TITLE:
Relationship of Cognition, Depression and Anxiety to Glycemic Control in Older Adults with Diabetes
AUTHORS:
Moatassem Salah Amer, Tomader Taha Abdel Rahman, Salma Mohamed Samir El Said, Nermien Naim Adly, Shaimaa Nabil Rohaiem, Randa Abdel Wahab Reda
KEYWORDS:
Diabetes Mellitus, Cognition, Depression, Anxiety, Hb A1c, Elders
JOURNAL NAME:
Advances in Aging Research,
Vol.3 No.2,
May
19,
2014
ABSTRACT:
Objective: This study aimed to assess the relationship of cognition, depression and anxiety to glycemic
control in elders with diabetes. DM
is a chronic medical condition. Its control depends on adherence to medical therapy
and making decisions related to lifestyle changes. This decision making capacity
is affected by many factors including cognition and psychological status. Design:
It was a case control study. Setting: It was done in Ain Shams University Hospital
inpatients and DM outpatient clinic, Cairo, Egypt. Participants: Of the one hundred
diabetic patients aged ≥ 60 years, 50 had Hemoglobin A1c (HbA1c) ≥ 7.5 (cases) and 50 had Hb A1c 7.5 (controls). Measurements: Cognition was assessed using minimental
status examination (MMSE) test, Mattis Organic
Mental Syndrome Screening Examination (MOMSSE) and Cambridge Cognitive
Examination (CAMCOG) test. Geriatric depression scale-15 (GDS-15) was performed
for depression assessment, while anxiety was assessed by DSM IV criteria. Laboratory
investigations included: fasting blood sugar (FBS), post-prandial blood sugar (PPBS),
glycated haemoglobin (Hb A1c), low density lipoprotein (LDL), high-density lipoprotein
(HDL), total cholesterol, and triglycerides (TG). Results: Significant difference
was found between the two groups regarding scores of cognitive tests: MMSE score
(p = 0.004); below average (p = 0.02) and average scores (p = 0.05) of MOMSSE; CAMCOG
score (p = 0.015); and CAMCOG divided items score including orientation (p = 0.003),
comprehension (p = 0.005), expression (p = 0.020), attention (p = 0.002), and abstraction
(p = 0.008) as well as depression screening scores (P = 0.002). Using Receiver Operating Characteristic, CAMCOG had
better sensitivity and MOMSSE had better specificity. Conclusion: Cognitive impairment
was associated with poor glycemic control, and impairment in attention and abstraction,
related to executive function, functions were found to be associated with poor glycemic
control. These functions may be more needed in self management of DM and hence affected
glycemic control. Depression was associated with poor glycemic control but anxiety
was not.