2003). Cognitive ability and brain structure in type 1 diabetes: Relation to microangiopathy and preceding severe hypoglycemia. Diabetes, 52, 149156.CrossRefGoogle ScholarPubMed
Flykanaka-Gantenbein, C. (2004). Hypoglycemia in childhood: Long-term effects. Pediatric Endocrinology Reviews, 1(Suppl. 3), 530536.Google ScholarPubMed
Gaudieri, P.A., Chen, R., Greer, T.F., Holmes, C.S. (2008). Cognitive function in children with type 1 diabetes: A meta-analysis. Diabetes Care, 31(9), 18921897.CrossRefGoogle ScholarPubMed
Giedd, J.N., Rapoport, J.L. (2010). Structural MRI of pediatric brain development: What have we learned and where are we going? Neuron, 67(5), 728734.CrossRefGoogle ScholarPubMed
Gioia, G.A., Isquith, P.K., Guy, S.C., Kenworthy, L. (2000). Behavior rating inventory of executive function. Lutz, FL: PAR, Inc.Google ScholarPubMed
Haumont, D., Dorchy, H., Pelc, S. (1979). EEG abnormalities in diabetic children: Influence of hypoglycemia and vascular complications. Clinical Pediatrics, 18, 750753.CrossRefGoogle ScholarPubMed
Hershey, T., Craft, S., Bhargava, N., White, N.H. (1997). Memory and Insulin Dependent Diabetes Mellitus (IDDM): Effects of childhood onset and severe hypoglycemia. Journal of the International Neuropsychological Society, 3(6), 509520.Google ScholarPubMed
Hershey, T., Lillie, R., Sadler, M., White, N.H. (2003). Severe hypoglycemia and long-term spatial memory in children with type 1 diabetes mellitus: A retrospective study. Journal of the International Neuropsychological Society, 9(5), 740750.CrossRefGoogle ScholarPubMed
Hershey, T., Lillie, R., Sadler, M., White, N.H. (2004). A prospective study of severe hypoglycemia and long-term spatial memory in children with type 1 diabetes. Pediatric Diabetes, 5, 6371.CrossRefGoogle ScholarPubMed
Hershey, T., Perantie, D.C., Warren, S.L., Zimmerman, E.C., Sadler, M., White, N.H. (2005). Frequency and timing of severe hypoglycemia affects spatial memory in children with type 1 diabetes. Diabetes Care, 10, 23722377.CrossRefGoogle Scholar
Hochberg, Y. (1988). A sharper Bonferroni procedure for multiple tests of significance. Biometrika, 75, 800802.CrossRefGoogle Scholar
Hyllienmark, L., Maltez, J., Dandenell, A., Luvigsson, J., Brismar, T. (2005). EEG abnormalities with and without relation to severe hypoglycemi in adolescents with type 1 diabetes. Diabetologia, 48, 412419.CrossRefGoogle ScholarPubMed
Jacobson, A.M., Ryan, C.M., Cleary, P.A., Waberski, B.H., Weinger, K., Musen, G., … DCCT/EDIC Research Group (2011). Biomedical risk factors for decreased cognitive functioning in type 1 diabetes: An 18 year follow-up of the Diabetes Control and Complications Trial (DCCT) cohort. Diabetologia, 54(2), 245255.CrossRefGoogle ScholarPubMed
Korkman, M., Kirk, U., Kemp, S. (2007). NEPSY-II: Neuropsychological battery for children, second edition. San Antonio, TX: Harcourt Assessment.Google Scholar
Kovacs, M., Goldston, D., Obrosky, D.S., Bonar, L.K. (1997). Psychiatric disorders in youths with IDDM: Rates and risk factors. Diabetes Care, 20(1), 3644.CrossRefGoogle ScholarPubMed
Lin, A., Northam, E.A., Rankins, D., Werther, G.A., Cameron, F.J. (2010). Neuropsychological profiles of young people with type 1 diabetes 12 yr after disease onset. Pediatric Diabetes, 11, 235243.CrossRefGoogle ScholarPubMed
Ly, T.T., Anderson, M., McNamara, K.A., Davis, E.A., Jones, T.W. (2011). Neurocognitive outcomes in young adults with early-onset type 1 diabetes: A prospective follow-up study. Diabetes Care, 34(10), 21922197.CrossRefGoogle ScholarPubMed
Manschot, S.M., Brands, A.M.A., van der Grond, J., Kessels, R.P.C., Algra, A., Kappelle, L.J., Biessels, G.J. (2006). Brain magnetic resonance imaging correlates of impaired cognition in patients with type 2 diabetes. Diabetes, 55(4), 11061113.CrossRefGoogle ScholarPubMed
Marzelli, M., Barnea-Goraly, N., Mazaika, P.K., Hershey, T., Tsalikian, E., Tamborlane, W., Reiss, A.L. (2013). Neuroanatomical correlates of dysglycemia in young children with type 1 diabetes mellitus. Diabetes, [Epub ahead of print].Google Scholar
Murrough, J.W., Iacoviello, B., Neumeister, A., Charney, D.S., Iosifescu, D.V. (2011). Cognitive dysfunction in depression: Neurocircuitry and new therapeutic strategies. Neurobiology of Learning and Memory, 96(4), 553563.CrossRefGoogle ScholarPubMed
Musen, G., Lyoo, I.K., Sparks, C.R., Weinger, K., Hwang, J., Ryan, C.M., Jacobson, A.M. (2006). Effects of type 1 diabetes on gray matter density as measured by voxel-based morphometry. Diabetes, 55, 326333.CrossRefGoogle ScholarPubMed
Naguib, J.M., Kulinskaya, E., Lomax, C.L., Garralda, M.E. (2009). Neuro-cognitive performance in children with type 1 diabetes- A meta-analysis. Journal of Pediatric Psychology, 34(3), 271282.CrossRefGoogle ScholarPubMed
Northam, E.A., Anderson, P.J., Jacobs, R., Hughes, M., Warne, G.L., Werther, G.A. (2001). Neuropsychological profiles of children with type 1 diabetes 6 years after disease onset. Diabetes Care, 24, 15411546.CrossRefGoogle Scholar
Northam, E.A., Anderson, P.J., Werther, G.A., Warne, G.L., Adler, R.G., Andrewes, D. (1998). Neuropsychological complications of IDDM in children 2 years after disease onset. Diabetes Care, 21, 379384.CrossRefGoogle Scholar
Northam, E.A., Anderson, P.J., Werther, G.A., Warne, G.L., Andrewes, D. (1999). Predictors of change in the neuropsychological profiles of children with type 1 diabetes 2 years after disease onset. Diabetes Care, 22, 14381444.CrossRefGoogle ScholarPubMed
Northam, E.A., Rankins, D., Lin, A., Wellard, R.M., Pell, G.S., Finch, S.J., Cameron, F.J. (2009). Central nervous system function in youth with type 1 diabetes 12 years after disease onset. Diabetes Care, 32(3), 445450.CrossRefGoogle ScholarPubMed
Perantie, D.C., Koller, J.M., Weaver, P.M., Lugar, H.M., Black, K.J., White, N.H., Hershey, T. (2011). Prospectively determined impact of type 1 diabetes on brain volume during development. Diabetes, 60(11), 30063014.CrossRefGoogle ScholarPubMed
Perantie, D.C., Lim, A., Wu, J., Weaver, P., Warren, S.L., Sadler, M., Hershey, T. (2008). Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus. Pediatric Diabetes, 9(2), 8795.CrossRefGoogle ScholarPubMed
Perantie, D.C., Wu, J., Koller, J.M., Lim, A., Warren, S.L., Black, K.J., Hershey, T. (2007). Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with type 1 diabetes. Diabetes Care, 30(9), 23312337.CrossRefGoogle ScholarPubMed
Perros, P., Deary, I.J., Sellar, R.J., Best, J.J., Frier, B.M. (1997). Brain abnormalities demonstrated by magnetic resonance imaging in adult IDDM patients with and without a history of recurrent severe hypoglycemia. Diabetes Care, 20, 10131018.CrossRefGoogle ScholarPubMed
Reynolds, C.R., Kamphaus, R.W. (2004). Behavior Assessment System for Children, second edition parent rating scales. Circle Pines, MN: American Guidance Service.Google Scholar
Rovet, J.F., Ehrlich, R.M. (1999). The effect of hypoglycemic seizures on cognitive function in children with diabetes: A 7-year prospective study. Journal of Pediatrics, 134(4), 503506.CrossRefGoogle ScholarPubMed
Rovet, J.F., Ehrlich, R.M., Hoppe, M. (1987). Intellectual deficits associated with early onset of insulin-dependent diabetes mellitus in children. Diabetes Care, 10(4), 510515.CrossRefGoogle ScholarPubMed
Ryan, C., Vega, A., Drash, A. (1985). Cognitive deficits in adolescents who developed diabetes early in life. Pediatrics, 75, 921927.Google ScholarPubMed
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. (2007). Long-term effect of diabetes and its treatment on cognitive function. New England Journal of Medicine, 356(18), 18421852.CrossRefGoogle ScholarPubMed
van den Berg, E., Reijmer, Y.D., de Bresser, J., Kessels, R.P.C., Kappelle, L.J., Biessels, G.J., Utrecht Diabetic Encephalopathy Study Group. (2010). A 4 year follow-up study of cognitive functioning in patients with type 2 diabetes mellitus. Diabetologia, 53(1), 5865.CrossRefGoogle ScholarPubMed
Wechsler, D. (1999). Wechsler Adult Scale of Intelligence. New York, NY: The Psychological Corporation.Google Scholar
Wechsler, D. (2002). Wechsler Preschool and Primary Scale of Intelligence, third edition. San Antonio, TX: Psychological Corporation.Google Scholar
Woodcock, R.W., McGrew, K.S., Mather, N. (2001). Woodcock-Johnson Test of Cognitive Abilites (third edition). Itasca, IL: Riverside Publishing.Google Scholar
Yeates, K.O., Ris, M.D., Taylor, H.G., Pennington, B.F. (2010). Pediatric Neuropsychology, Second Edition: Research, Theory, and Practice. New York: Guilford Press.Google Scholar
52
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Cognitive Functioning in Young Children with Type 1 Diabetes
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Cognitive Functioning in Young Children with Type 1 Diabetes
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Cognitive Functioning in Young Children with Type 1 Diabetes
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *