Cognitive impairment in type 2 diabetes : Opportunities for diagnosis, prevention and management

In the Netherlands, hundreds of thousands of people aged 70 years or older are currently living with type 2 diabetes, and these numbers are expected to increase further. Older people with type 2 diabetes have an increased risk of cognitive impairment, including both mild cognitive impairment and dementia. We studied the impact of cognitive impairment on people with type 2 diabetes. We found that, besides a higher risk of cardiovascular events and death, people with diabetes have more depressive symptoms and visit the emergency room and the general practice out-of-hours services more often when they have cognitive impairment. We conclude that this is a vulnerable group that may benefit from tailored diabetes care. We also investigated possible starting points for the prevention of cognitive impairment in type 2 diabetes. We found that both low and high mean blood glucose levels are related to poor cognitive functioning, particularly in older women. Furthermore, we focused on the question “how should general practitioners identify cognitive impairment?”. Until now, all people who visit their general practitioner with cognitive complaints are offered the same cognitive test, the MMSE. Using three different cognitive tests (the clock-drawing-test, the MoCA and the MMSE), with the choice of the test depending on the chance that the patient has cognitive impairment, offers the opportunity to provide people more accurate answers to questions about their cognitive functioning. Finally, we demonstrated that the ‘Test-Your-Memory’ and ‘Self-Administered-Gerocognitive-Examination’ are suitable tests to screen for cognitive impairment in people with type 2 diabetes.