title: Cognitive dysfunction is associated with poor diabetes control in older adults.
abstract: OBJECTIVE
  To evaluate the association between cognitive dysfunction and other barriers and glycemic control in older adults with diabetes.
  
  
  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 (< or =5), and 38% of patients had low CDT (< or =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.
authors.affiliation: Division of Adult Diabetes, Joslin Diabetes Center, Boston, Massachusettes, USA. mmunshi@bidmc.harvard.edu
authors.forename: Medha
authors.initials: M
authors.lastname: Munshi
authors.forename: Laura
authors.initials: L
authors.lastname: Grande
authors.forename: Mellody
authors.initials: M
authors.lastname: Hayes
authors.forename: Darlene
authors.initials: D
authors.lastname: Ayres
authors.forename: Emmy
authors.initials: E
authors.lastname: Suhl
authors.forename: Roberta
authors.initials: R
authors.lastname: Capelson
authors.forename: Susan
authors.initials: S
authors.lastname: Lin
authors.forename: William
authors.initials: W
authors.lastname: Milberg
authors.forename: Katie
authors.initials: K
authors.lastname: Weinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications* / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male