title: Neurocognitive functioning in children and adolescents at the time of type 1 diabetes diagnosis: associations with glycemic control 1 year after diagnosis.
abstract: OBJECTIVE
  To determine whether impairments in neurocognitive functioning are detectable at type 1 diabetes diagnosis and associated with subsequent glycemic control.
  
  
  METHODS
  Children/adolescents (N = 147) aged 5-18 years completed neuropsychological testing during their inpatient hospitalization for new-onset type 1 diabetes. Test scores were compared with normative data using one-sample Student t tests. Children with onset before 8 years of age were compared with children aged 9-18 years using ANOVA, and associations between neurocognitive performance at diagnosis and glycemic control 1 year postdiagnosis were examined using regression analyses.
  
  
  RESULTS
  Children with type 1 diabetes performed significantly below expectations on most neurocognitive measures (P values <0.0001), with large decrements from the normative mean evident in psychomotor speed (>1 SD), visuomotor integration (0.7 SD), and phonemic fluency (0.8 SD). High incidence of impairment (scores less than second percentile) was evident on all tasks except digit span. Dominant-hand psychomotor speed was significantly associated with poor glycemic control (A1C ≥9.5% [80 mmol/mol]; P = 0.032) 1 year postdiagnosis, controlling for race/ethnicity, sex, and reading ability. Impaired psychomotor speed was associated with a 0.77% increase in mean A1C (8.4 mmol/mol).
  
  
  CONCLUSIONS
  Deficits were evident in neurocognitive functioning within days of diabetes diagnosis that were associated with diabetes outcomes over 1 year postdiagnosis. Impairment was most apparent in psychomotor speed, consistent with research implicating damage to posterior white matter tracts and associated gray matter regions in type 1 diabetes. Psychomotor impairment may be an early marker for a broader neurobehavioral vulnerability that has implications for long-term diabetes management.
authors: Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX Psychology Service, Texas Children's Hospital, Houston, TX ddschwar@bcm.edu.
authors: David D
authors: DD
authors: Schwartz
authors: Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX Psychology Service, Texas Children's Hospital, Houston, TX.
authors: Marni E
authors: ME
authors: Axelrad
authors: Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX Psychology Service, Texas Children's Hospital, Houston, TX.
authors: Barbara J
authors: BJ
authors: Anderson
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D005006:Ethnicity; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006760:Hospitalization; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011597:Psychomotor Performance
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human