Perceived cognitive deficits are associated with diabetes self-management in a multiethnic sample

The impact of musical reward responses on cognitive function in older adults with type 2 diabetes

Cognitive decline is prevalent in older adults with type 2 diabetes (T2DM). The use of music has emerged to improve cognitive health. Even though reward from music has been shown to improve cognitive function, no studies have focused on specific factors of musical reward. This study investigated which factors of musical reward impact cognitive function in older adults with T2DM. A secondary data analysis was conducted with 185 older adults with T2DM and subjective cognitive decline. Among the musical reward factors, mood regulation significantly influenced subjective cognitive function (β = 0.315; p < 0.001). The findings suggest that music interventions for older adults with T2DM may need to focus on managing their psychological states for the intervention to have beneficial effects on cognitive function. Future rigorous studies with larger sample sizes should be done to obtain robust evidence for optimal music interventions for older adults with T2DM.

Cognitive Function and Self-Management Behaviors in Older Adults With Type 2 Diabetes

BACKGROUND

Type 2 diabetes (T2D) is strongly associated with cognitive impairment. Decreased cognitive function could affect daily self-management behaviors critical for people with T2D. Executive function is significant for daily self-management, and decreased subjective cognitive function could be an early indicator of poor daily self-management. However, little is known about whether executive or subjective cognitive function affects daily self-management behaviors in older adults.

OBJECTIVES

We investigated the effect of executive function or subjective cognitive function on daily self-management behaviors (diet, glucose management, physical activity, and physician contact) in older adults with T2D.

METHODS

We used a cross-sectional, observational design with convenience sampling of 84 adults aged ≥60 years with T2D. Telephone-administered cognitive function tests measured participants' overall cognitive and executive function levels. Subjective cognitive function, diabetes self-management, and covariates, including demographic information (age, gender, race/ethnicity, and level of education), body mass index, depressive symptoms, and diabetes duration, were assessed using online surveys. Data were analyzed using bivariate correlation and backward stepwise regression.

RESULTS

The mean age of the sample was 68.46 ± 5.41 years. Participants were predominantly female and White, and the majority had normal cognitive function. Controlling for demographics, body mass index, depressive symptoms, and diabetes duration, a decrease in executive function indicated by a greater number of errors made during the telephone-administered Oral Trail Making Test Part B relative to the sample was associated with poorer adherence to physician contact behaviors. Subjective cognitive function was not associated with any self-management behaviors.

DISCUSSION

A reduction in executive function was associated with poorer adherence to physician contact behaviors in older adults with T2D and normal cognitive function; lack of adherence to physician contact behaviors could be an early indicator of declining cognitive function. Difficulties or changes in routine diabetes self-management behaviors should be closely monitored in older adults. Cognitive assessment should be followed when needed.

Perceptions and responses to cognitive decline in people with diabetes: A systematic review of qualitative studies

Objective

We aimed at summarizing the perceptions and responses to cognitive decline, assessing the disease management, identifying deficiencies and proposing new strategies for improvement in people with diabetes (PWDs).

Methods

A comprehensive search was performed in the following nine databases: PubMed, EMBASE, Web of Science, The Cochrane Library, PsycINFO, CINAHL, WanFang, CNKI, and VIP. The Joanna Briggs Institute (JBI) Critical Appraisal Tool for qualitative research was utilized to evaluate the quality of included studies. Descriptive texts and quotations relating to patient experience were extracted from the included studies and thematically analyzed.

Results

Eight qualitative studies met the inclusion criteria and 2 overarching themes were identified: (1) self-perception of cognitive decline referred to perceived cognitive symptoms, lack of knowledge and, impaired self-management and coping in multiple methods; (2) reported benefits of cognitive interventions referred to how cognitive interventions improved disease management, attitudes and needs of PWDs.

Conclusion

PWDs described misconceptions about their cognitive decline and suffered from them during disease management. This study provides a patient-specific reference for cognitive screening and intervention in PWDs, supporting disease management with cognitive decline in clinical practice.

