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dc.contributor.advisorAstell, Arlene Jean
dc.contributor.authorJohnston, Harriet N.
dc.description.abstractThe physical complications of Type 1 diabetes mellitus (T1DM) have been understood as an accelerated ageing process (Morley, 2008). Do people with T1DM also experience accelerated cognitive and brain ageing? Using findings from research of the normal cognitive and brain ageing process and conceptualized in theories of the functional brain changes in cognitive ageing, a combination of cognitive testing and functional magnetic resonance imaging (fMRI) techniques were used to evaluate evidence of accelerated cognitive and brain ageing in middle-aged adults with T1DM. The first part of this thesis comprises a cognitive study of 94 adults (≥ 45 years of age) with long duration (≥ 10 years) of T1DM. Participants completed cognitive assessment and questionnaires on general mood and feelings about living with diabetes. Findings highlighted the importance of microvascular disease (specifically retinopathy) as an independent predictor of cognitive function. The incidence and predictors of mild cognitive impairment (MCI) were then explored. Results indicate a higher percentage of the group met criteria for MCI than expected based on incidence rates in the general population, providing initial evidence of accelerated cognitive ageing. Psychological factors were explored next. The relationship between the measures of well-being, diabetes health, and cognitive function highlighted the need for attention to patient’s psychological well-being in diabetes care. Finally, a subgroup of 30 participants between the ages of 45 and 65 who differed on severity of retinopathy were selected to take part in an fMRI study. Blood oxygen level dependent (BOLD) activity was evaluated while participants were engaged in cognitive tasks and during rest. The findings provided evidence that the pattern of BOLD activation and functional connectivity for those with high severity of retinopathy are similar to patterns found in adults over the age of 65. In line with the theories of cognitive ageing, functional brain changes appear to maintain a level of cognitive function. Evidence of accelerated brain ageing in this primarily middle-aged group, emphasizes the importance of treatments and regimens to prevent or minimize microvascular complications.  en_US
dc.publisherUniversity of St Andrews
dc.subjectType 1 diabetes mellitusen_US
dc.subjectMicrovascular diseaseen_US
dc.subjectCognitive functionen_US
dc.subjectBrain functionen_US
dc.subjectCognitive ageingen_US
dc.subjectBrain ageingen_US
dc.subjectFunctional Magnetic Resonance Imagingen_US
dc.subjectFunctional connectivityen_US
dc.subjectMild cognitive impairmenten_US
dc.subjectPsychological well-beingen_US
dc.subjectDiabetes well-beingen_US
dc.subjectResting stateen_US
dc.subjectAccelerated ageingen_US
dc.subjectPhysical healthen_US
dc.subjectInsulin resistanceen_US
dc.subject.lcshMild cognitive impairmenten_US
dc.subject.lcshMicrocirculation disordersen_US
dc.subject.lcshMagnetic resonance imagingen_US
dc.titleCognitive and brain function in adults with Type 1 diabetes mellitus : is there evidence of accelerated ageing?en_US
dc.contributor.sponsorScottish Imaging Network (SINAPSE)en_US
dc.contributor.sponsorUniversity of St Andrewsen_US
dc.contributor.sponsorUniversity of Dundee, Ninewells Hospital and Medical School, Anonymous Trusten_US
dc.type.qualificationnamePhD Doctor of Philosophyen_US
dc.publisher.institutionThe University of St Andrewsen_US
dc.publisher.departmentUniversity of St Andrews School of Psychology and Neuroscienceen_US
dc.publisher.departmentUniversity of Dundee Ninewells Hospital and Medical Schoolen_US
dc.publisher.departmentNinewells Hospital and Medical School Clinical Research Centreen_US

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