Journal of Behavioral Medicine

, Volume 35, Issue 2, pp 190–199

The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes

  • Denise G. Feil
  • Carolyn W. Zhu
  • David L. Sultzer
Article

Abstract

Although nearly one-third of older diabetics are cognitively impaired, their diabetes management remains poorly understood. To examine the relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. Cross-sectional observational analysis. 1,398 persons with diabetes, aged 60 years or older, who responded to the 2003 Health and Retirement Study Diabetes Survey. We conducted logistic regressions on the effects of cognitive impairment on respondents’ self-management ability after controlling for diabetes comorbidities, demographics, and clinical characteristics. Participants with greater cognitive impairment were less likely to adhere to exercise (Adjusted Odds ratio [AOR] = 0.725 and 0.712 for moderate and severe cognitive impairment, both P < 0.05), and to diet (AOR = 0.906 and 0.618 for moderate and severe cognitive impairment, both P < 0.01). Cognitive impairment is associated with worse self-care and may pose challenges to diabetic older persons, notably in diet and exercise. Cognitive screening may be indicated in this high risk group.

Keywords

Diabetes mellitus Cognitive impairment Self-management Comorbidity Health behaviors 

References

  1. Anderson, R. M., Funnell, M. M., Butler, P. M., Arnold, M. S., Fitzgerald, J. T., & Feste, C. C. (1995). Patient empowerment. Results of a randomized controlled trial. Diabetes Care, 18, 943–949.PubMedCrossRefGoogle Scholar
  2. Areosa, S. A., & Grimley, E. V. (2002). Effect of the treatment of Type II diabetes mellitus on the development of cognitive impairment and dementia. Cochrane Database of Systematic Reviews, 4, CD003804.Google Scholar
  3. Asimakopoulou, K. G., & Hampson, S. E. (2002). Cognitive functioning and self-management in older people with diabetes. Diabetes Spectrum, 15, 116–121.CrossRefGoogle Scholar
  4. Ballard, C., Lowery, K., Powell, I., O’Brien, J., & James, I. (2000). Behavioral and psychological symptoms of dementia (BPSD): A clinical and research update; impact of behavioral and psychological symptoms of dementia on caregivers. International Psychogeriatrics, 12, 93–105.CrossRefGoogle Scholar
  5. Biessels, G. J., Staekenborg, S., Brunner, E., Brayne, C., & Scheltens, P. (2006). Risk of dementia in diabetes mellitus: A systematic review. The Lancet Neurology, 5, 64–74.CrossRefGoogle Scholar
  6. Brandt, J., Spencer, M., & Folstein, M. (1988). The Telephone Interview for Cognitive Status. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 1, 111–117.Google Scholar
  7. Breitner, J. C., Welsh, K. A., Gau, B. A., McDonald, W. M., Steffens, D. C., Saunders, A. M., et al. (1995). Alzheimer’s disease in the National Academy of Sciences–National Research Council Registry of Aging Twin Veterans. III. Detection of cases, longitudinal results, and observations on twin concordance. Archives of Neurology, 52, 763–771.PubMedCrossRefGoogle Scholar
  8. Brown, A. F., Mangione, C. M., Saliba, D., & Sarkisian, C. A. (2003). Guidelines for improving the care of the older person with diabetes mellitus. Journal of the American Geriatrics Society, 51, S265–S280.PubMedCrossRefGoogle Scholar
  9. Bruce, J. M., Hancock, L. M., Arnett, P., & Lynch, S. (2010). Treatment adherence in multiple sclerosis: Association with emotional status, personality, and cognition. Journal of Behavioral Medicine, 33, 219–227.PubMedCrossRefGoogle Scholar
  10. Chodosh, J., Petitti, D. B., Elliott, M., Hays, R. D., Crooks, V. C., Reuben, D. B., et al. (2004). Physician recognition of cognitive impairment: evaluating the need for improvement. Journal of the American Geriatrics Society, 52, 1051–1059.PubMedCrossRefGoogle Scholar
  11. Christensen, A. J. (2004). Chapter 3: Determinants of patient adherence. In Patient adherence to medical treatment regimens; bridging the gap between behavioral science and biomedicine. New Haven, CT: Yale University Press.Google Scholar
  12. Ciechanowski, P. S., Katon, W. J., & Russo, J. E. (2000). Depression and diabetes: Impact of depressive symptoms on adherence, function, and costs. Archives of Internal Medicine, 160, 3278–3285.PubMedCrossRefGoogle Scholar
  13. Clement, S. (1995). Diabetes self-management education. Diabetes Care, 18, 1204–1214.PubMedGoogle Scholar
  14. Conn, V., Taylor, S., & Miller, R. (1994). Cognitive impairment and medication adherence. Journal of Gerontological Nursing, 20, 41–47.PubMedGoogle Scholar
  15. Cukierman, T., Gerstein, H. C., & Williamson, J. D. (2005). Cognitive decline and dementia in diabetes—systematic overview of prospective observational studies. Diabetologia, 48, 2460–2469.PubMedCrossRefGoogle Scholar
  16. deWet, H., Levitt, N., & Tipping, B. (2007). Executive cognitive impairment detected by simple bedside testing is associated with poor glycaemic control in type 2 diabetes. South African Medical Journal, 97, 1074–1076.Google Scholar
  17. Feil, D. G., Pearman, A., Victor, T., Harwood, D., Weinreb, J., Kahle, K., et al. (2009). The role of cognitive impairment and caregiver support in diabetes management of older outpatients. International Journal of Psychiatry in Medicine, 39, 199–214.PubMedCrossRefGoogle Scholar
  18. Fitzgerald, J. T., Davis, W. K., Connell, C. M., Hess, G. E., Funnell, M. M., & Hiss, R. G. (1996). Development and validation of the Diabetes Care Profile. Evaluation & the Health Professions, 19, 208–230.CrossRefGoogle Scholar
  19. Fontbonne, A., Berr, C., Ducimetiere, P., & Alperovitch, A. (2001). Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: Results of the Epidemiology of Vascular Aging Study. Diabetes Care, 24, 366–370.PubMedCrossRefGoogle Scholar
  20. Fultz, N. H., Ofstedal, M. B., Herzog, A. R., & Wallace, R. B. (2003). Additive and interactive effects of comorbid physical and mental conditions on functional health. Journal of Aging and Health, 15, 465–481.PubMedCrossRefGoogle Scholar
  21. Goodall, T. A., & Halford, W. K. (1991). Self-management of diabetes mellitus: A critical review. Health Psychology, 10, 1–8.PubMedCrossRefGoogle Scholar
  22. Greenfield, S., Sullivan, L., Dukes, K. A., Silliman, R., D’Agostino, R., & Kaplan, S. H. (1995). Development and testing of a new measure of case mix for use in office practice. Medical Care, 33, AS47–AS55.PubMedGoogle Scholar
  23. Gregg, E. W., Engelgau, M. M., & Narayan, V. (2002). Complications of diabetes in elderly people. British Medical Journal, 325, 916–917.PubMedCrossRefGoogle Scholar
  24. Gregg, E. W., Yaffe, K., Cauley, J. A., Rolka, D. B., Blackwell, T. L., Narayan, K. M., et al. (2000). Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group. Archives of Internal Medicine, 160, 174–180.PubMedCrossRefGoogle Scholar
  25. Grodstein, F., Chen, J., Wilson, R. S., & Manson, J. E. (2001). Type 2 diabetes and cognitive function in community-dwelling elderly women. Diabetes Care, 24, 1060–1065.PubMedCrossRefGoogle Scholar
  26. Hachinski, V., Iadecola, C., Petersen, R. C., Breteler, M. M., Nyenhuis, D. L., Black, S. E., et al. (2006). National Institute of Neurological Disorders and Stroke–Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke, 37, 2220–2241.PubMedCrossRefGoogle Scholar
  27. Hall, P. A., Elias, L. J., & Crossley, M. (2006). Neurocognitive influences on health behavior in a community sample. Health Psychology, 25, 778–782.PubMedCrossRefGoogle Scholar
  28. Hall, P. A., Fong, G. T., Epp, L. J., & Elias, L. J. (2008). Executive function moderates the intention-behavior link for physical activity and dietary behavior. Psychology & Health, 23, 309–326.CrossRefGoogle Scholar
  29. Hayward, R. A., Manning, W. G., Kaplan, S. H., Wagner, E. H., & Greenfield, S. (1997). Starting insulin therapy in patients with type 2 diabetes: Effectiveness, complications, and resource utilization. Journal of the American Medical Association, 278, 1663–1669.PubMedCrossRefGoogle Scholar
  30. Hebert, L. E., Scherr, P. A., Bienias, J. L., Bennett, D. A., & Evans, D. A. (2003). Alzheimer disease in the US population: Prevalence estimates using the 2000 census. Archives of Neurology, 60, 1119–1122.PubMedCrossRefGoogle Scholar
  31. Heisler, M., Bouknight, R. R., Hayward, R. A., Smith, D. M., & Kerr, E. A. (2002). The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. Journal of General Internal Medicine, 17, 243–252.PubMedCrossRefGoogle Scholar
  32. Heisler, M., Vijan, S., Anderson, R. M., Ubel, P. A., Bernstein, S. J., & Hofer, T. P. (2003). When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make? Journal of General Internal Medicine, 18, 893–902.PubMedCrossRefGoogle Scholar
  33. Herzog, A. R., & Wallace, R. B. (1997). Measures of cognitive functioning in the AHEAD Study 224. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 52 Spec No, 37–48.Google Scholar
  34. Hinkin, C. H., Castellon, S. A., Durvasula, R. S., Hardy, D. J., Lam, M. N., Mason, K. I., et al. (2002). Medication adherence among HIV + adults: Effects of cognitive dysfunction and regimen complexity. Neurology, 59, 1944–1950.PubMedGoogle Scholar
  35. Hinkin, C. H., Hardy, D. J., Mason, K. I., Castellon, S. A., Durvasula, R. S., Lam, M. N., et al. (2004). Medication adherence in HIV-infected adults: Effect of patient age, cognitive status, and substance abuse. AIDS, 18, S19–S25.PubMedCrossRefGoogle Scholar
  36. Insel, K., Morrow, D., Brewer, B., & Figueredo, A. (2006). Executive function, working memory, and medication adherence among older adults. Journal of Gerontology, Series B: Psychological Sciences and Social Sciences, 61, 102–107.CrossRefGoogle Scholar
  37. Jacobson, A. M., Musen, G., Ryan, C. M., Silvers, N., Cleary, P., Waberski, B., et al. (2007). Long-term effect of diabetes and its treatment on cognitive function. New England Journal of Medicine, 356, 1842–1852.PubMedCrossRefGoogle Scholar
  38. Kaufer, D. I., Cummings, J. L., Ketchel, P., Smith, V., MacMillan, A., Shelley, T., et al. (2000). Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 233–239.CrossRefGoogle Scholar
  39. Krapek, K., King, K., Warren, S. S., George, K. G., Caputo, D. A., Mihelich, K., et al. (2004). Medication adherence and associated hemoglobin A1c in type 2 diabetes. Annals of Pharmacotherapy, 38, 1357–1362.PubMedCrossRefGoogle Scholar
  40. Krishnan, L. L., Petersen, N. J., Snow, A. L., Cully, J. A., Schulz, P. E., Graham, D. P., et al. (2005). Prevalence of dementia among Veterans Affairs medical care system users. Dementia and Geriatric Cognitive Disorders, 20, 245–253.PubMedCrossRefGoogle Scholar
  41. Levine, A. J., Hinkin, C. H., Marion, S., Keuning, A., Castellon, S. A., Lam, M. M., et al. (2006). Adherence to antiretroviral medications in HIV: Differences in data collected via self-report and electronic monitoring. Health Psychology, 25, 329–335.PubMedCrossRefGoogle Scholar
  42. Luchsinger, J. A., Reitz, C., Honig, L. S., Tang, M. X., Shea, S., & Mayeux, R. (2005). Aggregation of vascular risk factors and risk of incident Alzheimer disease. Neurology, 65, 545–551.PubMedCrossRefGoogle Scholar
  43. MacKnight, C., Rockwood, K., Awalt, E., & McDowell, I. (2002). Diabetes mellitus and the risk of dementia, Alzheimer’s disease and vascular cognitive impairment in the Canadian Study of Health and Aging. Dementia and Geriatric Cognitive Disorders, 14, 77–83.PubMedCrossRefGoogle Scholar
  44. Middleton, L. E., & Yaffe, K. (2009). Promising strategies for the prevention of dementia. Archives of Neurology, 66, 1210–1215.PubMedCrossRefGoogle Scholar
  45. Miller, D. R., Safford, M. M., & Pogach, L. M. (2004). Who has diabetes? Best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient data. Diabetes Care, 27, B10–B21.PubMedCrossRefGoogle Scholar
  46. Narayan, K. M., Boyle, J. P., Geiss, L. S., Saaddine, J. B., & Thompson, T. J. (2006). Impact of recent increase in incidence on future diabetes burden: US, 2005–2050. Diabetes Care, 29, 2114–2116.PubMedCrossRefGoogle Scholar