Executive function predict the quality of life and negative emotion in older adults with diabetes: A longitudinal study

AIMS

To investigate the influence of executive function (EF) on current and future quality of life (QoL) and negative emotion (NE) in older adults with diabetes.

METHODS

A total of 128 older adults with diabetes were recruited. Independent variables (demographic information, health and medical conditions, cognitive function, life function) were collected in the first year. Dependent variables (QoL and NE) were collected for 3 years. Pearson's correlation coefficient analysis and stepwise multiple linear regression analysis were performed to identify the predictors of QoL and NE.

RESULTS

EF was the strongest predictor for overall QoL and NE in all 3 years, and accounted for 23.0-36.2% and 11.1-17.1% of the variance, respectively. The second strongest predictor for overall QoL in all 3 years was pain interference, which accounted for 3.2-5.8% of the variance. Pain interference was also the second strongest predictor for NE in the second year, accounting for 5.5% of the variance.

CONCLUSIONS

The present study revealed that EF is more predictive than pain for current and future QoL and NE in older adults with diabetes. We recommend that EF be included as an indicator for diabetes surveillance, and that prevention of EF decline be a part of diabetes management plans.

FEASibility testing a randomized controlled trial of an exercise program to improve cognition for T2DM patients (the FEAST trial): A study protocol

While cognitive dysfunction is an important concern in persons with type 2 diabetes mellitus (T2DM), it has received little attention in the T2DM literature. Although it often remains unrecognized, cognitive dysfunction associated with T2DM can lead to severe consequences. Prior research studies have consistently shown that aerobic exercise enhances cognitive function among healthy subjects. However, very few studies have examined the effects of aerobic exercise on cognitive function in persons with T2DM. In addition, one important single-nucleotide polymorphism that influences cognition in humans is the brain-derived neurotrophic factor (BDNF) Val66Met variant. Despite strong evidence suggesting aerobic exercise has a beneficial effect on cognitive function, there is significant variability in individual response to exercise programs on cognitive outcomes among Val/Val versus Met carriers. However, the evidence on how the BDNF Val66Met variant influences cognitive outcomes following an aerobic exercise intervention among individuals with T2DM is currently lacking. Therefore, the purpose of this randomized controlled trial is to pilot-test a 3-month supervised exercise program to improve plasma BDNF levels and cognition, overall and according to genotypes of the BDNF Val66Met variant. A total of 81 patients with T2DM will be randomly assigned to either aerobic exercise group (n = 54) or attention control group (n = 27) for 3 months. Outcomes of interest include postintervention changes in plasma BDNF levels, fasting blood glucose, hemoglobin A1c, body mass index, executive function, memory, and processing speed. This study will provide further evidence on use of exercise as a non-pharmaceutical, low-cost intervention to improve cognition in this population.

Life satisfaction and emotional distress in people living with type 2 diabetes mellitus: The mediating effect of cognitive function

AIMS AND OBJECTIVES

To explore the relationships among emotional distress, cognitive function and life satisfaction in people living with type 2 diabetes mellitus (T2DM), and to verify the mediating role of cognitive function.

BACKGROUND

People with T2DM face cognitive decline caused by age and disease complications. Emotional distress will reduce their life satisfaction, and cognitive function will also affect the life satisfaction, but whether cognitive function mediates the effect of emotional distress on life satisfaction has not been verified.

DESIGN

A cross-sectional study.

METHODS

A total of 200 people living with T2DM in the community by convenience sampling were enrolled from November-December 2018. Data collection involved a demographic and disease characteristic questionnaire, Problem Areas in Diabetes Scale, Subjective and Objective Cognitive Function Evaluation and Life Satisfaction Questionnaire. Data analysis included descriptive statistics and structural equation modelling. This report followed the STROBE guideline.

RESULTS

The emotional distress and subjective memory complaints of cognitive function had a significant positive correlation, while both emotional distress and cognitive function showed significant negative correlations with life satisfaction. In addition, cognitive function completely mediated the relationship between emotional distress and life satisfaction.

