Cognitive dysfunction in older adults with diabetes: what a clinician needs to know
Abstract
One of the challenges of managing older adults with diabetes is the individualization of care in people with multiple comorbid conditions. Although macrovascular and microvascular complications of diabetes are well recognized, there is a lack of awareness regarding other conditions such as cognitive dysfunction, depression, and physical disabilities. Cognitive dysfunction is of particular importance because of its impact on self-care and quality of life. In this Perspective, I discuss common and practical questions faced by clinicians managing diabetes in older adults who also have cognitive dysfunction.
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Evidence is lacking regarding a known course of cognitive decline in diabetes.
“Declines have been shown to impact executive function and information processing speed; they are not consistent between people, and evidence is lacking regarding a known course of decline (426).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [426]
Cognitive declines in diabetes are not consistent between people.
“Declines have been shown to impact executive function and information processing speed; they are not consistent between people, and evidence is lacking regarding a known course of decline (426).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [426]
Cognitive declines in diabetes impact executive function and information processing speed.
“Declines have been shown to impact executive function and information processing speed; they are not consistent between people, and evidence is lacking regarding a known course of decline (426).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [426]
Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53221.x · Cited by 25,553 · see citing works
Diabetes mellitus and the risk of dementia: The Rotterdam Study
Ott, A., Stolk, R. P., van Harskamp, F., Pols, H. A. P., Hofman, A., & Breteler, M. M. B. (1999) · Neurology · doi:10.1212/wnl.53.9.1937 · Cited by 2,175 · see citing works
Kirkman, M. S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S., Korytkowski, M. T., Munshi, M. N., Odegard, P. S., et al. (2012) · Diabetes Care · doi:10.2337/dc12-1801 · Cited by 1,274 · see citing works
Self-citationType 2 Diabetes, APOE Gene, and the Risk for Dementia and Related Pathologies
Peila, R., Rodriguez, B. L., & Launer, L. J. (2002) · Diabetes · doi:10.2337/diabetes.51.4.1256 · Cited by 1,207 · see citing works
Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus
Whitmer, R. A. (2009) · JAMA · doi:10.1001/jama.2009.460 · Cited by 1,128 · see citing works
The Effects of Type 1 Diabetes on Cognitive Performance
Brands, A. M. A., Biessels, G. J., de Haan, E. H. F., Kappelle, L. J., & Kessels, R. P. C. (2005) · Diabetes Care · doi:10.2337/diacare.28.3.726 · Cited by 738 · see citing works
Long-term effect of diabetes and its treatment on cognitive function
(2007) · New England Journal of Medicine · doi:10.1056/nejmoa066397 · Cited by 646 · see citing works
Launer, L. J., Miller, M. E., Williamson, J. D., Lazar, R. M., Gerstein, H. C., Murray, A. M., Sullivan, M., Horowitz, K. R., Ding, J., Marcovina, S., et al. (2011) · The Lancet Neurology · doi:10.1016/s1474-4422(11)70188-0 · Cited by 574 · see citing works
Cukierman‐Yaffe, T., Gerstein, H. C., Williamson, J. D., Lazar, R. M., Lovato, L., Miller, M. E., Coker, L. H., Murray, A. M., Sullivan, M. D., Marcovina, S. M., et al. (2009) · Diabetes Care · doi:10.2337/dc08-1153 · Cited by 452 · see citing works
Diabetes in Midlife and Cognitive Change Over 20 Years: A Cohort Study
