By Rivka Borochov
Diabetes has long been associated with the deterioration of vision and kidney function. But a new center in Israel is illuminating a lesser-known problem, one that will affect the world’s aging population in additional ways.
Research over the last decade, culminating in a study three years ago by the US National Institutes of Health, has found that people with type 2 diabetes are twice as likely to suffer from dementia.
Given that people are living longer than ever before, and adult-onset diabetes is on the rise, what’s happening to the elderly today is like one big social and medical experiment, says Dr. Tali Cukierman-Yaffe, head of the Center for Successful Aging with Diabetes at the Sheba Medical Center at Tel Hashomer in Israel.
The endocrinologist and epidemiologist has worked for the last decade uncovering how diabetes affects the mind and the body, with an emphasis on staving off brain disorders.
Her work has forged a path in a first-of-its-kind clinical approach that aims to help people over 60 live more healthily with diabetes and achieve a higher quality of life.
A better quality of life, at home
Consider that over the next 30 years about one quarter of the world will be over the age of 60. Cukierman-Yaffe, who is also a researcher at Tel Aviv University, recognizes that the world’s population will be living longer, and her mission is to enable people to spend their sunset years at home, in comfortable surroundings where they can take care of themselves.
“One of the first things we chose [to study] was people with diabetes experiencing accelerated cognitive decline because they are at a greater risk for dementia and reduced cognitive functioning,” she says. “Over the past 10 years I have studied thousands of articles and they are showing this link over and over again.”
Yet, “there are many unanswered questions about the relationship between diabetes and dementia,” says Cukierman-Yaffe. “Which domains are affected? Or what are the mechanisms?”
At the center, located in the outskirts of Tel Aviv, patients come for a five-hour appointment and checkup after being referred by their physicians or on their own initiative.
The patients are seen by several clinicians and therapists at one session, with a main goal of giving the diabetic patient a holistic approach to help manage the disease.
As part of the standard medical tests, the team also looks at gait, balance, hormones, sexual function, diet and lifestyle.
According to Cukierman-Yaffe, diabetes sufferers are more prone to problems that we know about already, like circulation and eyesight loss, but also more instances of dementia, cognitive impairment in general, frailty and an overall deterioration of physical functioning.
Helping to see a clearer picture for each person is a staff that includes a medical doctor, a neuropsychologist, a physical therapist, an occupational therapist and a nutritionist.
Recommendations could include diet augmentation or adjusting medications, but the biggest impact on a person’s well-being, asserts Cukierman-Yaffe, seems to be exercise.
The fountain of youth?
The idea came about to make this a lifelong mission when Cukierman-Yaffe was working on post-graduate research at McMaster University in Canada.
Under her supervisor there, Cukierman-Yaffe started understanding that type 2 diabetes appears to be a condition that affects multiple systems in the body and appears to accelerate the aging process in general, she says.
Patients who come to her new center in Israel may be hoping for a miracle cure, but Cukierman-Yaffe is sure that no such thing exists for diabetes or dementia. The key for living better is recommending ways to manage the disease.
This might include cognitive training and a set of recommendations given at the second follow-up session at the clinic.
“We look at what’s been effective, like physical activities and cognitive training. And how we can profile individuals based on strengths and weaknesses. We then apply our tools to the individual,” she says.
One advantage of being located in Israel is the country’s unfortunate experience with brain trauma from treating soldiers wounded on the battlefield. The army, says Cukierman-Yaffe, offers unique opportunities and tools for cognitive rehab of traumatic brain injury.
Groups from Japan and the United States are already consulting Cukierman-Yaffe on her groundbreaking methods, hoping to replicate the approach elsewhere.
She knows of other Centers for Successful Living around the world, but none focus on diabetes and managing the growing associated problem of dementia.