Several executive functions decline with the development of type-1 diabetes (T1D), particularly working memory (WM). In adults, WM ensures efficient cognitive processing by focusing on task-relevant information while suppressing distractors. It has been well documented that WM can be influenced by emotional stimuli, which may facilitate the retention of information, interfere with uptake, or even affect its capacity. We evaluated the effect of T1D on visual WM processing using emotional faces as stimuli, in young patients with satisfactory clinical evolution, and matched controls without T1D. All subjects performed a 2-back task detecting facial identity using neutral, happy or fearful faces in a block design for fMRI. Behavioral performance was similar with the exception that patients responded significantly slower. Most importantly, between-group differences were found in patterns of brain activation. In comparison, more widespread brain activation -predominantly prefrontal- was found in the participants with T1D when processing neutral faces, while a decrease was observed when processing happy and fearful ones. Statistical contrasts demonstrated significantly-different activation patterns between groups when processing emotional faces, as controls exhibited greater activation in the cuneus, posterior cortex and parahippocampal gyrus, while the patients showed greater activation in the prefrontal structures. Results may reflect compensatory efforts made to minimize the deleterious effects of disease development on attention allocation processes and the operational efficiency of WM. The results suggest that emotional parameters should be periodically assessed in individuals with T1D in order to anticipate the emergence of attention and WM impairment.
Keywords: Facial emotion; N-back; Type-1 diabetes; Working memory; fMRI.
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