Tun P A, Nathan D M, Perlmuter L C
Department of Psychology, Brandeis University, Waltham, Massachusetts.
Clin Geriatr Med. 1990 Nov;6(4):731-46.
In non-insulin-dependent diabetes mellitus, performance of complex cognitive tasks requiring the storage and retrieval of new information is poorer than in age-matched controls. By contrast, performance of less demanding tasks such as immediate memory and simple reaction time is essentially equivalent for NIDDM patients and controls. This pattern parallels the cognitive change observed with normal aging, in which age differences are minimal on less demanding immediate memory tasks but older adults perform more poorly than young adults on secondary or long-term memory tasks. Age-related changes in cognitive performance have been attributed to a reduction in processing resources or working memory capacity. Although the explanation for NIDDM-related deficits remains to be identified, reduced glucose control and elevated levels of triglycerides appear to play some role in cognitive impairment. Non-insulin-dependent diabetes is associated not only with elevated levels of depression, but with an increased frequency of self-reported memory problems. Moreover, elevated levels of depression are associated with various indicators of neuropathy and with significant reductions in self-regulated control of glucose at the time of medical office visits. Diabetic patients may perceive less control over their lives as a result of the many restrictions associated with the disease. When provided with the opportunity to exercise control, however, performance on many cognitive tasks can be improved in NIDDM as well as in age-matched controls. This suggests that by providing NIDDM patients with opportunities to exercise increased control over their lives it may be possible to enhance motivation and to increase the likelihood of the patient's adopting more effective self-regulatory behaviors.
在非胰岛素依赖型糖尿病中，执行需要存储和检索新信息的复杂认知任务的表现比年龄匹配的对照组差。相比之下，对非胰岛素依赖型糖尿病患者和对照组而言，即时记忆和简单反应时间等要求较低的任务表现基本相当。这种模式与正常衰老过程中观察到的认知变化相似，即在要求较低的即时记忆任务中年龄差异最小，但在次级或长期记忆任务中老年人的表现比年轻人差。认知表现中与年龄相关的变化归因于处理资源或工作记忆能力的下降。虽然与非胰岛素依赖型糖尿病相关的缺陷的解释仍有待确定，但血糖控制不佳和甘油三酯水平升高似乎在认知障碍中起了一定作用。非胰岛素依赖型糖尿病不仅与抑郁水平升高有关，还与自我报告的记忆问题频率增加有关。此外，抑郁水平升高与神经病变的各种指标以及在就诊时自我调节血糖的显著降低有关。由于与该疾病相关的许多限制，糖尿病患者可能会觉得对自己生活的掌控力降低。然而，当有机会行使控制权时，非胰岛素依赖型糖尿病患者以及年龄匹配的对照组在许多认知任务上的表现都可以得到改善。这表明，通过为非胰岛素依赖型糖尿病患者提供更多掌控自己生活的机会，可能会增强他们的动机，并增加患者采取更有效自我调节行为的可能性。
