title: The relationship between neuropsychological assessment, numeracy, and functional status in older adults with type 1 diabetes.
abstract: While data are accumulating on the association between neuropsychological performance and real-world endpoints, less is known about the association with medical self-management skills. The self-management of type 1 diabetes (T1D) is often complex, and mismanagement can result in hypoglycaemia and hyperglycaemia and associated morbidity and mortality. The T1D Exchange conducted a case-control study evaluating factors associated with severe hypoglycaemia in older adults (≥ 60 years old) with longstanding T1D (≥ 20 years). A battery of neuropsychological and functional assessments was administered, including measures of diabetes-specific self-management skill (diabetes numeracy) and instrumental activities of daily living (IADL). After adjusting for confounding variables, diabetes numeracy was related to memory and complex speeded attention; while IADL were associated with simple processing speed, executive functioning, complex speeded attention and dominant hand dexterity. The severity of overall cognitive deficit was uniquely associated with both diabetes numeracy and IADL, when controlling for age, education, frailty and depression. This study demonstrates that the cognitive deficits in older adults with T1D have functional implications for both diabetes management and IADL. Further research is needed to determine specific interventions to maximise diabetes self-management in older adults with declining cognition.
authors.affiliation: a Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA.
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Chaytor
authors.affiliation: b Jaeb Center for Health Research , Tampa , FL , USA.
authors.forename: Tonya D
authors.initials: TD
authors.lastname: Riddlesworth
authors.affiliation: c Joslin Diabetes Center, Department of Endocrinology, Diabetes, and Metabolism , State University of New York- Upstate Medical University , Syracuse , NY , USA.
authors.forename: Suzan
authors.initials: S
authors.lastname: Bzdick
authors.affiliation: d School of Pharmacy , University of Washington , Seattle , WA , USA.
authors.forename: Peggy S
authors.initials: PS
authors.lastname: Odegard
authors.affiliation: d School of Pharmacy , University of Washington , Seattle , WA , USA.
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
authors.affiliation: e Department of Medicine, Division of Diabetes, Diabetes Center of Excellence , University of Massachusetts School of Medicine , Worcester , MA , USA.
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Lock
authors.affiliation: b Jaeb Center for Health Research , Tampa , FL , USA.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: DuBose
authors.affiliation: b Jaeb Center for Health Research , Tampa , FL , USA.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D001288:Attention; D016022:Case-Control Studies; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D056344:Executive Function; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D008297:Male; D055641:Mathematical Concepts; D008568:Memory; D008875:Middle Aged; D009048:Motor Skills; D009483:Neuropsychological Tests; D012648:Self Care / Q000379:methods / Q000523:psychology*; D012720:Severity of Illness Index
keywords: Cognitive aspects; Disease management; Mellitus; Neuropsychological tests; Older adults; Type 1 diabetes