  47. National Committee for Quality Assurance-HEDIS. (2010). Technical specifications (Vol. 2), Washington, DC.Google Scholar
  48. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2007). Retrieved from http://diabetes.niddk.nih.gov/dm/pubs/statistics/#allages
  49. Nicklett, E. J., & Liang, J. (2010). Diabetes-related support, regimen adherence, and health decline among older adults. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 65B, 390–399.CrossRefGoogle Scholar
  50. Okura, T., Heisler, M., & Langa, K. M. (2009). Association between cognitive function and social support with glycemic control in adults with diabetes mellitus. Journal of the American Geriatrics Society, 57, 1816–1824.PubMedCrossRefGoogle Scholar
  51. Pladevall, M., Williams, L. K., Potts, L. A., Divine, G., Xi, H., & Lafata, J. E. (2004). Clinical outcomes and adherence to medications measured by claims data in patients with diabetes. Diabetes Care, 27, 2800–2805.PubMedCrossRefGoogle Scholar
  52. Plassman, B. L., Langa, K. M., Fisher, G. G., Heeringa, S. G., Weir, D. R., Ofstedal, M. B., et al. (2007). Prevalence of dementia in the United States: The aging, demographics, and memory study. Neuroepidemiology, 29, 125–132.PubMedCrossRefGoogle Scholar
  53. Qaseem, A., Vijan, S., Snow, V., Cross, J. T., Weiss, K. B., & Owens, D. K. (2007). Glycemic control and type 2 diabetes mellitus: The optimal hemoglobin A1c targets. A guidance statement from the American College of Physicians. Annals of Internal Medicine, 147, 417–422.PubMedGoogle Scholar
  54. Rockwood, K., Middleton, L. E., Moorhouse, P. K., Skoog, I., & Black, S. E. (2009). The inclusion of cognition in vascular risk factor clinical practice guidelines. Journal of Clinical Interventions in Aging, 4, 425–433.Google Scholar
  55. Rosen, M. I., Beauvais, J. E., Rigsby, M. O., Salahi, J. T., Ryan, C. E., & Cramer, J. A. (2003). Neuropsychological correlates of suboptimal adherence to metformin. Journal of Behavioral Medicine, 26, 349–360.PubMedCrossRefGoogle Scholar
  56. Rosen, C. S., Chow, H. C., Greenbaum, M. A., Finney, J. F., Moos, R. H., Sheikh, J. I., et al. (2002). How well are clinicians following dementia practice guidelines? Alzheimer Disease Association Disorders, 16, 15–23.CrossRefGoogle Scholar
  57. Schnaider, B. M., Goldbourt, U., Silverman, J. M., Noy, S., Schmeidler, J., Ravona-Springer, R., et al. (2004). Diabetes mellitus in midlife and the risk of dementia three decades later. Neurology, 63, 1902–1907.Google Scholar
  58. Skaer, T. L., Sclar, D. A., Markowski, D. J., & Won, J. K. (1993). Effect of value-added utilities on prescription refill compliance and Medicaid health care expenditures—a study of patients with non-insulin-dependent diabetes mellitus. Journal of Clinical Pharmacy Therapeutics, 18, 295–299.CrossRefGoogle Scholar
  59. Stoehr, G. P., Lu, S. Y., Lavery, L., Bilt, J. V., Saxton, J. A., Chang, C. C., et al. (2008). Factors associated with adherence to medication regimens in older primary care patients: The Steel Valley Seniors Survey. American Journal of Geriatric Pharmacotherapy, 6, 255–263.PubMedCrossRefGoogle Scholar
  60. Veterans Administration/Department of Defense. (2010). Clinical practice guideline for the management of diabetes mellitus in primary care. Retrieved from http://www.healthquality.va.gov/diabetes_mellitus.asp
  61. Williams, P. G., Suchy, Y., & Rau, H. K. (2009). Individual differences in executive functioning: Implications for stress regulation. Annals of Behavioral Medicine, 37, 126–140.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2011

Authors and Affiliations

  • Denise G. Feil
    • 1
  • Carolyn W. Zhu
    • 2
  • David L. Sultzer
    • 1
  1. 1.Department of Psychiatry and Biobehavioral Sciences, Greater Los Angeles VA Healthcare System, West L.A. Veterans Health Care CenterUCLALos AngelesUSA
  2. 2.JJP VA Medical CenterMount Sinai School of MedicineManhattanUSA

Personalised recommendations