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Cognitive Dysfunction Is Associated With Poor Diabetes Control in Older Adults

¹ Division of Adult Diabetes, Joslin Diabetes Center, Boston, Massachusettes
² Gerontology Division, Beth Israel Deaconess Medical Center, Boston, Massachusettes
³ Department of Medicine, Harvard Medical School, Boston, Massachusettes
⁴ Geriatric Neuropsycology Laboratory, New England Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Health Care System, Boston, Massachusettes

Address correspondence and reprint requests to Medha Munshi, MD, Division of Geriatrics, Beth Israel Deaconess Medical Center, 110 Francis St., LMOB 1B, Boston, MA 02215. E-mail: mmunshi{at}bidmc.harvard.edu

OBJECTIVE—To evaluate the association between cognitive dysfunction and other barriers and glycemic control in older adults with diabetes.

RESEARCH DESIGN AND METHODS—Patients over the age of 70 years presenting to a geriatric diabetes clinic were evaluated for barriers to successful diabetes management. Patients were screened for cognitive dysfunction with the Mini Mental State Examination (MMSE) and a clock-drawing test (CDT) scored by 1) a method validated by Mendez et al. and 2) a modified CDT (clock in a box [CIB]). Depression was evaluated with the Geriatric Depression Scale. Interview questionnaires surveyed activities of daily living (ADLs) and instrumental ADLs (IADLs), as well as other functional disabilities.

RESULTS—Sixty patients (age 79 ± 5 years, diabetes duration 14 ± 13 years) were evaluated. Thirty-four percent of patients had low CIB (5), and 38% of patients had low CDT (13). Both CIB as well as CDT were inversely correlated with HbA_1c, suggesting that cognitive dysfunction is associated with poor glycemic control (r = –0.37, P < 0.004 and r = –0.38, P < 0.004, respectively). Thirty-three percent of patients had depressive symptoms with greater difficulty completing the tasks of the IADL survey (5.7 ± 1.7 vs. 4.6 ± 2.0; P < 0.03). These older adults with diabetes had a high incidence of functional disabilities, including hearing impairment (48%), vision impairment (53%), history of recent falls (33%), fear of falls (44%), and difficulty performing IADLs (39%).

CONCLUSIONS—Older adults with diabetes have a high risk of undiagnosed cognitive dysfunction, depression, and functional disabilities. Cognitive dysfunction in this population is associated with poor diabetes control.

Abbreviations: ADL, activity of daily living • CDT, clock-drawing test • CIB, clock in a box • GDS, Geriatric Depression Scale • IADL, instrumental ADL • MMSE, Mini Mental State Examination

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