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Blood Glucose Levels Effect on Cognition

Nutrition 1150 Term Paper

In current times, glucose has become a readily available nutrient; glucose in the form of
carbohydrates is found in breads, French fries, and in almost every meal. Also, since glucose has
been classified as the brains food; thus several scientist were led to study glucoses effects on
cognition. Tests with rodents demonstrated that an administration of glucose may lead to an
increase in memory and in cognition, and yet other studies have demonstrated that patients with
high levels of blood glucose are more likely to suffer from dementia and a decrease in cognition;
thus studies were held to prove these theories in humans. Some argue that an increase in blood
glucose levels in humans has a positive effect in cognition; however, others believe that high
blood glucose levels are detrimental for the brain, eventually leading to dementia. So a subject of
controversy is whether elevating blood glucose levels enhances cognition.
Several researchers disagree with the fact that higher glucose levels increase cognition.
The study by Kerti, L., Witte, A., Winkler, A., Grittner, U., Rujescu, D., & Floel, A. (2013)
demonstrates that a lower glucose level is associated with better scores in memory tests. A trial

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performed by Crane, P., Walker, R., Hubbard, R., Li, G., & Nathan, D. (2013) shows that a
chronic increase in blood glucose levels are detrimental to cognition and may lead to dementia.
The study by Parsons, M., & Gold, P. (1992) establishes that enhancement of memory was
characterized by an inverted-U dose-response curve. Yet another study performed by Hall, J.,
Gonder-Frederick, L., Chewning, W., Silveira, J., & Gold, P. (1989) demonstrates that increase in
blood glucose leads to an overall improvement of cognition in the elderly. While some believe
that higher glucose levels significantly decrease cognition and increases the probability of
acquiring dementia, others believe that a relatively high dose of glucose improves memory.
Kerty, L. et al., (2013) studied the blood glucose and HbA1c (glycated hemoglobin)
levels of a sample of the population without diabetes in Germany to assess the effect of glucose
on memory in the short and long term. The study analyzed 141 healthy individuals (72 women
and 69 men) for 12 weeks. The participants were of age 50 to 80 years, and several applicants
were rejected if they had a body mass index of less than 25 or more than 30, consumed more
than 50 g of alcohol daily, smoke more than 10 cigarettes daily, and if they drunk more than 6
cups of coffee daily. Furthermore, if the applicants were not native German speakers, they were
excluded. The German version of the Mini-Mental State Examination also was used to rule out
participants with preexisting cognitive impairments. Using the Blood Mini Kit, blood samples
were collected from the participants to assess the blood glucose levels, and further testing was
done to monitor the HbA1c levels. Knowing this, the German version of the Rey Auditory Verbal
Learning Test was assessed in three areas: delayed recall (word recall after 30 minutes), learning
ability, and memory consolidation. By monitoring blood glucose and HbA1c markers, the short
and long term of glucose and HbA1c effects on cognition was assessed (Kerty, L. et al., 2013).
When the glycosylated hemoglobin concertation and blood glucose concentrations were
compared with the cognition test, a correlation was found between the two. Apparently, higher

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glucose and HbA1c levels both in long and short term were associated with cognitive impairment
in all 3 memory tasks (p<0.01). Furthermore, by taking MRI scans of the participants, the
hippocampal volume was analyzed, and it was found that higher HbA1c levels correlated with a
decrease in volume of the hippocampus (p<0.06). The authors concluded that there is a general
trend in decline in cognition in people with higher glucose or HbA1c levels in blood (Kerty, L. et
al., 2013).
This study does very well to exclude several confounding variables so the dependent
variable (cognition) of the study reflect the independent variable (blood glucose and HbA1c
levels). To remove confounding variables, the authors removed applicants who consumed
excessive alcohol and coffee; also, those who had too small or too large BMI were excluded.
This exclusion was done to demonstrate that even healthy individuals can suffer from a decrease
in cognition if blood glucose levels are risen. Furthermore, by assessing three different tests of
memory by using the German version of the Rey Auditory Verbal Learning Test added to the
credibility of the cognition assessment. These factors strengthened the study, making it more
reliable.
There are several weaknesses to this study, however. The sample size of the study is
relatively very small. This small sample limits its generalization to the world population.
Furthermore, only native German speakers were allowed into the study. This is definitely an
ethnic segregation, which further restricts the generalization of the study to only native Germans.
Even though the study assessed men and women, the ethnicities are not mentioned, and since the
age range is very narrow50 to 80 year oldsthe study cannot be extrapolated to a younger
generation. Finally, the P value of the correlation of blood glucose with a decrease in
hippocampal volume is higher than 0.05, which leaves more room to a result based on chance
alone. These weaknesses decrease the validity of the study.