Rawlings, A. M., Sharrett, A. R., Schneider, A. L. C., Coresh, J., Albert, M., Couper, D., Griswold, M., Gottesman, R. F., Wagenknecht, L. E., Windham, B. G., et al. (2014) · Annals of Internal Medicine · doi:10.7326/m14-0737 · Cited by 447 · see citing works
Yaffe, K. S. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.6176 · Cited by 434 · see citing works
Sinclair, A., Morley, J. E., Rodriguez-Mañas, L., Paolisso, G., Bayer, T., Zeyfang, A., Bourdel-Marchasson, I., Vischer, U., Woo, J., Chapman, I., et al. (2012) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2012.04.012 · Cited by 422 · see citing works
Glucose tolerance status and risk of dementia in the community
Ohara, T., Doi, Y., Ninomiya, T., Hirakawa, Y., Hata, J., Iwaki, T., Kanba, S., & Kiyohara, Y. (2011) · Neurology · doi:10.1212/wnl.0b013e31822f0435 · Cited by 420 · see citing works
Potential overtreatment of diabetes mellitus in older adults with tight glycemic control
Lipska, K. J., Ross, J. S., Miao, Y., Shah, N. D., Lee, S. J., & Steinman, M. A. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.7345 · Cited by 408 · see citing works
Risk factors for progression of brain atrophy in aging
Enzinger, C., Fazekas, F., Matthews, P. M., Ropele, S., Schmidt, H., Smith, S. M., & Schmidt, R. (2005) · Neurology · doi:10.1212/01.wnl.0000161871.83614.bb · Cited by 397 · see citing works
Cognitive Dysfunction Is Associated With Poor Diabetes Control in Older Adults
Munshi, M. N., Grande, L. J., Hayes, M., Ayres, D., Suhl, E., Capelson, R., Lin, S. X., Milberg, W., & Weinger, K. (2006) · Diabetes Care · doi:10.2337/dc06-0506 · Cited by 371 · see citing works
Self-citationCommon pathological processes in Alzheimer disease and type 2 diabetes: A review
Li, L., & Hölscher, C. (2007) · Brain Research Reviews · doi:10.1016/j.brainresrev.2007.09.001 · Cited by 367 · see citing works
Sinclair, A. J., Girling, A. J., & Bayer, A. J. (2000) · Diabetes Research and Clinical Practice · doi:10.1016/s0168-8227(00)00195-9 · Cited by 362 · see citing works
Poor Cognitive Function and Risk of Severe Hypoglycemia in Type 2 Diabetes
Punthakee, Z., Miller, M. E., Launer, L. J., Williamson, J. D., Lazar, R. M., Cukierman-Yaffee, T., Seaquist, E. R., Ismail-Beigi, F., Sullivan, M. D., Lovato, L. C., et al. (2012) · Diabetes Care · doi:10.2337/dc11-1855 · Cited by 337 · see citing works
Munshi, M. N., Florez, H., Huang, E. S., Kalyani, R. R., Mupanomunda, M., Pandya, N., Swift, C. S., Taveira, T. H., & Haas, L. B. (2016) · Diabetes Care · doi:10.2337/dc15-2512 · Cited by 243 · see citing works
Self-citationRizzo, M. R., Marfella, R., Barbieri, M., Boccardi, V., Vestini, F., Lettieri, B., Canonico, S., & Paolisso, G. (2010) · Diabetes Care · doi:10.2337/dc10-0389 · Cited by 213 · see citing works
Enhancement of Vasoreactivity and Cognition by Intranasal Insulin in Type 2 Diabetes
Novak, V., Milberg, W., Hao, Y., Munshi, M. N., Novák, P., Galica, A. M., Manor, B., Roberson, P. K., Craft, S., & Abduljalil, A. (2013) · Diabetes Care · doi:10.2337/dc13-1672 · Cited by 207 · see citing works
Self-citationManschot, S., Biessels, G. J., de Valk, H. W., Algra, A., Rutten, G. E. H. M., van der Grond, J., Kappelle, L. J., & on behalf of the Utrecht Diabetic Encephalopathy Study Group (2007) · Diabetologia · doi:10.1007/s00125-007-0792-z · Cited by 198 · see citing works
Frequent Hypoglycemia Among Elderly Patients With Poor Glycemic Control
Munshi, M. N. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.539 · Cited by 196 · see citing works
Self-citationA look inside the diabetic brain: Contributors to diabetes-induced brain aging
