Cognitive impairment, physical disability and depressive symptoms in older diabetic patients: the Fremantle Cognition in Diabetes Study.
OBJECTIVE
To determine whether the prevalence of dementia, depression and/or disability in older diabetic subjects warrants an active screening approach by diabetes health care workers.


METHODS
The initial 223 members of a cohort of 529 eligible diabetic subjects, aged 70 years or over, were screened for cognitive impairment (using the Mini-Mental State Examination (MMSE) and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE)), physical impairments and depressive symptoms.


RESULTS
Virtually all subjects were community-dwelling (99%) and mobile (86%) and relatively few had moderate or severe deficits in activities of daily living (ADL) (17.5%). The prevalences of cognitive impairment and probable dementia estimated from the screening tests were high (range 10.8-17.5%) compared with population studies. Any deficit with ADL was reported by 53% of the subjects and common problems included urinary and faecal incontinence. Scores consistent with clinical depression were reported by 14.2% of the sample but 50.2% of the remainder reported one or more depressive symptoms below the cut-off point for clinical depression. Only 36% of the study subjects were free of deficits in any domain.


CONCLUSIONS
Community-living older diabetic subjects have high rates of cognitive impairment, deficits in physical function and depressive symptomatology suggesting that screening programs for functional impairments and depression may be beneficial in health care systems that manage older diabetic patients.
Bruce
David G
DG
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia. dbruce@cyllene.uwa.edu.au
Casey
Genevieve P
GP
Grange
Valerie
V
Clarnette
Roger C
RC
Almeida
Osvaldo P
OP
Foster
Jonathan K
JK
Ives
Franklyn J
FJ
Davis
Timothy M E
TM
D000203:Activities of Daily Living; D017668:Age of Onset; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology*; D003710:Demography; D003863:Depression / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000503:physiopathology* / Q000523:psychology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors