In Older People with Diabetes - Determining the Optimal Set of Cognitive Tools Associated with Self-Care Capacity

Background: Self-care is a cornerstone in diabetes management and prevention of its long-term complications. Population studies have shown that lower cognitive function is associated with worse self-care abilities. Despite this, cognitive assessment is not part of the evaluation process of aging people with diabetes and their cognitive function is not assessed while constructing their treatment plan. A partial reason for this is the variety of cognitive assessment tools and the difficulty choosing the optimal instrument to assess the individual self-care capacity.

Objective: To assess which cognitive instruments best correlate with the 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 cross-sectional association between clinical and self-reported variables of self-care capacity and different cognitive assessment tools was determined. Second, self-care capacity Principal Components (PCs) were constructed, using Principal Component Analysis (PCA) on the self-care capacity variables. Next, the association between different cognitive assessment tools and the constructed PCs was evaluated.

Results: Two PCA models were conducted to express all self-care capacity variables, each revealing two PCs. PC1 from the first model was significantly associated with the MoCA (Montreal Cognitive Assessment) and the NeuroTrax (Mindstreams) scores. MoCA was the single significant cognitive instrument to be associated with PC1 from the second model.

Conclusions: The MoCA, previously validated as a brief cognitive impairment screening tool, was associated with most of the self-care capacity variables. Future studies using MoCA are needed to evaluate if using this screening tool may improve treatment plan and self-care ability.