Wrighten, S. A., Piroli, G. G., Grillo, C. A., & Reagan, L. P. (2009) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2008.10.013 · Cited by 195 · see citing works
Williamson, J. D., Launer, L. J., Bryan, R. N., Coker, L. H., Lazar, R. M., Gerstein, H. C., Murray, A. M., Sullivan, M. D., Horowitz, K. R., Ding, J., et al. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.13656 · Cited by 187 · see citing works
Feinkohl, I., Price, J. F., Strachan, M. W. J., & Frier, B. M. (2015) · Alzheimer s Research & Therapy · doi:10.1186/s13195-015-0130-5 · Cited by 183 · see citing works
Risk factors associated with severe hypoglycemia in older adults with type 1 diabetes
Weinstock, R. S., DuBose, S. N., Bergenstal, R. M., Chaytor, N. S., Peterson, C., Olson, B. A., Munshi, M. N., Perrin, A. J. S., Miller, K. M., Beck, R. W., et al. (2016) · Diabetes Care · doi:10.2337/dc15-1426 · Cited by 171 · see citing works
Self-citationJacobson, A. M., Ryan, C. M., Cleary, P. A., Waberski, B. H., Weinger, K., Musen, G., & Dahms, W. T. (2010) · Diabetologia · doi:10.1007/s00125-010-1883-9 · Cited by 170 · see citing works
Brands, A. M. A., Kessels, R. P. C., Hoogma, R. P. L. M., Henselmans, J. M. L., Boter, J. W. V. D. B., Kappelle, L. J., de Haan, E. H. F., & Biessels, G. J. (2006) · Diabetes · doi:10.2337/db05-1226 · Cited by 167 · see citing works
Sussman, J. B., Kerr, E. A., Saini, S. D., Holleman, R. G., Klamerus, M. L., Min, L. C., Vijan, S., & Hofer, T. P. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.5110 · Cited by 160 · see citing works
Okereke, O. I., Kang, J. H., Cook, N. R., Gaziano, J. M., Manson, J. E., Buring, J. E., & Grodstein, F. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.01686.x · Cited by 155 · see citing works
Thorpe, C. T., Gellad, W. F., Good, C. B., Zhang, S., Zhao, X., Mor, M., & Fine, M. J. (2015) · Diabetes Care · doi:10.2337/dc14-0599 · Cited by 140 · see citing works
Dubowitz, N., Xue, W., Long, Q., Ownby, J. G., Olson, D. E., Barb, D., Rhee, M. K., Mohan, A. V., Watson-Williams, P. I., Jackson, S. L., et al. (2014) · Diabetic Medicine · doi:10.1111/dme.12459 · Cited by 140 · see citing works
Sullivan, M. D., Katon, W. J., Lovato, L., Miller, M. E., Murray, A. M., Horowitz, K. R., Bryan, R. N., Gerstein, H. C., Marcovina, S. M., Akpunonu, B. E., et al. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.1965 · Cited by 130 · see citing works
Simplification of insulin regimen in older adults and risk of hypoglycemia
Munshi, M. N., Slyne, C., Segal, A. R., Saul, N., Lyons, C., & Weinger, K. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.2288 · Cited by 124 · see citing works
Self-citationStrachan, M. W. J. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2010.03199.x · Cited by 115 · see citing works
Brands, A. M. A., Biessels, G. J., Kappelle, L. J., de Haan, E. H. F., de Valk, H. W., Algra, A., & Kessels, R. P. C. (2007) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000100980 · Cited by 103 · see citing works
Aung, P. P., Strachan, M. W. J., Frier, B. M., Butcher, I., Deary, I. J., Price, J. F., & on behalf of the Edinburgh Type 2 Diabetes Study Investigators (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03505.x · Cited by 95 · see citing works
The influence of cognition on self-management of type 2 diabetes in older people
Sinclair, & Tomlin, A. (2016) · Psychology Research and Behavior Management · doi:10.2147/prbm.s36238 · Cited by 93 · see citing works
Self management and patient understanding of diabetes in the older person
Hewitt, J., Smeeth, L. L., Chaturvedi, N., Bulpitt, C. J., & FLETCHER, A. E. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2010.03142.x · Cited by 79 · see citing works
