PREVALENCE AND PATTERN OF COGNITIVE DYSFUNCTION IN TYPE 2 DIABETES MELLITUS L Kataria, H Pandya

*

, S Shah, H Shah, R Gerg

1AssociateProfessor,Dept.ofPsychiatry;2Professor,Dept.ofMedicine;3Professor,Dept.ofPsychiatry;4JuniorResident,Dept.ofMedicine;5JuniorResident,Dept.ofPsychiatryABSTRACT

The deleterious effect of diabetes mellitus on cognitive function is not well documented. In this study, we investigated cognitive functioning in type 2 diabetes mellitus with neurocognitive test Mini Mental Status Examination (MMSE) test, thus providing insight into magnitude and severity of cognitive decrement with possible risk factors assessment in type 2 diabetes mellitus. This cross sectional study included 104 consecutive type 2 diabetes mellitus patients attending diabetes clinic of tertiary hospital. A neurocognitive assessment addressing all cognitive domains was done by using gold standard MMSE. A total of 37 type 2 diabetes mellitus patients (35%) scored 24 or less on MMSE. Mean MMSE score of study group was 24.79 4.22. Attention, calculation, recall, registration, language and orientation were the affected domains of cognition in study participants. Severe cognitive impairment (MMSE score

21) was seen more commonly in elderly patients (70%). The association of development of cognitive impairment and duration of diabetes is highly significant statistically (p value < 0.001), though this complication is also observed in many recently diagnosed diabetic patients also. As cognitive dysfunction is highly prevalent in type 2 diabetes mellitus, the routine screening of cognition by MMSE should be done in all type 2 diabetic mellitus patients.

Keywords:

Type 2 diabetes mellitus, Cognitive dysfunction, Mini Mental Status Examination (MMSE) INTRODUCTION Diabetes mellitus, complex metabolic disease is a pandemic affecting all regions and all ethnic population of the world, having devastating effects on multiple organs in the body .The worldwide prevalence has risen dramatically over the past two decades. From an estimated 30 million cases in 1985 to 285 million in 2010. The estimated diabetes prevalence by year 2030 is 439 million adults worldwide [1]. Although the prevalence of both type 1 and type 2 DM is increasing worldwide, the prevalence of type 2 DM is rising much more rapidly, especially in developing countries like India and China presumably because of increasing obesity reduced activity levels as countries become more industrialized and also because of the aging of the population [2]. The deleterious effects of Diabetes on renal, cardiovascular, retinal and peripheral nervous system are widely known and acknowledged. Cognitive dysfunction is a relative less known and less addressed complication of diabetes. Patients with type 1 and type 2 diabetes mellitus report wide range of neuropsychiatry problems. Several studies had determined relationship between cognitive disorder and diabetes mellitus [3-5]. Various cognitive defects have been reported in type 2 diabetes mellitus patients. Type 2 diabetes mellitus is associated with decrease in psychomotor speed, frontal lobe/executive function, verbal memory, processing speed, complex motor functioning, working memory, immediate recall and many others [6].

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This heterogeneity of presentation is probably caused by difference in patient characteristics, diabetes pattern and the psychometric Paradigm used. The various neurocognitive tests are used to assess cognitive dysfunction in the literature are Mini Mental Status Examination (MMSE), Wisconsin card sort test (WCST), Addenbrooks cognitive Examination, Clock drawing test (CDT), Clock-in-a-box test, etc. The impact of these subtle neurocognitive deficits on the daily lives of patients with type 2 diabetes mellitus is not much clear. Sinclair et al had reported that diabetic subjects with Mini Mental Status Examination score less than 23 faced worse on measures of self care and ability to perform activities of daily living. These subjects also displayed an increased need for personal care and increased rate of hospitalization when compared to controls [6]. Bruce et al had also reported that 11.3% of elderly type 2 diabetic mellitus patients had cognitive impairment having moderate to severe deficits in activities of daily living [3]. So early detection may help the patient and his/her treating clinician for better management.

Table 1: The Mini-Mental State Examination (MMSE)

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As the exact prevalence and pattern of cognitive dysfunction in type 2 diabetes mellitus is still unclear, especially in south Asian population due to paucity data, the present study aims to assess the prevalence and types of cognitive dysfunction in type 2 diabetes mellitus as well as to find out the correlation between duration and improper control of Diabetes with presence and severity of cognitive dysfunction in Indian population.

MATERIAL AND METHOD:

This cross-sectional study was conducted by the department of General Medicine and department of Psychiatry at S.B.K.S. Medical institute and Research Centre (S.B.K.S. M.I.R.C.), Gujarat, India after obtaining clearance for Institutional Ethical Committee. As S.B.K.S. M.I.R.C. is situated in the periphery of Vadodara city, we receive patients both from urban & rural areas of Gujarat and Madhya Pradesh states of India. 104 consecutive type 2 diabetes mellitus patients attending diabetes clinic run by the department of General Medicine were enrolled for the study after taking written informed consent. Patients having history of alcohol or drug abuse or having psychological or neurological disorder that were likely to limit their ability to comply with MMSE were excluded from the study. Besides demographic information including their education and socio economical status, detailed history and examination was done. All subjects were assessed for cognitive function status by psychiatrist by Mini Mental Status Examination (MMSE) (Table 1). MMSE was performed with well established test battery consisting of specific question related to attention, orientation, memory, calculation and language. The scoring is based on 30 total points, and impairment is indicated by a score of 24 or lower. Data is presented as mean SD for continuous data and as n (%) for frequency data. The Chi-square test is used to test the association between the events.

RESULTS:

Total of 104 consecutive type 2 diabetes mellitus patients were enrolled in the study. Mean age of study population was 54.16 11.41 years. 58.65% were male patients while same percentage of patients were rural inhabitants (area having population of < 1,00,000). Our study comprised of patients mainly from middle and lower socioeconomic class. Only 17.3% of study population was educated up to higher secondary or beyond that. Most of the participants had low education level (53.84% had studied up to 7

th

standard or less and 28.84% up to 8

th

to 10

th

standard). Almost two third of our patients were diagnosed having type 2 diabetes mellitus in last 5 years only (75.95%) and most of the subjects (82.69%) had controlled diabetes status (Table 2).

Cognitive Function analysis:

Mean MMSE score of study group was 24.79 4.22. Among the study participants, 35.57% had MMSE score

24, so categorized as having cognitive dysfunction. Out of these 37 patients, 24 (64.86%) had MMSE score between 21 and 24, so had milder form of cognitive dysfunction (Figure 1). The various components of cognitive function affected in decreasing frequency were attention and calculation, recall, registration, language, orientation and construction. (Figure 2)

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