Factors affecting cognitive decline among patients with diabetes: A cross-sectional study in Lebanon

Abstract

Introduction and objectivesPatients with diabetes are prone to cognitive decline, including memory loss, decreased attention, and processing speed. This study aims to evaluate cognitive impairment in patients with diabetes and the factors associated with cognitive decline. Materials and methodsA cross-sectional study was conducted over 5 months targeting 318 previously diagnosed patients with diabetes from 2 endocrinology clinics. The Arab version of the Mini-Mental State Examination assessed cognitive function through 11 items exploring 6 cognitive domains. Participants' general characteristics, lifestyle, and medical history were collected. They were also asked about the management of their diabetes (type of and adherence to medication and doing regular laboratory tests or glycemic monitoring at home). Other information, such as glycated hemoglobin A1c, cholesterol, and triglycerides level, was retrieved from the patient's files while noting the patient's systolic and diastolic blood pressures. ResultsPatients had a mean age of 59.8 (10.7). Around 68% of patients had a possible cognitive impairment, and 31.8% a normal cognitive function. Significantly lower scores were noted among females (20.0; P < .001), and older patients had lower cognitive functions than others (19.4; P < .001). Illiterate had significantly lower scores (15.0) than those with advanced education (24.9; P < .001). Participants with diabetes for more than 5 years (20.8) and those with uncontrolled glycemia (20.8) had lower cognitive function than patients diagnosed more recently (22.2; P = .021) or those with controlled glycemia (23.1; P < .001). A cognitive decline was found among those with total cholesterol ≥200 mg/dL (20.7 vs. 21.9; P = .044), a systolic blood pressure of 140 mmHg or more (20.0 vs. 22.5; P < .001), and hematocrit levels below 40% (20.6 vs. 22.4; P = .002). After adjusting for covariates, a lower cognitive function score was found per increase of 1 year of age (b=−0.120, CI (−0.13, −0.03); P = .038) and among females (−0.186 (−3.30, −0.35); P = .016). An increase of a factor of 0.342 was found between the levels of education (CI (0.71–2.04); P < .001), and patients with uncontrolled glycemia had a significantly lower score than others. Moreover, having a systolic blood pressure ≥140 mmHg decreased the cognitive function score by a factor of 0.147 (CI (−2.98, −0.01); P = .049). ConclusionThe combined effect of these factors should be considered for treatment management and glycemic control to help early referrals of patients at risk.