A study to assess the relationship between cognitive impairment and glycemic management in patients with type 2 diabetes using MoCA score
Main Article Content
Abstract
Background: Later in life, people with diabetes mellitus 2 experience cognitive impairment, which lowers their quality of life. There is little local literature on cognitive diseases, particularly mild cognitive impairment (MCI), despite mounting evidence of these conditions.
Materials and Methods: We used the Montreal Cognitive Assessment (MoCA) test to determine the prevalence of mild cognitive impairment (MCI), which was previously unknown, in type 2 diabetic patients who were visiting a tertiary care centre. We also looked at the relationships between the MoCA scores and HbA1c, fasting blood sugar (FBS), postprandial blood sugar (PPBS), age, and length of diabetes. The study comprised seventy individuals with type 2 diabetes mellitus. Normal cognition (NC) was defined as patients with MoCA scores ≥26, while MCI was defined as those with scores <26.
Results: While 55% of individuals with type 2 diabetes mellitus had MCI (MoCA score <26), 50 or 45% of those patients had normal cognitive function (MoCA score ≥26). Patients with mild cognitive impairment had significantly higher fasting, PPBS, and HbA1c levels. The groups' mean ages and the length of time they had diabetes did not differ significantly. The MoCA scores were negatively correlated with the levels of HbA1c, FBS, and 2hr PPBS
Conclusion: According to the study's findings, individuals with type 2 diabetes are very susceptible to mild cognitive impairment. There was a negative correlation between the MoCA score and HbA1c, higher disease duration, and fasting blood sugar levels.
Keywords:
Diabetes, Cognitive impairment, Dementia, MoCA
Article Details
How to Cite
RAY, Saswati; RAY, Aparajita; MITRA, Asis.
A study to assess the relationship between cognitive impairment and glycemic management in patients with type 2 diabetes using MoCA score.
Medical Research Archives, [S.l.], v. 13, n. 3, apr. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6465>. Date accessed: 15 apr. 2025.
doi: https://doi.org/10.18103/mra.v13i3.6465.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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16. Lin Y, Gong Z, Ma C, Wang Z, Wang K. Relationship between glycemic control and cognitive impairment: A systematic review and meta-analysis. Front Aging Neurosci. 2023 Jan 26;15:1126183. doi: 10.3389/fnagi.2023.1126183. PMID: 36776436; PMCID: PMC9909073.
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19. Roy S, Kim N, Desai A, Komaragiri M, Baxi N, Jassil N, Blessinger M, Khan M, Cole R, Desai N, Terrigno R, Hunter K. Cognitive Function and Control of Type 2 Diabetes Mellitus in Young Adults. N Am J Med Sci. 2015 May;7(5):220-6. doi: 10.4103/1947-2714.157627. PMID: 26110134; PMCID: PMC4462818.
20. Khullar S, Dhillon H, Kaur G, Sharma R, Mehta K, Aggarwal R, Singh M, Singh P. The Prevalence and Predictors of Depression in Type 2 Diabetic Population of Punjab. Community Ment Health J. 2016 May;52(4):479-83. doi: 10.1007/s10597-015-9985-y. Epub 2016 Jan 2. PMID: 26724818.
21. Solanki RK, Dubey V, Munshi D. Neurocognitive impairment and comorbid depression in patients of diabetes mellitus. Int J Diabetes Dev Ctries. 2009 Jul;29(3):133-8. doi: 10.4103/0973-3930.54291. PMID: 20165651; PMCID: PMC2822218.
22. Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME, Coker LH, Murray A, Sullivan MD, Marcovina SM, Launer LJ; Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Investigators. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care. 2009 Feb;32(2):221-6. doi: 10.2337/dc08-1153. PMID: 19171735; PMCID: PMC2628683.
23. Munshi M, Grande L, Hayes M, Ayres D, Suhl E, Capelson R, Lin S, Milberg W, Weinger K. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care. 2006 Aug;29(8):1794-9. doi: 10.2337/dc06-0506. PMID: 16873782; PMCID: PMC1615865.
24. Li X, Jia S, Zhou Z, Jin Y, Zhang X, Hou C, Zheng W, Rong P, Jiao J. The role of the Montreal Cognitive Assessment (MoCA) and its memory tasks for detecting mild cognitive impairment. Neurol Sci. 2018 Jun;39(6):1029-1034. doi: 10.1007/s10072-018-3319-0. Epub 2018 Mar 17. PMID: 29550982.
25. Luchsinger JA, Palmas W, Teresi JA, Silver S, Kong J, Eimicke JP, Weinstock RS, Shea S. Improved diabetes control in the elderly delays global cognitive decline. J Nutr Health Aging. 2011 Jun;15(6):445-9. doi: 10.1007/s12603-011-0057-x. PMID: 21623465; PMCID: PMC3328757.
26. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. doi: 10.1111/j.1532-5415.2005.53221.x. Erratum in: J Am Geriatr Soc. 2019 Sep;67(9):1991. doi: 10.1111/jgs.15925. PMID: 15817019.
27. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, Ritchie K, Rossor M, Thal L, Winblad B. Current concepts in mild cognitive impairment. Arch Neurol. 2001 Dec;58(12):1985-92. doi: 10.1001/archneur.58.12.1985. PMID: 11735772.
2. Kodl CT, Seaquist ER. Cognitive dysfunction and diabetes mellitus. Endocr Rev. 2008 Jun;29(4):494-511. doi: 10.1210/er.2007-0034. Epub 2008 Apr 24. PMID: 18436709; PMCID: PMC2528851.
3. Cheng G, Huang C, Deng H, Wang H. Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J. 2012 May;42(5):484-91. doi: 10.1111/j.1445-5994.2012.02758.x. PMID: 22372522.
4. Kodl CT, Seaquist ER. Cognitive dysfunction and diabetes mellitus. Endocr Rev. 2008 Jun;29(4):494-511. doi: 10.1210/er.2007-0034. Epub 2008 Apr 24. PMID: 18436709; PMCID: PMC2528851.
5. Punthakee Z, Miller ME, Launer LJ, Williamson JD, Lazar RM, Cukierman-Yaffee T, Seaquist ER, Ismail-Beigi F, Sullivan MD, Lovato LC, Bergenstal RM, Gerstein HC; ACCORD Group of Investigators; ACCORD-MIND Investigators. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Diabetes Care. 2012 Apr;35(4):787-93. doi: 10.2337/dc11-1855. Epub 2012 Feb 28. PMID: 22374637; PMCID: PMC3308284.
6. Gao Y, Huang C, Zhao K, Ma L, Qiu X, Zhang L, Xiu Y, Chen L, Lu W, Huang C, Tang Y, Xiao Q. Depression as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Int J Geriatr Psychiatry. 2013 May;28(5):441-9. doi: 10.1002/gps.3845. Epub 2012 Jul 19. Retraction in: Int J Geriatr Psychiatry. 2015 Apr;30(4):435. doi: 10.1002/gps.4279. PMID: 22815126.
7. Pal K, Mukadam N, Petersen I, Cooper C. Mild cognitive impairment and progression to dementia in people with diabetes, prediabetes and metabolic syndrome: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2018 Nov;53(11):1149-1160. doi: 10.1007/s00127-018-1581-3. Epub 2018 Sep 4. PMID: 30182156; PMCID: PMC6208946.
8. Velayudhan L, Ryu SH, Raczek M, Philpot M, Lindesay J, Critchfield M, Livingston G. Review of brief cognitive tests for patients with suspected dementia. Int Psychogeriatr. 2014 Aug;26(8):1247-62. doi: 10.1017/S1041610214000416. Epub 2014 Mar 31. PMID: 24685119; PMCID: PMC4071993.
9. Cooper C, Katona C, Lyketsos K, Blazer D, Brodaty H, Rabins P, de Mendonça Lima CA, Livingston G. A systematic review of treatments for refractory depression in older people. Am J Psychiatry. 2011 Jul;168(7):681-8. doi: 10.1176/appi.ajp.2011.10081165. Epub 2011 Mar 31. PMID: 21454919.
10. Sokołowska N, Sokołowski R, Oleksy E, Kasperska P, Klimkiewicz-Wszelaki K, Polak-Szabela A, Podhorecka M, Kędziora-Kornatowska K. Usefulness of the Polish versions of the Montreal Cognitive Assessment 7.2 and the Mini-Mental State Examination as screening instruments for the detection of mild neurocognitive disorder. Neurol Neurochir Pol. 2020;54(5):440-448. doi: 10.5603/PJNNS.a2020.0064. Epub 2020 Aug 18. PMID: 32808669.
11. Tong T, Thokala P, McMillan B, Ghosh R, Brazier J. Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care. Int J Geriatr Psychiatry. 2017 Dec;32(12):1392-1400. doi: 10.1002/gps.4626. Epub 2016 Nov 22. PMID: 27874210.
12. Keskin FE, Ozyazar M, Pala AS, Elmali AD, Yilmaz B, Uygunoglu U, Bozluolcay M, Tuten A, Bingöl A, Hatipoglu E. Evaluation of cognitive functions in gestational diabetes mellitus. Exp Clin Endocrinol Diabetes. 2015 Apr;123(4):246-51. doi: 10.1055/s-0034-1395634. Epub 2015 Apr 13. PMID: 25868060.