CONCLUSION

The cognitive function played a mediating role in life satisfaction and explains how emotional distress affects life satisfaction of people with T2DM. Therefore, it is suggested that diabetes nurses should early identify the decline of cognitive function, and to intervene at an early stage.

RELEVANCE TO CLINICAL PRACTICE

This study provides opinions on the mediating factors of cognitive function. Coping strategies and supporting resources to help the T2DM people to improve their life satisfaction are suggested.

Effects of Berberine on Diabetes and Cognitive Impairment in an Animal Model: The Mechanisms of Action

Diabetes is a group of metabolic disorders with an increased risk of developing cognitive impairment and dementia. The hippocampus in the forebrain contains an abundance of insulin receptors related to cognitive function and plays an important role in the pathophysiology of neurodegenerative disorders. Berberine from traditional Chinese medicine has been used to treat diabetes and diabetic cognitive impairment, although its related mechanisms are largely unknown. In this study, a STZ diabetes rat model feeding with a high-fat diet was used to test the effects of berberine compared with metformin. Oral glucose tolerance and hyperinsulinemic-euglycemic clamp were used for glucose metabolism and insulin resistance. The Morris water maze was used to observe the compound effects on cognitive impairment. Serum and hippocampal [Formula: see text]-amyloid peptide (A[Formula: see text], Tau and phosphorylated Tau protein deposition in the hippocampi were measured. The TUNEL assay was used to detect the neuronal apoptosis, supported by histomorphological changes and transmissional electron microscopy (TEM) image. Our data showed that the diabetic rats had a significantly cognitive impairment. In addition to improving glucose metabolism and reducing insulin resistance, berberine significantly improved the cognitive function in the rat. Berberine also effectively decreased the expression of hippocampal tau protein, phosphorylated Tau, and increased insulin receptor antibodies. Moreover, berberine downregulated the abnormal phosphorylation of A[Formula: see text] and Tau protein and improved hippocampal insulin signaling. The TUNEL assay confirmed that berberine reduced hippocampal neuronal apoptosis supported by TEM. Thus, berberine significantly improved the cognitive function in diabetic rats by changing the peripheral and central insulin resistance. The reduction of neuronal injury, A[Formula: see text] deposition, abnormal phosphorylation of Tau protein, and neuronal apoptosis in the hippocampus were observed as the related mechanisms of action.

Relationships Between Cognitive Impairment and Self-Management in Older Adults With Type 2 Diabetes: An Integrative Review

Cognitive impairment is common in older adults with diabetes and is likely to negatively affect their daily diabetes self-management behaviors (DSMB). The primary aim of this integrative review was to summarize and synthesize the current state of knowledge about relationships between cognitive impairment and DSMB in older adults with type 2 diabetes. The review was guided by Whittemore and Knafl's 2005 framework, and study quality was evaluated using the Crowe Critical Appraisal Tool. Of 27 studies reviewed, 24 were quantitative, and three were qualitative. Heterogeneity was noted in study design, participant characteristics, and measures of cognitive function and DSMB. Overall, global cognitive impairment and executive function impairment related particularly to poor medication management and glucose self-monitoring. The findings supported the need for routine cognitive assessment of older adults with diabetes, but more longitudinal and interventional studies are needed to better define cognitive impairment-DSMB relationships. [Research in Gerontological Nursing, 14(2), 104-112.].

The Influence of the BDNF Val66Met Polymorphism on the Association of Regular Physical Activity With Cognition Among Individuals With Diabetes

INTRODUCTION

Diabetes is associated with cognitive dysfunction that comes with substantial lifetime consequences, such as interference with diabetes self-management and reduced quality of life. Although regular physical activity has been consistently shown to enhance cognitive function among healthy subjects, significant interpersonal differences in exercise-induced cognitive outcomes have been reported among brain-derived neurotrophic factor (BDNF) Val/Val vs. Met carriers. However, the evidence on how the BDNF Val66Met variant influences the relationship between regular physical activity and cognition among individuals with diabetes is currently lacking.

