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Segev O, Raz I, Gerstein HC, Aviezer H, Sela Y, Cukierman D, Shankar R, Natovich R, Cukierman-Yaffe T. Development and first-stage validation of a digital version of the Digit Symbol Substitution test for use in assessing cognitive function in older people with diabetes. Diabetes Obes Metab 2024. [PMID: 38757537 DOI: 10.1111/dom.15657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
AIMS To describe the development and report the first-stage validation of a digital version of the digit symbol substitution test (DSST), for assessment of cognitive function in older people with diabetes. MATERIALS AND METHODS A multidisciplinary team of experts was convened to conceptualize and build a digital version of the DSST and develop a machine-learning (ML) algorithm to analyse the inputs. One hundred individuals with type 2 diabetes (aged ≥ 60 years) were invited to participate in a one-time meeting in which both the digital and the pencil-and-paper (P&P) versions of the DSST were administered. Information pertaining to demographics, laboratory measurements, and diabetes indices was collected. The correlation between the digital and P&P versions of the test was determined. Additionally, as part of the validation process, the performance of the digital version in people with and without known risk factors for cognitive impairment was analysed. RESULTS The ML model yielded an overall accuracy of 89.1%. A strong correlation was found between the P&P and digital versions (r = 0.76, p < 0.001) of the DSST, as well as between the ML model and the manual reading of the digital DSST (r = 0.99, p < 0.001). CONCLUSIONS This study describes the development of and provides first-stage validation data for a newly developed digital cognitive assessment tool that may be used for screening and surveillance of cognitive function in older people with diabetes. More studies are needed to further validate this tool, especially when self-administered and in different clinical settings.
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Affiliation(s)
- Omri Segev
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Raz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel
| | - Hertzel C Gerstein
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Science, Hamilton, Ontario, Canada
| | - Hillel Aviezer
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Sela
- Nursing Sciences Department, Faculty of Social and Community Sciences, Ruppin Academic Center, Emeq Hefer, Israel
| | - Dani Cukierman
- The Rehabilitation Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | | | | | - Tali Cukierman-Yaffe
- Epidemiology Department, School of Public Health, Faculty of Medicine, Herczeg Institute on Aging, Tel-Aviv University, Tel-Aviv, Israel
- Division of Endocrinology & Metabolism Sheba Medical Center, Ramat-Gan, Israel
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Brzecka A, Madetko N, Nikolenko VN, Ashraf GM, Ejma M, Leszek J, Daroszewski C, Sarul K, Mikhaleva LM, Somasundaram SG, Kirkland CE, Bachurin SO, Aliev G. Sleep Disturbances and Cognitive Impairment in the Course of Type 2 Diabetes-A Possible Link. Curr Neuropharmacol 2020; 19:78-91. [PMID: 32148197 PMCID: PMC7903492 DOI: 10.2174/1570159x18666200309101750] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
There is an increasing number of patients worldwide with sleep disturbances and diabetes. Various sleep disorders, including long or short sleep duration and poor sleep quality of numerous causes, may increase the risk of diabetes. Some symptoms of diabetes, such as painful peripheral neuropathy and nocturia, or associated other sleep disorders, such as sleep breathing disorders or sleep movement disorders, may influence sleep quality and quantity. Both sleep disorders and diabetes may lead to cognitive impairment. The risk of development of cognitive impairment in diabetic patients may be related to vascular and non-vascular and other factors, such as hypoglycemia, hyperglycemia, central insulin resistance, amyloid and tau deposits and other causes. Numerous sleep disorders, e.g., sleep apnea, restless legs syndrome, insomnia, and poor sleep quality are most likely are also associated with cognitive impairment. Adequate functioning of the system of clearance of the brain from toxic substances, such as amyloid β, i.e. glymphatic system, is related to undisturbed sleep and prevents cognitive impairment. In the case of coexistence, sleep disturbances and diabetes either independently lead to and/or mutually aggravate cognitive impairment.
