Cognition, Diabetes and Exercise: CODEX Study: Cognitive dysfunction in typ 2 diabetes mellitus: implication of aerobiC fitness.

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Diabetes mellitus have been associated with cognitive dysfunction. The main risk factors for cognitive decline in type 2 diabetics (T2DM) are hypertension, dyslipidaemia, depression, chronically elevation or fluctuations in glucose levels, insulin resistance and inflammation. Physical inactivity has not been investigated as possible independed factor for diabetes associated cognitive dysfunction. We conducted a study with the aim to evaluate a possible relationship between the fitness status and the cognitive performance by T2DM. 78 voluntary persons were recruited (52 T2DM, 26 healthy controls; Ages: 40-65 years) without depression or dementia. They were screened to ensure MRI scan eligibility, and no contraindications for perform a maximal cardiopulmonary exercise testing (CPX). A neuropsychological battery of test was assessed using computer based examination but also paper pencil tests. Additionally, during CPX we measured different neurotrophins like brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1(IGF-1), vascular endothelial growth factor (VEGF) as well as interleucin 10 (IL-10) in serum of all participants because is well known that these neurotrophins play a central role in exercise-mediated brain plasticity and thus also in learning and memory processes (Rojas Vega et al. 2012). Blood samples were collected at rest (R), at 65% of maximal hearth frequency (65%HF) and at the end of the test when the maximal heart frequency or subjective exhaustion was achieved. Considering the blood lactate profile curves (BLC) and the maximal oxygen uptake (VO2max) obtained from the CPX test, it was found that T2DM with low fitness (T2DM_low) displayed a left shift of the BLC compared to healthy controls, and diabetics with higher aerobic fitness (T2DM_high) showed a right shift of the BLC and this coincided with a higher VO2 at the aerob-anaerob threshold (4 mmol/La) by T2DM_high volunteers. After adjustment of age, gender, academic grade, BMI, hypertension and dyslipidaemia, the correlation analysis revealed a significant association between this submaximal fitness indice (VO2 at 4 mmol/La) with cognitive performance (i.e. executive function in Stroop test), which were no evident with maximal indices like maximal power, total METS or VO2max. The results of the present study suggest potential pathways that can link training induced individual aerobic fitness gains with cognitive function in T2DM. Taking account that physical activity already at an intensity corresponding to 65%HF (ca. 2mmol/La) elicited a significant augmentation of the concentration of all neurotrophins in serum of all volunteers, it is reasonable assume that repetitive bouts of moderate physical activity during training could contribute to repetitive neurotrophins- mediated neuroplastic effects in areas involved in cognitive functions. Thus a low aerobic fitness status could be considered as a risk factor contributing for cognitive dysfunction associated to diabetes, although currently the scientific literature does not provide this important clue. Physical inactivity represents a modifiable factor that may be targeted to develop prevention strategies to modify this diabetes-associated complication. For future research investigating the link between cardiovascular fitness and cognition outcomes, submaximal indices of aerobic fitness must be included because they may reflect better the link between physical activity and brain function.
Original languageEnglish
Title of host publicationN.N.
Publication date12.2019
Article numberOP 0144
Publication statusPublished - 12.2019
EventInternational Diabetes Federation Congress: Shape the future of diabetes - Busan, Korea, Republic of
Duration: 02.12.201906.12.2019

ID: 5241114

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