Blood sugar affects brain function

DEAR DR. ROACH>>

Can you talk about cognitive impairment in diabetes? I’ve been assured that diabetes does not increase risk of Alzheimer’s disease, but my brother is a noncompliant elderly diabetic. When his blood sugar is high (which is frequently), he has poor judgment, slurs his words, makes no sense, can’t control bodily functions, has forgetfulness and can’t think straight. This happens when he runs out of medicine, too. This seems like cognitive impairment to me. He has been admitted to the hospital after accidents and frequent crises, but the cycle begins again after he is discharged. Can you help us deal with this behavior?

— V.R.

ANSWER>> The changes in brain function you mention all may be seen when a person has very high blood sugar. They return to normal when blood sugar is back under control.

Dementia and diabetes are definitely connected. Some, but not all, studies show that people with diabetes, especially those whose blood sugar is not well controlled, are at higher risk for Alzheimer’s dementia. However, a different type of dementia, vascular dementia, is much more likely among people with poorly controlled diabetes. Vascular dementia is caused by multiple small strokes — some small enough to not notice at the time — which add up to loss of brain function.

Breaking the cycle of poor medication adherence is one of the hardest things to try to do as a physician or family member. Trying to identify and minimize the reasons for poor adherence with the medical and dietary regimens is critical. Sometimes it can help to find regimens with fewer pills (or shots) or ones that minimize particular side effects. Having a family member or aide help administer medication can be helpful, particularly with people who have more advanced memory issues. Unfortunately, in many cases patients themselves have to decide that it is worth it to take the treatment for their condition.

The first step in a successful outcome is always identifying the reasons for not taking the medication. Communication is the key.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.