13. Kawamura T, Umemura T, Hotta N. Cognitive impairment in diabetic patients: Can diabetic control prevent cognitive decline? J Diabetes Investig. 2012 Oct 18;3(5):413-23. doi: 10.1111/j.2040-1124.2012.00234.x. Epub 2012 Aug 29. PMID: 24843599; PMCID: PMC4019239.
14. Whitmer RA. Type 2 diabetes and risk of cognitive impairment and dementia. Curr Neurol Neurosci Rep. 2007 Sep;7(5):373-80. doi: 10.1007/s11910-007-0058-7. PMID: 17764626.
15. Albai O, Frandes M, Timar R, Roman D, Timar B. Risk factors for developing dementia in type 2 diabetes mellitus patients with mild cognitive impairment. Neuropsychiatr Dis Treat. 2019 Jan 3;15:167-175. doi: 10.2147/NDT.S189905. PMID: 30655669; PMCID: PMC6322491.
16. Lin Y, Gong Z, Ma C, Wang Z, Wang K. Relationship between glycemic control and cognitive impairment: A systematic review and meta-analysis. Front Aging Neurosci. 2023 Jan 26;15:1126183. doi: 10.3389/fnagi.2023.1126183. PMID: 36776436; PMCID: PMC9909073.
17. Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME, Coker LH, Murray A, Sullivan MD, Marcovina SM, Launer LJ; Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Investigators. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care. 2009 Feb;32(2):221-6. doi: 10.2337/dc08-1153. PMID: 19171735; PMCID: PMC2628683.
18. Naguib, R., Soliman, E.S., Neimatallah, F.M. et al. Cognitive impairment among patients with diabetes in Saudi Arabia: a cross-sectional study. Middle East Curr Psychiatry 27, 49 (2020). https://doi.org/10.1186/s43045-020-00058-5
19. Roy S, Kim N, Desai A, Komaragiri M, Baxi N, Jassil N, Blessinger M, Khan M, Cole R, Desai N, Terrigno R, Hunter K. Cognitive Function and Control of Type 2 Diabetes Mellitus in Young Adults. N Am J Med Sci. 2015 May;7(5):220-6. doi: 10.4103/1947-2714.157627. PMID: 26110134; PMCID: PMC4462818.
20. Khullar S, Dhillon H, Kaur G, Sharma R, Mehta K, Aggarwal R, Singh M, Singh P. The Prevalence and Predictors of Depression in Type 2 Diabetic Population of Punjab. Community Ment Health J. 2016 May;52(4):479-83. doi: 10.1007/s10597-015-9985-y. Epub 2016 Jan 2. PMID: 26724818.
21. Solanki RK, Dubey V, Munshi D. Neurocognitive impairment and comorbid depression in patients of diabetes mellitus. Int J Diabetes Dev Ctries. 2009 Jul;29(3):133-8. doi: 10.4103/0973-3930.54291. PMID: 20165651; PMCID: PMC2822218.
22. Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME, Coker LH, Murray A, Sullivan MD, Marcovina SM, Launer LJ; Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Investigators. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care. 2009 Feb;32(2):221-6. doi: 10.2337/dc08-1153. PMID: 19171735; PMCID: PMC2628683.
23. Munshi M, Grande L, Hayes M, Ayres D, Suhl E, Capelson R, Lin S, Milberg W, Weinger K. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care. 2006 Aug;29(8):1794-9. doi: 10.2337/dc06-0506. PMID: 16873782; PMCID: PMC1615865.
24. Li X, Jia S, Zhou Z, Jin Y, Zhang X, Hou C, Zheng W, Rong P, Jiao J. The role of the Montreal Cognitive Assessment (MoCA) and its memory tasks for detecting mild cognitive impairment. Neurol Sci. 2018 Jun;39(6):1029-1034. doi: 10.1007/s10072-018-3319-0. Epub 2018 Mar 17. PMID: 29550982.
25. Luchsinger JA, Palmas W, Teresi JA, Silver S, Kong J, Eimicke JP, Weinstock RS, Shea S. Improved diabetes control in the elderly delays global cognitive decline. J Nutr Health Aging. 2011 Jun;15(6):445-9. doi: 10.1007/s12603-011-0057-x. PMID: 21623465; PMCID: PMC3328757.
26. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. doi: 10.1111/j.1532-5415.2005.53221.x. Erratum in: J Am Geriatr Soc. 2019 Sep;67(9):1991. doi: 10.1111/jgs.15925. PMID: 15817019.
27. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, Ritchie K, Rossor M, Thal L, Winblad B. Current concepts in mild cognitive impairment. Arch Neurol. 2001 Dec;58(12):1985-92. doi: 10.1001/archneur.58.12.1985. PMID: 11735772.