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Affiliation(s)
- Anna Brzecka
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Natalia Madetko
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Vladimir N Nikolenko
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russian Federation
| | - Ghulam M Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Leszek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Cyryl Daroszewski
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Sarul
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Liudmila M Mikhaleva
- Research Institute of Human Morphology,3 Tsyurupy Street, Moscow, 117418, Russian Federation
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem, WV, 26426, United States
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV, 26426, United States
| | - Sergey O Bachurin
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, 142432, Russian Federation
| | - Gjumrakch Aliev
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya Str., Moscow, 119991, Russian Federation
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Natovich R, Gayus N, Azmon M, Michal H, Gury Twito O, Yair T, Raudoi S, Kapra O, Cukierman-Yaffe T. A Comprehensive Intervention for Promoting Successful Aging Amongst Older People With Diabetes With Below-Normal Cognitive Function-A Feasibility Study. Front Endocrinol (Lausanne) 2020; 11:348. [PMID: 32670196 PMCID: PMC7326129 DOI: 10.3389/fendo.2020.00348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/04/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Older people with diabetes have an increased risk for disability and cognitive dysfunction, which may impede self-care capacity. These are not evaluated routinely in current health systems. In the Center for Successful Aging with Diabetes, patients over the age of 60 undergo multi-disciplinary evaluation days and are provided with an integrated (cognitive, physical, nutritional, and medical) treatment plan. Among individuals with below-normal cognitive function, self-adherence to these recommendations poses a challenge. Thus, the aim of this study was to test the feasibility of a multidisciplinary intervention amongst older people with diabetes with below-normal cognitive function and sub-optimal glucose control. Methods: Patients with a MoCA score under 26 and A1C >= 7.5% participated in a two-arm intervention: (A) a medical intervention: monthly meetings with a diabetes nurse-educator, supervised by a diabetes specialist and study psychologist during which changes in their pharmacological regimen of glucose, blood pressure, and lipid control were made and (B) a cognitive/physical rehabilitation intervention. This arm consisted of (1) an intensive phase-group meetings which included computerized cognitive training, aerobic, balance, and strength exercise, and group discussions and (2) a monthly consolidation phase. Outcomes included change in A1C, change in strength, balance, and aerobic exercise capacity as well as change in quality of life. Results: After 12 months there was a 0.7% reduction in A1C. After 3 months there was a statistically significant improvement in physical indices, including aerobic capacity (6-min walk), balance (FSST) and indices assessing the risk of fall (10-meter walk, time up and go). There was no additional improvement in physical indices between the 3 and 12 month visits. For some of the physical measures, the improvement observed after 3 months persisted partially to the 12-month visit. Conclusions: This feasibility study provides preliminary data that support the efficacy of the complex interventions described. The findings suggest that this older population would require an ongoing "intensive phase" intervention. Larger prospective randomized trials are needed.
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Affiliation(s)
- Rachel Natovich
- Endocrinology Division, The Center for Successful Aging With Diabetes, Sheba Medical Center, Gertner Institute, Ramat Gan, Israel
- Sheba Medical Center, The Rehabilitation Hospital, Ramat Gan, Israel
| | - Noa Gayus
- Endocrinology Division, The Center for Successful Aging With Diabetes, Sheba Medical Center, Gertner Institute, Ramat Gan, Israel
| | - Michal Azmon
- The Physiotherapy Department, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Hila Michal
- Endocrinology Division, The Center for Successful Aging With Diabetes, Sheba Medical Center, Gertner Institute, Ramat Gan, Israel
| | - Omri Gury Twito
- Endocrinology Division, The Center for Successful Aging With Diabetes, Sheba Medical Center, Gertner Institute, Ramat Gan, Israel
- Sheba Medical Center, The Rehabilitation Hospital, Ramat Gan, Israel
| | - Tomer Yair
- Endocrinology Division, The Center for Successful Aging With Diabetes, Sheba Medical Center, Gertner Institute, Ramat Gan, Israel
| | - Svetlana Raudoi
- Endocrinology Division, The Center for Successful Aging With Diabetes, Sheba Medical Center, Gertner Institute, Ramat Gan, Israel
| | - Ori Kapra
- Endocrinology Division, The Center for Successful Aging With Diabetes, Sheba Medical Center, Gertner Institute, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Endocrinology Division, The Center for Successful Aging With Diabetes, Sheba Medical Center, Gertner Institute, Ramat Gan, Israel
- The Epidemiology Department, Sackler School of Medicine, The Herczeg Institute on Aging, Tel-Aviv University, Ramat Gan, Israel
- *Correspondence: Tali Cukierman-Yaffe
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Mordenfeld N, Gayus N, Azmon M, Guri-Twito O, Yahalom Peri T, Natovich R, Cukierman-Yaffe T. Determining the Optimal Cognitive Screening Tool in Older People With Diabetes. Front Endocrinol (Lausanne) 2020; 11:322. [PMID: 32528414 PMCID: PMC7258911 DOI: 10.3389/fendo.2020.00322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Self-care is an important perspective to aging and transitional states in diabetes management. Population studies have shown that lower cognitive function is associated with worse self-care abilities. Several guidelines have emphasized the importance of assessing cognitive function in older people with diabetes and tailoring treatment plan accordingly. Those guidelines do not specify which tools are the most appropriate for this population. One approach to delineate which tools should be used is to assess which tools best correlate with self-care capacity. Objective: To assess which cognitive assessment tools best correlate with self-care capacity in older people with type 2 diabetes. Methods: Cross-sectional study, conducted amongst individuals with diabetes over the age of 60. The association between self-care capacity indices and different cognitive assessment tools was examined. Principal Component self-care constructs were determined and the association between these and the different cognitive assessment tools was examined. Results: A significant association was found between the Principal Component self-care construct and the Montreal Cognitive Assessment and MindstreamsTM scores. In a stepwise regression model including only the Montreal Cognitive Assessment score, a significant association was found between this score and the Principal Component self-care construct. The same was not found in a model that included only the MindstreamsTM scores. Conclusions: The Montreal Cognitive Assessment, previously validated as a brief cognitive screening tool, may be useful as an adjunct to assess the self-care capacity of older individuals with diabetes. Future studies in the clinic are needed to evaluate if using this tool may improve treatment plans.
