As we get older, it’s normal for our memory to slip. But if you are having trouble managing your diabetes, or maintaining self-care practices, you might be experiencing some changes in your thinking and memory processes.

“We don’t know the exact cause of mild cognitive impairment in diabetes, but we do know there is a relationship,” says Medha Munshi, M.D., Director of Geriatric Diabetes Program at Joslin Diabetes Center. “About 30 percent of older adults with diabetes have some mild cognitive deficit.”

Mild cognitive impairment is not just a memory problem. It’s also about a person’s ability to incorporate changes into day-to-day life. Because diabetes is a condition that requires diligent self-care, any condition that interferes with this ability can lead to serious health problems.

In recent years, some research has linked diabetes to cognitive decline in older people. “The good news is that those who do develop mild cognitive dysfunction can still maintain their independence and live a good quality life,” says Dr. Munshi, whose paper about cognitive dysfunction in older adults with diabetes appears in Diabetes Care (April 2017).
 

Dr. Munshi has these suggestions:
 

Start with your doctor
When you notice new or sudden changes in thinking or behavior, discuss these challenges with your doctor. Sometimes prescribed medications and other medical problems can make cognition worse.

“Once we have identified what is going on, there is plenty we can do to make life easier for the patient. Simplifying the treatment strategy and making small changes over time can lead to better diabetes management,” says Dr. Munshi.

“If a regimen is too complex, it may overwhelm the patient and they may not able to follow it, or they may develop hypoglycemia and not be able to treat it. This, in turn, promotes falls, which can lead to a fracture and loss of independence.”

Caregivers and family members can help

Family members should pay attention to early red flags — subtle changes in a person’s ability to make decisions, follow instructions or manage their diabetes.

The normal cognitive performance involves mental skills such as reasoning, memory, and problem-solving. When cognitive decline occurs, a person’s behavior begins to change: they suddenly start missing insulin doses or stop performing self-care practices—things they have been doing for a long time.

“Unfortunately, how diabetes affects cognitive function remains under-recognized by clinicians,” says Dr. Munshi. “And cognitive changes often occur so subtly that they go unrecognized by patients themselves.”

When cognitive changes are serious enough to interfere with daily living, it’s time to get screened for cognitive decline.
 

For those diagnosed with mild cognitive impairment

“For patients, the key move to make,” says Dr. Munshi,” is to maintain a positive attitude, because it’s possible to live a fulfilling life with mild cognitive impairment.”

There are a number of things a person can do. Using a pillbox, trying long-acting insulin once daily, replacing insulin sliding scale with fixed insulin dose before meals, using alarms and other reminders, or having a family member check in daily—all can help a person stay independent.

And for clinicians, it is important that they identify cognitive decline when problems start to interfere with diabetes management, and then educate their patients and caregivers in areas that are critical for safety such as hypoglycemia recognition and treatment, says Dr. Munshi. “Most people can live independently, as long as they are not given a task that is beyond their capacity.”