title: Cognitive Impairment in Diabetes: Rationale and Design Protocol of the Cog-ID Study.
abstract: BACKGROUND
  Cognitive impairment frequently co-occurs with type 2 diabetes but is often undiagnosed. Cognitive impairment affects self-management leading to treatment-related complications.
  
  
  OBJECTIVE
  The aim of this study is to develop a stepped diagnostic procedure, consisting of a screening test complemented by an evaluation by a general practitioner (GP), to detect undiagnosed cognitive impairment in older people with type 2 diabetes.
  
  
  METHODS
  The accuracy of two self-administered cognitive tests, the "Test Your Memory" (TYM) and "Self-Administered Gerocognitive Examination" (SAGE) alone, and in combination with an evaluation by a GP will be assessed. A diagnosis of mild cognitive impairment (MCI) or dementia at a memory clinic will serve as reference standard. This cognitive impairment in diabetes (Cog-ID) study will include 513 people from primary care facilities aged ≥70 with type 2 diabetes. The participants will first fill out the TYM and SAGE tests, followed by a standardized GP evaluation for cognitive impairment, including a mini mental state examination (MMSE). Subsequently, participants suspected of cognitive impairment (on either test or the GP assessment) and a random sample of 15% (65/435) of participants without suspected cognitive impairment will be referred to the memory clinic. At the memory clinic, a medical examination, neuropsychological examination, and magnetic resonance imaging (MRI) of the brain will be performed. Participants will also fill out questionnaires assessing health status and depressive symptoms at baseline and after 6 and 24 months.
  
  
  RESULTS
  This research obtained funding and ethical approval. Enrolment started in August, 2012, and all study-related activities will be completed in September, 2016.
  
  
  CONCLUSIONS
  With the results from this study, physicians will be able to detect cognitive impairment affecting type 2 diabetes patients through case-finding, and can use tailored care to reduce associated complications. Additionally, the results may stimulate discussions about cognitive impairment and whether early recognition is desirable.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands. p.s.koekkoek-3@umcutrecht.nl.
authors.forename: Paula S
authors.identifier: http://orcid.org/0000-0002-4530-8821
authors.initials: PS
authors.lastname: Koekkoek
authors.forename: Jolien
authors.identifier: http://orcid.org/0000-0002-3898-6472
authors.initials: J
authors.lastname: Janssen
authors.forename: Minke
authors.initials: M
authors.lastname: Kooistra
authors.forename: Esther
authors.identifier: http://orcid.org/0000-0002-8218-7870
authors.initials: E
authors.lastname: van den Berg
authors.forename: L Jaap
authors.identifier: http://orcid.org/0000-0001-8665-6630
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: Geert Jan
authors.identifier: http://orcid.org/0000-0001-6862-2496
authors.initials: GJ
authors.lastname: Biessels
authors.forename: Guy Ehm
authors.identifier: http://orcid.org/0000-0001-5773-2614
authors.initials: GE
authors.lastname: Rutten
keywords: cognitive impairment; dementia; diagnostic procedure; elderly; screening; type 2 diabetes mellitus