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Affiliation(s)
- Nadia Mordenfeld
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
- The Epidemiology Department, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- *Correspondence: Nadia Mordenfeld
| | - Noa Gayus
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
| | - Michal Azmon
- The Physiotherapy Department, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Omri Guri-Twito
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
| | - Tal Yahalom Peri
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
| | - Rachel Natovich
- The Rehabilitation Hospital, Sheba Medical Center, Rama Gan, Israel
| | - Tali Cukierman-Yaffe
- The Center for Successful Aging With Diabetes, Sheba Medical Center, Endocrinology Institute, Rama Gan, Israel
- The Epidemiology Department, Sackler School of Medicine, Herczeg Institute on Aging, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Maghsoudi Z, Razavi Z, Razavi M, Javadi M. Efficacy Of Acceptance And Commitment Therapy For Emotional Distress In The Elderly With Type 2 Diabetes: A Randomized Controlled Trial. Diabetes Metab Syndr Obes 2019; 12:2137-2143. [PMID: 31802921 PMCID: PMC6802537 DOI: 10.2147/dmso.s221245] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/02/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Diabetes is among the common diseases in the elderly which results in depression, anxiety, and emotional distress in the elderly and impacts the disease control by the individual. This study was conducted with the aim of exploring the effectiveness of acceptance and commitment therapy (ACT) in the improvement of emotional distress in the elderly with type 2 diabetes. MATERIALS AND METHODS In this randomized control trial, 80 elderly with type 2 diabetes aged ≥60 years were randomly selected among the individuals visiting Yazd Diabetes Research Center. Then, the patients were randomly divided into two 40 individual groups, ie, the intervention group and the control group. The intervention group underwent group ACT during eight 90-min sessions. The diabetes-related emotional distress questionnaire was completed before the intervention, after the end of the group sessions and 2 months after that. The statistical software SPSS version 21 was used for data analysis. RESULTS The emotional mean scores in the intervention and control groups were not significantly different before the intervention. However, the mean score of the intervention group was lower than of the control group immediately after the intervention (p=0.02) and 2 months after the intervention (p=0.02). CONCLUSION ACT results in the improvement of diabetes-related emotional distress in the intervention group. Considering the effectiveness of ACT, this therapeutic method is recommended to be used for the amelioration of emotional distress in the elderly with type 2 diabetes.
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Affiliation(s)
- Zahra Maghsoudi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mohammadreza Razavi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mostafa Javadi
- Research Centre for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Azmon M, Gayus N, Michal H, Olmer L, Cukierman-Yaffe T. The Association between Glucose Control and Functional Indices in Older People with Diabetes. Int J Endocrinol 2018; 2018:1053815. [PMID: 30675156 PMCID: PMC6323481 DOI: 10.1155/2018/1053815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022] Open
Abstract
Diabetes may be viewed as a disease of accelerated aging as it is a risk factor for physical disability and impairment in simple and complex activities, and is a higher risk for falls and fractures. Data from the last several years suggests that this increased risk is due not only to recognized diabetes complications but also to an accelerated decline in physical capacity due to lower muscle quality and a more rapid decline in muscle mass and lower extremity strength over time. Aim. To find the association between glucose control and functional indices. Methods. A cross-sectional study conducted at the Center for Successful Aging with Diabetes at the Sheba Medical Center. Individuals with a diagnosis of type 2 diabetes over the age of 60 were included. Functional status was assessed using tools that assess aerobic, strength, and balance capacities. Medical assessment was conducted through interview, physical examination, and collection of information from medical records. The association between functional indices and A1C was assessed using linear regression. Results. 153 consecutive individuals were evaluated. There was an inverse association between A1C and score achieved on the 6-minute walk; with increasing meters walked on the 6-minute walk test, there was a reduction in A1C (p = 0.003). There was also an inverse association with the 10-meter walk (p = 0.007), BERG balance test (p = 0.0006), and timed up and go (p = 0.01). Conclusion. In this cohort of older people with diabetes, there was an association between A1C and measures of functional indices. Future studies of glucose-lowering medication should include physical and functional assessment.
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Affiliation(s)
- M. Azmon
- Physiotherapy Department, Ariel University, Ariel, Israel
- The “Segal” Center for Successful Aging with Diabetes, Endocrinology Institute, Sheba Medical Center, Israel
| | - N. Gayus
- The “Segal” Center for Successful Aging with Diabetes, Endocrinology Institute, Sheba Medical Center, Israel
| | - H. Michal
- The “Segal” Center for Successful Aging with Diabetes, Endocrinology Institute, Sheba Medical Center, Israel
| | - L. Olmer
- The “Segal” Center for Successful Aging with Diabetes, Endocrinology Institute, Sheba Medical Center, Israel
| | - T. Cukierman-Yaffe
- The “Segal” Center for Successful Aging with Diabetes, Endocrinology Institute, Sheba Medical Center, Israel
- The Epidemiology Department, Sackler School of Medicine, Tel-Aviv University, Israel
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