METHODS

A total of 3,040 individuals with diabetes were included in this analysis using data from the Health and Retirement Study. Associations among moderate and vigorous physical activities (MVPA) and measures of cognitive function were evaluated using multivariable linear regression models within each stratum of the Val66Met genotypes.

RESULTS

MVPA was more strongly associated with total cognitive score, mental status, and words recall among Met/Met carriers, compared to Val/Val and Val/Met carriers.

CONCLUSIONS

This study provided preliminary findings on how BDNF variants may modulate the exercise-induced cognitive benefits among mid-aged and older adults with diabetes. Given the limitations of the current study, it is necessary for randomized controlled trials to stratify by BDNF genotypes to more conclusively determine whether Met carriers benefit more from increased physical activity. In addition, future research is needed to examine how the interplay of BDNF Val66Met variants, DNA methylation, and physical activity may have an impact on cognitive function among adults with diabetes.

Executive Function and Diabetes: A Clinical Neuropsychology Perspective

Objective

Diabetes is a global public health concern. Management of diabetes depends on successful implementation of strategies to alleviate decline in executive functions (EFs), a characteristic of diabetes progression. In this review, we describe recent research on the relationship between diabetes and EF, summarize the existing evidence, and put forward future research directions and applications.

Methods

Herein, we provide an overview of recent studies, to elucidate the relationship between DM and EF. We identified new screening objectives, management tools, and intervention targets for diabetes management. We also discuss the implications for clinical practice.

Results

In both types 1 and 2 diabetes mellitus (DM), hyperglycemia substantially impairs EF in people of all age groups and ethnicities. Hypoglycemia can similarly impair EF. Interestingly, a decline in EF contributes to DM progression. Glucose dysregulation and EF decline exacerbate each other in a vicious cycle: poor blood glucose control, impaired EF, diabetes management task failure, then back to poor blood glucose control. Many pathophysiological indexes (e.g., obesity, metabolic index, inflammatory and immune factors), neuropsychological indexes (e.g., compliance, eating habits, physical exercise, sleep, and depression), and genetic factors are changed by this pathological interaction between DM and EF. These changes can provide insight into the pathophysiological mechanisms of diabetes-related EF decline.

Conclusion

Further studies, including large-scale prospective and randomized controlled trials, are needed to elucidate the mechanism of the interaction between diabetes and EF and to develop novel strategies for breaking this cycle.

Online Cognitive Training: An Adaptation of the Memory, Attention, and Problem Solving Skills for Persons With Diabetes Intervention

Research shows the risk for cognitive impairment and the rate of cognitive decline double after type 2 diabetes mellitus is diagnosed and can make self-management more difficult. Cognitive training has been found to be one way to improve self-management and cognitive function, and this article reports the adaptation of one such intervention to an online format. Ten adults with diabetes participated in an 8-week intervention that combined webinar classes with online computer game training. Perceived memory ability, executive function, self-management, and self-efficacy were measured. Evaluation of recruitment, data collection, and implementation demonstrated good feasibility and reduced barriers to engagement. Although the intervention did not result in significant changes in cognitive function, scores on all surveys improved. Adherence to diet, exercise, and foot care recommendations also improved. Most participants stated they preferred the intervention's online format to "traditional" in-person formats. Online technology in this 8-week intervention helped improve recruitment, retention, participant engagement, and use of cognitive strategies in people with type 2 diabetes mellitus. Overall, participants found the intervention helpful and said it reduced the time and travel burden associated with educational interventions. A larger randomized controlled trial is needed to further explore the intervention's potential impact over a longer period.

Quality of Life in Type 2 Diabetes Mellitus Patients with Neuropsychological Deficits

OBJECTIVE

We investigated: (i) the cognitive performance of type 2 diabetes mellitus (T2DM) patients compared to healthy control participants and (ii) the Health-related Quality of life (HRQOL) of type 2 diabetics with neuropsychological deficits.

METHOD

We conducted a prospective study in (N = 44) T2DM patients and (N = 28) demographically matched healthy controls. All participants were assessed with a flexible comprehensive neuropsychological battery of tests that have been standardized in Greece and found to be sensitive in detecting cognitive deficits in type 2 diabetics. They were additionally assessed on measures of general intelligence, general mental state, and depression. They were also administered the WHO QOL-BREF self-report questionnaire to evaluate perceived health-related quality of life.

