Cognitive impairment, physical disability and depressive symptoms in older diabetic patients: the Fremantle Cognition in Diabetes Study
Introduction
The prevalence of type 2 diabetes increases with age and more than 20% of octogenarians have diabetes [1]. In addition, many patients with type 1 diabetes survive into older age. The ageing of society in developed countries has led to substantial increases in the number of elderly diabetic people and this trend is likely to continue for several decades.
Impairments in cognition and physical abilities are common in older age and can be caused by a range of chronic diseases. Older diabetic people can have cognitive and physical impairments because of co-morbid disabling diseases, but diabetes is itself a risk factor for cognitive impairment [2], [3], depression [4] and impairment of normal physical activity [5]. These factors may contribute to the high disability burden of diabetes [6].
Deficits in cognitive and physical function have important consequences for older diabetic patients and their families. They are likely to have considerable impact on the management of diabetes [7], including a need for careful assessment of appropriate blood glucose lowering therapies and glycaemic targets, maximising adherence to dosing schedules, close monitoring of compliance with the prescribed treatment, provision of practical and educational support for family caregivers, and appropriate referral to specialist rehabilitation and support services.
There is considerable evidence that depression and dementia in elderly patients are under-recognised in primary and secondary care and that the systematic use of validated screening instruments can be used to improve the detection of these disorders [8]. It is possible that similar screening programs could be helpful in diabetes care, but we are not aware of any previous studies in this area. Because of this situation, we started the Fremantle Cognition in Diabetes Study (FCDS) in September 2001. The FCDS aims to offer a comprehensive cognitive and clinical assessment for older adults with diabetes from a community-based patient cohort. Because we have found particularly high rates of cognitive impairment, physical disability and mood disorders amongst FCDS subjects, we report interim findings in half of the target FCDS sample.
Section snippets
Patients
The sample comprised 223 patients with diabetes. These patients were older participants in the Fremantle Diabetes Study (FDS), details of which have been published previously [9], [10]. Briefly, the FDS is a prospective community-based study of diabetes care, control and complications in a representative sample of patients living within the primary catchment area of Fremantle Hospital, a postcode-defined population of 120 097 people. We identified 2258 patients from all available sources
Data analysis
The data were analysed as proportions above and below validated cut-off points. The cut-off points for MMSE scores (<24/30) and IQCODE (>3.61) are recommended for the diagnosis of ‘dementia’ in epidemiological studies based on community samples [12], [14]. The EBAS-DEP cut-off point of 4 or more is suggestive of the presence of clinically significant depression [15]. An MBI score less than maximum (<100) indicates clinically significant difficulties in ADL [16]. Combining the results of the
Study sample
Table 1 presents demographic and clinical details of the study sample as well as comparative data with eligible but yet to be recruited subjects and those from the original cohort who died prior to recruitment. The present patients were significantly younger, and had shorter duration of diabetes compared with the other groups. Most had type 2 DM, were community dwelling and lived with a spouse or partner. Median scores for the MMSE, IQCODE and EBAS-DEP were within the normal range and the
Discussion
We found high rates of cognitive dysfunction, difficulties with basic ADL and depressive disorders using simple validated screening instruments in a sample of predominantly community-dwelling older people with type 2 diabetes. These problems were associated with increasing age such that our patients aged 75 years or older had high frequencies of dementia (approximately 20%), depression (15%) and physical disability (over 50%). In fact, only one-third of our subjects were free from functional
Acknowledgements
This project was funded by the National Health and Medical Research Council of Australia. We thank Wendy Davis for her assistance with the data analysis.
References (31)
- et al.
Mini-mental state: a practical method for grading the cognitive state of patients for the clinician
J. Psychiatr. Res.
(1975) - et al.
Mild cognitive impairment: conceptual basis and current nosological status
Lancet
(2000) - et al.
Diabetes in the elderly
Diabetic Med.
(1995) - et al.
Type 2 diabetes mellitus, cognitive impairment and dementia
Diabetic Med.
(1999) - et al.
Diabetes mellitus and the risk of dementia: the Rotterdam Study
Neurology
(1999) - et al.
Recognizing and managing depression in patients with diabetes
- et al.
Diabetes and physical disability among older US adults
Diabetes Care
(2000) - et al.
The burden of disease and injury in Australia. AIHW cat. No. PHE 17
(1999) - et al.
Impact of dementia on diabetic care in the aged
J. R. Soc. Med.
(1994) - et al.
Care of older people: mental health problems
Br. Med. J.
(2001)
Glycemic control in older diabetic patients in the Fremantle Diabetes Study
J. Am. Geriatr. Soc.
Autoantibodies to glutamic acid decarboxylase in diabetic patients from a multiethnic Australian community: the Fremantle Diabetes Study
Diabetic Med.
The mini-mental state examination: a comprehensive review
J. Am. Geriatr. Soc.
A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation
Psychol. Med.
Informant ratings of cognitive decline of elderly people: relationship to longitudinal change on cognitive tests
Age Ageing
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