Glycated haemoglobin and cognitive decline: the Atherosclerosis Risk in Communities (ARIC) study
Christman, A. L., Matsushita, K., Gottesman, R. F., Mosley, T. H., Alonso, Á., Coresh, J., Hill‐Briggs, F., Sharrett, A. R., & Selvin, E. (2011) · Diabetologia · doi:10.1007/s00125-011-2095-7 · Cited by 77 · see citing works
Umegaki, H. (2009) · Age and Ageing · doi:10.1093/ageing/afp211 · Cited by 63 · see citing works
Neuropsychological Correlates of Suboptimal Adherence to Metformin
Rosen, M. I., Beauvais, J. E., Rigsby, M. O., Salahi, J. T., Ryan, C. E., & Cramer, J. A. (2003) · Journal of Behavioral Medicine · doi:10.1023/a:1024257027839 · Cited by 58 · see citing works
Sinclair, A. J., Gadsby, R., Hillson, R., Forbes, A., & Bayer, A. J. (2013) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2013.01.001 · Cited by 52 · see citing works
The Role of Cognitive Impairment and Caregiver Support in Diabetes Management of Older Outpatients
Feil, D. G., Pearman, A. M., Victor, T. L., Harwood, D. G., Weinreb, J. E., Kahle‐Wrobleski, K., & Unützer, J. (2009) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.39.2.h · Cited by 51 · see citing works
Impact of Nutrition on Cerebral Circulation and Cognition in the Metabolic Syndrome
Mellendijk, L., Wiesmann, M., & Kiliaan, A. J. (2015) · Nutrients · doi:10.3390/nu7115477 · Cited by 43 · see citing works
Potentials of incretin‐based therapies in dementia and stroke in type 2 diabetes mellitus
Groeneveld, O. N., Kappelle, L. J., & Biessels, G. J. (2015) · Journal of Diabetes Investigation · doi:10.1111/jdi.12420 · Cited by 41 · see citing works
Shortfalls of the use of HbA1C-derived eAG in older adults with diabetes
Munshi, M. N., Segal, A. R., Slyne, C., Samur, A. A., Brooks, K. M., & Horton, E. S. (2015) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2015.07.012 · Cited by 37 · see citing works
Self-citationAccuracy of Self-Monitored Blood Glucose in Type 2 Diabetes
Kazlauskaite, R., Soni, S., Evans, A. T., Graham, K., & Fisher, B. (2009) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2008.0111 · Cited by 37 · see citing works
Kuan, Y., Huang, K.-W., Yen, D., Hu, C., Lin, C., & Kao, C. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.06.215 · Cited by 31 · see citing works
Whitmer, R. A., Biessels, G. J., Quesenberry, C. P., et al. (2015) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2015.07.046 · Cited by 9 · see citing works
Samieri, C., Morris, M. L., Bennett, D. A., et al. (2015) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2015.07.146 · Cited by 5 · see citing works
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- Authors
- Munshi, M. N.
- Affiliations
- Joslin Diabetes Center (US)
- Corresponding author
- Munshi, Medha N.
- ORCID
- Munshi, Medha N.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2017-03-10
- Volume
- 40
- Issue
- 4
- Pages
- 461-467
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2600024976
- Cited by
- 255
- References
- 54
- Citations by year
- 2026: 17 · 2025: 22 · 2024: 23 · 2023: 29 · 2022: 49 · 2021: 36 · 2020: 31 · 2019: 27 · 2018: 17 · 2017: 4
- FWCI
- 17.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- cognitive impairment, older adults, diabetes mellitus, depression, physical disability, self-care, quality of life, comorbidities, individualized care, clinical management
- MeSH terms
- Adult, Blood Glucose, Diabetes Mellitus, Type 2, Follow-Up Studies, Humans, Middle Aged, Prospective Studies, Quality of Life, Self Care, Prevalence, Cognitive Dysfunction
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