RESULTS

Groups were well matched on baseline demographic characteristics and estimated premorbid intelligence. The groups did not differ on general mental state but varied in the encoding of verbal material, total verbal learning, delayed recall of verbal information, mental information processing speed, phonological and semantic verbal fluency and executive functions, set-shifting. Glycosylated hemoglobin levels and an interaction of age, education, and premorbid intelligence were the most important predictors of domain-specific neuropsychological performance. T2DM patients with deficits in verbal learning, executive functions, set-shifting, and semantic verbal fluency, had significantly lower QOL in the domains of psychological and environmental health, social relationships, and general health, respectively.

CONCLUSION

T2DM patients have cognitive deficits on several domains compared to healthy participants. Domain specific neuropsychological deficits in middle aged T2DM patients have a significant impact on HRQOL.

Cognitive Dysfunction in Persons with Type 2 Diabetes Mellitus: A Concept Analysis

Although cognitive dysfunction is related to type 2 diabetes mellitus (T2DM), the concept has not yet been well defined. The purpose of this study was to define the concept of cognitive dysfunction in persons with T2DM and examine its defining attributes, antecedents, and consequences. Literature was retrieved from 2008 to 2018 by systematically searching the PubMed, CINAHL, and PsycINFO databases. Based on 37 included studies, three defining attributes were identified: cognitive dysfunction is a recognized or unrecognized symptom, is characterized by a subtle decline in one or more cognitive domains, and is accompanied by pronounced structural changes observed in brain imaging. One major antecedent was diabetes-related or diabetes-specific pathological changes. Consequences included interference with diabetes self-management, nonadherence to recommended self-management behaviors, and a higher risk of having hypoglycemic events. The concept analysis provides a theoretical foundation that can be used to guide evaluations and interventions related to cognitive dysfunction in individuals with T2DM.

A Nurse-Led Cognitive Training Intervention for Individuals With Type 2 Diabetes

Diabetes increases the risk for cognitive impairment and doubles the rate of cognitive decline after diagnosis. In turn, cognitive dysfunction makes diabetes self-management more difficult. Nurses who help manage these conditions are focused on identifying patients at risk for complications, promoting symptom management, and preventing further decline. The purpose of the current study was to develop and pilot test a nurse-led comprehensive cognitive training intervention for individuals with type 2 diabetes mellitus (T2DM), the Memory Attention and Problem Solving Skills in Persons With Diabetes Mellitus (MAPSS-DM). The 8-week intervention combined in-person classes and online computer training. Development included: (a) adaptation of established, tested interventions; (b) interviews with stakeholders; (c) integration of course content; and (d) pilot testing of the intervention in a one-group, pre-/posttest design (N = 19). Postintervention scores improved in all areas; improvements were statistically significant for diet adherence (t[18] = -2.41, p < 0.005), memory ability (t[18] = 5.54, p < 0.01), and executive function (t[18] = 3.11, p < 0.01). Fifty-eight percent of participants stated the intervention helped their diabetes self-management, and 74% indicated they wanted to continue using cognitive strategies learned in the intervention. Results from this study showed the MAPSS-DM to be a promising cognitive training intervention for individuals with T2DM.

TARGETS

Individuals with T2DM.

INTERVENTION DESCRIPTION

In-person classes and online computer training of a cognitive training intervention.

MECHANISMS OF ACTION

Participants who completed the intervention would show improved cognitive function, which would result in improved self-management adherence followed by better glycemic control.

OUTCOMES

Improved diabetes self-management and sustained use of learned cognitive strategies. [Res Gerontol Nurs. 2019; 12(4):203-212.].

The measurement of participant-reported memory across diverse populations and settings: a systematic review and meta-analysis of the Multifactorial Memory Questionnaire

The Multifactorial Memory Questionnaire (MMQ) is a participant-reported measure of memory satisfaction, ability, and strategy use. Initially validated with healthy older adults, it has since been used in many different populations and settings for a variety of purposes. We conducted a systematic review and meta-analysis of the measurement properties of the MMQ across multiple, diverse studies.

