Neurocognitive Impairment in Older Adults with Diabetes Mellitus from a Gender Perspective
Keywords:
Diabetes Mellitus; Neurocognitive Disorders; Elderly; Health Disparities; Sexual Factors; Gender Factors.Abstract
Introduction: Diabetes mellitus (DM) and neurocognitive impairment (NCI) in older adults represent a growing public health challenge. The scientific literature has highlighted the need to incorporate a gender perspective to identify disparities in prevalence, pathophysiology, clinical expression, and management between men and women.
Objective: To conduct a comprehensive review of the scientific evidence on the association between DM and NCI in older adults, integrating a gender perspective and using DSM-5 terminology.
Methods: A systematic search was conducted in PubMed/MEDLINE, SciELO, Scopus, Web of Science, and the Cochrane Library (2015–2024) using MeSH/DeCS keywords related to DM, NCD, gender, and aging. Systematic reviews, meta-analyses, and cohort studies were prioritized.
Results: DM is a potent risk factor for the entire spectrum of NCD. Pathophysiological mechanisms include cerebrovascular disease, central insulin resistance, neuroinflammation, and hypoglycemia. Gender analysis reveals that women with DM have a higher risk of vascular dementia, attributable to postmenopausal estrogen deprivation, a higher burden of cardiometabolic risk factors, and social determinants such as lower cognitive reserve. Men show differential patterns with earlier involvement of executive domains.
Conclusions: Incorporating a gender perspective is essential and should result in mandatory cognitive screening with instruments sensitive to non-memory domains, personalized prevention strategies, optimization of glycemic control, and policies that address gender inequalities.
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Copyright (c) 2025 Yuniel Abreu Hernández, Daimara Barrera León, Jorge Luis Lorente Montiel
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