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Even though the study tried to filter out extraneous variables, the study harmed itself by
removing several participants. Since the study did not select participants randomly and secluded
non-native Germans, the results of this study cannot be generalized to other populations.
Definitely, the weaknesses of this study outweigh the strengths. Because the study only studies
people from a very narrow criteria, the conclusion that high glucose levels decrease cognition
cannot be fully supported. This study is therefore weak to generalize to a wider population for its
narrow criteria of age and ethnicity; this makes the study unprofitable to use (Kerty, L. et al.,
2013).
Crane, P. et al., (2013) conducted a well-controlled trial to determine whether higher
levels of blood glucose leads to dementia. In this study 2067 randomly selected elderly
participants from the age 65 or higher were monitored over 6.8 years to find a correlation
between high blood glucose levels and dementia. Only participants without dementia were
selected. The study monitored the participants every two years by taking a blood sample and
measuring blood glucose levels and HbA1c levels. Factors such as exercise, smoking, drinking,
and current self-rated health were assessed with questionnaires. Cognition was tested by using
the Cognitive Abilities Screening Instrument; with the average cognition being 100. Participants
whose cognition declined below 85 were further tested and studied. The study analyzed 343
participants with diabetes and 1724 participants without diabetes (Crane P. et al., 2013).
The study analyzed the participants cognition and their blood glucose levels and a
correlation between higher risks of dementia with higher levels of blood glucose was found. 524
of the 2067 participants developed dementia, including 450 of the 1724 nondiabetics and 74 of
the 343 diabetics. Also, it was found that 403 affected participants suffered from Alzheimers, 55
suffered dementia from vascular disease, and 66 suffered dementia from other causes. The

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authors concluded that the risk of dementia increased as glucose levels increased, with a P value
of 0.01 (Crane P. et al., 2013).
This study had several strengths. The sample size of the population was very large,
making the study more generalizable to a larger population. Also the study included men and
women, several ethnicities, and took into account the different educational levels. This
strengthens the study to make it more applicable to a more diverse population. Also, the sample
size was randomly picked. The study time was very long (6.8 years), allowing the authors
analyze the effect of blood glucose on its long term. Furthermore, the authors included people
with diabetes as well as people without it. This inclusion lets us compare between the general
trends of a diabetic population and a nondiabetic one. Finally, the study uses previous records of
blood glucose levels of the participants to guide their research. These careful considerations of
population, ethnicities, and inclusion of diabetics strengthen the argument that higher blood
glucose is closely correlated with dementia.
There are few weaknesses, however. Since participants are being monitored every 2
years, it is very easy for confounding variables not to be taken into account. Also, since the
physical activity, smoking, and drinking variables are recorded by self-rated questionnaires,
several patients may not write their honest answer. This means that confounding variables may
still play a role. Finally, the study only addressed individuals of age 65 or older; this limits the
generalizability of the study since the results cannot be applied to those who already suffer from
dementia earlier in their lives.
The strengths of this study outweigh the weaknesses, making this study a strong
proponent that higher levels of glucose can lead to dementia. Even though the studys assessment
of confounding variables such as smoking, drinking, and exercise were not the most accurate
since these variables were self-reported, the study is very applicable to a greater and more
diverse population since there were 2067 participants. Also, since study was monitored for a long

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time (6.8 years) the correlation of blood glucose and dementia can be clearly seen. This study
demonstrates that higher blood glucose levels are correlated with higher increase in dementia and
a fall in cognition in the elderly (Crane P. et al., 2013).
Parsons, M. et al., (1992) led a double blind study on the effects of blood glucose on
memory of the elderly. Unlike other experiments, this study manipulated the blood glucose of 10
individuals (5 men and 5 women) of 60 to 82 years of age and assessed their performance in
memory tests after 15 minutes and 55 minutes of glucose ingestion. The Ammins Quick test and
a modified version of the Wechsler Memory scale were administered to assess the memory of the
individuals. After 5 and 50 minutes after glucose ingestion, the blood glucose was evaluated
using a glucose meter, Glucoscan 2000. Glucose was administered by giving participants lemon
flavored drinks with 1, 10, 25, and 50g of glucoseone drink per visit. In total, the study asked
for 4 visits per participantone visit per week. The study was mean to last for 4 weeks, but it
lasted for 2 months due to the failure of the participants to come to the study. Finally, the
participants acted as their own control group by testing their memories at basal glucose levels.
This result was used to compare an increase in cognition (Parsons, M. et al., 1992).
The study resulted in an inverted-U dose-response manner in the logical memory tests.
The optimal dose of glucose for memory was found to be 25g, with an improvement of memory
at 5 and 40 minute tests, p<0.01 and p<0.05 respectively. At 10g doses of glucose, there was no
significant increase in score in memory tests. Also, when the 50g glucose dose was administered,
the participants did not show any improvement in cognition. This shows that cognition
improvement peaked at 25g of glucose and there was no improvement in 10g and 50g of glucose,
leading to the conclusion that glucose intake creates an inverted-U dose response in memory
tests (Parsons, M. et al., 1992).
This study presents some strengths. The glucose levels were constantly monitored using a
glucose meter. This is critical to measure the correlation between blood glucose levels with

