Decision-making in primary onset middle-age type 2 diabetes mellitus: a BOLD-fMRI study

Area of Science:

• Neuroscience
• Endocrinology
• Psychology

Background:

• Type 2 diabetes mellitus (T2DM) is a known dementia risk factor.
• Neural mechanisms of cognitive impairment in T2DM are not fully understood.
• Decision-making deficits may occur early in T2DM.

Purpose of the Study:

• Investigate the neural basis of decision making in early-stage T2DM.
• Utilize functional magnetic resonance imaging (fMRI) during the Iowa Gambling Task (IGT).
• Examine brain activity differences between T2DM patients and healthy controls.

Main Methods:

• Recruited 18 newly diagnosed T2DM patients and 18 matched controls.
• Administered a computerized Iowa Gambling Task (IGT).
• Used fMRI to measure brain activation during the task.

Main Results:

• T2DM patients made more disadvantageous decisions than controls.
• T2DM patients exhibited reduced activation in the ventral medial prefrontal cortex (VMPFC), orbitofrontal cortex (OFC), and anterior cingulate cortex.
• Increased activity was observed in the dorsolateral prefrontal cortex, posterior cingulate cortex, insula, and occipital lobes in T2DM patients.
• IGT performance correlated with VMPFC and OFC activation.
• Poor glycemic control was linked to impaired decision-making and altered VMPFC/OFC activity in T2DM patients.

Conclusions:

• Early-stage T2DM is associated with impaired decision-making under ambiguity.
• Weaknesses in prefrontal cortex function contribute to poorer decision-making in T2DM.
• Glycemic control is crucial for maintaining cognitive function in T2DM.