METHODS

The study was designed using the Consensus-Based Standards for the Selection of Health Measurement Instruments and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We calculated aggregate statistics and evaluated the methodological quality of 29 studies retrieved from PsycINFO, MEDLINE, EMBASE, and Web of Science.

RESULTS

Analyses revealed high-quality evidence for internal consistency, stability, measurement error, convergent validity, and known-groups validity of the three MMQ scales. There was moderate-quality evidence for responsiveness and structural validity, with some studies identifying separate factors for internal and external memory strategy use. Measurement properties were similar across languages, participant samples, and study designs.

CONCLUSIONS

The MMQ is a valid, reliable, and responsive measure across diverse settings and populations. Future research is needed to determine whether more detailed information can be obtained from the scales, specifically, internal versus external strategy use.

Participant Perspectives of Cognitive Rehabilitation for Type 2 Diabetes: Expectations and Impact

Purpose

To describe the experiences of people with type 2 diabetes who have completed a comprehensive cognitive rehabilitation intervention.

Method

Nineteen participants with type 2 diabetes enrolled in an 8-week intervention consisting of 4 educational classes to learn strategies to improve cognitive function and an online training program at home to practice cognitively stimulating activities. Two focus groups were conducted as part of a study designed to assess the feasibility of the comprehensive cognitive rehabilitation intervention.

Results

Three main themes were identified in the qualitative data: (1) expectations of cognitive change; (2) use of cognitive strategies; and (3) effect on diabetes self-management. Participants shared valuable insight into how their experiences with the intervention changed and how they viewed diabetes.

Conclusions

While the participants did not initially tie their cognitive complaints to diabetes, they were able to show how and why they might use cognitive strategies to improve diabetes self-management activities. By adapting those strategies for diabetes, quality of life can improve as well as potentially glycemic control.

Self-care competence in the administration of insulin in older people aged 70 or over1

Objective:

to analyze the self-care competence in the administration of insulin performed by older people aged 70 or over.

Method:

cross-sectional study carried out with 148 older people aged 70 or over, who performed self-administration of insulin. Data collection was carried out using a structured questionnaire and an adapted guide for the application of the Scale to Identify Self-Care Competence of Patients with Diabetes, at the participants’ home. Data analysis included descriptive and inferential statistical tests, with forward logistic regression.

Results:

the prevalence of self-care competence in the administration of insulin was 35.1%. Handwashing error was the most frequent in self-administration of insulin. Self-care competence was negatively associated with retirees and positively associated with senior patients who performed capillary blood glucose monitoring and skin pinching during insulin application.

Conclusion:

there was low self-care competence and it was associated with both the sociodemographic and the clinical characteristics with regard to self-application of insulin by the older people.

Thinking About Cognitive Function: Perceptions of Cognitive Changes in People With Type 2 Diabetes

Purpose The purpose of this study is 2-fold: (1) to explore how people with diabetes view diabetes-related cognitive problems and (2) to examine participants' ideas on a cognitive rehabilitation intervention to adapt it for persons diagnosed with type 2 diabetes (T2DM). Methods A qualitative descriptive study based on narrative interviews was conducted with adults (n = 10) with T2DM. The interview data were analyzed using content analysis. Results The interviews reflected 4 major themes: search for advice regarding cognitive complaints, cognitive symptoms, impact of perceived cognitive dysfunction on diabetes self-management, and maintenance of cognitive health. Specific areas of interest for an intervention included the following: understanding how cognitive function relates to diabetes, dealing with cognitive barriers to self-management, and learning how to incorporate a "brain healthy" lifestyle into daily activities. Conclusions Findings showed that perceived cognitive impairment impacted self-management and suggested that cognitive rehabilitation interventions have potential utility for people with T2DM. Existing successful interventions can be tailored to meet the needs of those whose diabetes self-management is impacted by cognitive problems.