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memory instead of grams of glucose consumed with memory. Not all glucose consumed may
have entered the blood. Furthermore, the usage of the Ammins Quick and the modified version
of the Wechsler Memory Scale strengthen the validity of the cognitive levels of the participants.
This adds to the reliability of the study. Finally, the study was double blinded, which eliminates
bias of the authors and of the participants of the study.
Despite the strengths, the study presented several weaknesses. The study only recruited
10 participants who were not randomly selected. This is detrimental to the study since the small
number of participants cannot represent a greater population. This study furthermore, does not
mention different ethnic groups and studies participants of 60 to 82 years of age; these
restrictions do not let the study be generalizable to other populations. Furthermore, the study
took place for a relatively short amount of time with only four measurements of the glucose
levels and mental tests. Since the study only required the participants to participate in the
experiment four times, the studys conclusion cannot be extrapolated to a long term effect of
glucose in memory. These weaknesses allow confounding variables to affect the results.
In this study, the weaknesses definitely outweigh the strengths, weakening the conclusion
that the different glucose doses lead to an inverted-U dose-response in the memory tests. The
sample population was too small and the participants were not randomly selected; this decreases
the validity and the applicability of the study to a greater population. This study cannot be
generalized. These weaknesses make the validity of the results questionable (Parsons, M. et al.,
1992).
Hall, J. et al., (1989) conducted a blind study in which young and elderly participants
ingested glucose and took a modified version of the Wechsler Memory Scale in order to test if an
increase in blood glucose levels is related to an increase in cognition and memory. 23
participants were recruited, 11 were elderly of ages 58 to 77 and 12 were college-aged
psychology students of 18 to 23 years of age. The study took place in three days, in which in

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each day the same routine of blood glucose testing and memory testing were assessed. In each
day, the basal blood glucose levels were measured using The Glucoscan Plus meter; then, a 50g
of glucose was administered to the participants in the form of lemon juice. After 15 minutes,
another blood glucose test (by finger pricks) was given to assess blood glucose levels, and right
after the blood test a memory test was given. The blood test was given before a mental test every
15 minutes for a total of 60 minutes each day. The memory test consisted of paired-associates, 24
hour delayed recall, logical memory, digit span, and visual memory. A measurement of memory
was performed with zero glucose ingestion (saccharin was used instead) to find the base level of
the individuals memory (Hall, J. et al., 1989).
This study determined that cognition improved as blood glucose levels increased, with a
higher improvement in mental test in the elderly than in the young. There was an increase in
memory tests after glucose administration, especially in the logical memory (p<0.05), digits
forward (p<0,01), and the composite memory score (sum of sub-test scores; p<0.02). In the
young, the digit forward test improved (p<0.05); however, there were no other improvements in
other sub-tests or in the composite memory score for the young population. In the elderly, the
logical memory test and the composite memory score improved (p<0.05) after glucose was
administered. The authors concluded that glucose enhances memory in humans, particularly in
the elderly participants (Hall, J. et al., 1989).
This study presented several strengths. The study was a blinded experiment; the
participants did not know whether they were ingesting glucose or saccharin. This eliminates bias
of the participants. Furthermore, the experiment had reliable p values and the glucose and
memory measures were accurate. Since finger pricking was administered every 15 minutes,
blood glucose levels could be accurately measured in those intervals. Also, by using a modified
version of the Wechsler Memory Scale and by administering several sub-tests, the cognition of

