Parkinson's Disease and Diabetes Mellitus: Individual and Combined Effects on Motor, Cognitive, and Psychosocial Functions

Jolie D Barter; Dwaina Thomas; Liang Ni; Allison A Bay; Theodore M Johnson 2nd; Todd Prusin; Madeleine E Hackney

doi:10.3390/healthcare11091316

Parkinson's Disease and Diabetes Mellitus: Individual and Combined Effects on Motor, Cognitive, and Psychosocial Functions

Healthcare (Basel). 2023 May 4;11(9):1316. doi: 10.3390/healthcare11091316.

Authors

Jolie D Barter¹, Dwaina Thomas², Liang Ni¹, Allison A Bay¹, Theodore M Johnson 2nd^{1

3

4}, Todd Prusin¹, Madeleine E Hackney^{1

4

5

6

7}

Affiliations

¹ Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA.
² School of Arts and Sciences, Clark Atlanta University, Atlanta, GA 30314, USA.
³ Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA.
⁴ Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Brookhaven, GA 30319, USA.
⁵ School of Nursing, Emory University, Atlanta, GA 30322, USA.
⁶ Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, GA 30033, USA.
⁷ Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA.

Abstract

Background/objective: Understanding the effects of multimorbidity on motor and cognitive function is important for tailoring therapies. Individuals with diabetes mellitus (DM) have a greater risk of developing Parkinson's disease (PD). This study investigated if individuals with comorbid PD and DM experienced poorer functional ability compared to individuals with only PD or DM.

Methods: A cross-sectional analysis of 424 individuals: healthy older adults (HOA), n = 170; PD without DM (PD-only), n = 162; DM without PD (DM-only), n = 56; and comorbid PD and DM (PD+DM), n = 36. Motor, motor-cognitive, cognitive, and psychosocial functions and PD motor symptoms were compared among groups using a two-way analyses of covariance with PD and DM as factors.

Results: The PD-only and DM-only participants exhibited slower gait, worse balance, reduced strength, and less endurance. Motor-cognitive function was impaired in individuals with PD but not DM. DM-only participants exhibited impaired inhibition. Individuals with comorbid PD+DM had worse PD motor symptoms and exhibited impaired attention compared to the PD-only group.

Conclusions: Having PD or DM was independently associated with poorer physical and mental quality of life, depression, and greater risk for loss of function. Both PD and DM have independent adverse effects on motor function. Comorbid PD+DM further impairs attention compared to the effect of PD-only, suggesting the importance of therapies focusing on attention. Understanding the functional ability levels for motor and cognitive domains will enhance the clinical care for PD, DM, and PD+DM.

Keywords: Parkinson’s disease; diabetes; executive function; mobility; multimorbidity.

Grants and funding

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health (NIH NIDDK)(1R25DK113652); National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002378); Department of Veterans Affairs Career Development Award (N0870W (5IK2RX000870-06)); pilot grants from the Dan and Merrie Boone Foundation, Emory Center for Injury Control, and Parkinson Foundation to M.E.H.; Emory Goizueta Alzheimer’s Disease Research Center (P50AG025688), Atlanta Center for Visual and Neurocognitive Rehabilitation, Patient Centered Outcomes Research Institute, and Emory Center for Health in Aging.