Cog-ID findings support screening for cognitive impairment in older diabetes patients
medwireNews: Findings from the Cog-ID study suggest that undiagnosed cognitive impairment is associated with depressive symptoms and poor quality of life (QoL) among older patients with type 2 diabetes.
However, screening for cognitive impairment, along with subsequent diagnosis, is not tied to an increase in depressive symptoms, say Jolien Janssen and colleagues, from University Medical Center Utrecht in the Netherlands.
The study included 179 patients aged 70 years or older (average 76.8 years) who attended primary care screening for cognitive impairment and underwent further evaluation at a memory clinic when screening results were positive.
As reported in BMJ Open, the 95 Cog-ID participants with suspected cognitive impairment based on positive screening results had more depressive symptoms and worse scores on most health-related QoL measures at the time of screening than the 84 screen-negative patients.
For example, mean scores on the Center for Epidemiologic Studies Depression Scale (CES-D) were 14.1 points for the 39 screen-positive patients who went on to receive a confirmed diagnosis of cognitive impairment and 12.2 points for the 56 screen-positive patients who then received a negative diagnosis, compared with 7.1 points for the screen-negative participants. The respective European Quality of Life-5 Dimensions scores were 0.71, 0.81, and 0.85 points, with a lower score indicating worse QoL.
Despite these differences at baseline, depressive symptoms in patients with confirmed cognitive impairment and in screen-negative individuals “remained quite stable over time,” say the researchers.
Therefore, “neither participating in a screening programme for cognitive impairment nor disclosure of a diagnosis led to a sustained increase in depressive symptoms,” they add.
On the other hand, patients who tested positive at screening but were not diagnosed with cognitive impairment at the memory clinic experienced a decrease in depressive symptoms over time, with mean CES-D scores declining by 3.1 points from baseline to the 6-month follow-up and by 2.1 points from baseline to 2 years.
Describing these findings as surprising, Janssen and team speculate that “[i]t could be that the assessment at the memory clinic and its result, indicating that the patient did not have [mild cognitive impairment] or dementia, decreased depressive symptoms,” or that depressive symptoms may have mimicked the symptoms of cognitive impairment during screening, and declined over follow-up “as a result of the natural course or as a result of therapy.”
Together, the study results suggest that screening for cognitive impairment “does not seem to affect depressive symptoms or [health-related QoL] negatively” in older type 2 diabetes patients, write the study authors.
They conclude: “Detection of cognitive impairment identifies a vulnerable patient group that may need extra attention and tailored care.”
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