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the participants were well measured in different areas of memory, adding credibility to the study.
The tests had variety, ameliorating the bias that some participants may be more talented in some
areas than other areas of cognition.
Despite the strengths, there were several weaknesses that decreased the validity of the
study. The study had a relatively small population, and the participants were not ethnically
diverse. This aspect limits the generalizability of the study. Also, the study was extremely short;
it only took three days. The patients may not have been in an ideal emotional or mental state
during these three days, and they could have performed better (or worse) if the study lasted
longer. This brevity allows confounding variables to affect results.
Despite the weaknesses, the study had strengths that outweighed the weaknesses. The p
values of the study were low, increasing the validity of the study and decreasing the probability
that the results happened by chance alone. Also since the memory tests had several sub-tests the
participants cognition could be very well assessed. This increases the evidence of the
improvement of overall memory. This study cannot fully support the idea that glucose
significantly improves the overall cognition of the college students. However, this study well
supports that glucose intake improves memory of the elderly for only a short period of time
(Hall, J. et al., 1989).
Different studies have concluded that an increase in blood glucose levels improve
cognition; others argue that blood glucose is beneficial only in moderate amounts; and yet others
argue that increasing blood glucose is detrimental in cognition and may lead to dementia. After
careful analysis of the studies, studies concluding that moderate amounts of glucose can be
beneficial and studies that conclude that very high levels of glucose may lead to dementia both
have strong and valid points. Therefore, it is safe to assume that glucose can have only short term
beneficial effects on memory after glucose intake (low glucose amount below 50g); however,
when participants have chronic high glucose levels, cognition can deteriorate. Kerty, L. et al.,

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(2013) performed a study in which participants blood glucose was measured to correlate with
each participants cognition. Although this study concluded that high levels of blood glucose and
HbA1c levels harmed cognition in the short and long term, this conclusion was not valid since
the population was very narrow ethnically and numerically. Crane, P. et al., (2013) also
conducted a study to find a relationship with blood glucose levels and cognition. This study is
very strong since the population studied is very large and the studys time was long (6.8 years).
The authors conclusion that chronic high levels of blood glucose is detrimental for cognition is
well supported. On the other hand, Parsons, M. et al., (1992) conducted a study to find a
correlation between different doses of glucose with cognition. This studys conclusion that there
is an optimal dose of glucose to improve cognition cannot be supported because the sample size
studied is extremely small, allowing for confounding variables to affect the results. The results of
Hall, J. et al., (1989) showed that a 50g dose of glucose has beneficial effects in several aspects
of cognition in comparison to zero glucose intake. This conclusion is valid because the study
covered a wide variety of cognitive aspects in relation to glucose intake, making the study more
trustworthy.
Blood glucose levels should be carefully regulated to prevent a decrease in cognition and
subsequently dementia. Although moderate amounts of glucose intake can be beneficial in the
short run, if a person chronically intakes high levels of glucose, high blood glucose levels can
increase the probability of acquiring dementia and a decrease in cognition. Blood glucose in
blood may be elevated by ingesting fruit juices, eating potatoes, and consuming bread. Ingesting
such foods with high carbohydrate or glucose content should be regulated and moderately
consumed to decrease the probability of chronic high levels of blood glucose and subsequently
decrease the probability of cognitive degradation. After careful consideration of the studies, it is
safe to conclude that it is critical to normalize blood glucose levels throughout life to decrease

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the probability of acquiring dementia and a decrease in cognition, and that moderate amounts of
glucose intake can be beneficial for overall cognition improvement, especially in the elderly.

Works Cited
Crane, P., Walker, R., Hubbard, R., Li, G., & Nathan, D. (2013). Glucose Levels and Risk of
Dementia. New England Journal of Medicine N Engl J Med, 369(6), 540-548.
doi:10.1056/NEJMoa1215740
Hall, J., Gonder-Frederick, L., Chewning, W., Silveira, J., & Gold, P. (1989). Glucose
enhancement of performance of memory tests in young and aged
humans. Neuropsychologia, 27(9), 1129-1138. doi:10.1016/0028-3932(89)90096-1
Kerti, L., Witte, A., Winkler, A., Grittner, U., Rujescu, D., & Floel, A. (2013). Higher glucose
levels associated with lower memory and reduced hippocampal
microstructure. Neurology, 81(20), 1746-1752. doi:10.1212/01.wnl.0000435561.00234.ee
Parsons, M., & Gold, P. (1992). Glucose enhancement of memory in elderly humans: An
inverted-U dose-response curve. Neurobiology of Aging, 401-404. doi:10.1016/01974580(92)90114-D