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Cuevas H, Stuifbergen AK, Hilsabeck R, Kim J, Wood S. Perceived Cognitive Function and Glycemic Variability: Baseline Results From a Cognitive Rehabilitation Intervention. Sci Diabetes Self Manag Care 2024; 50:310-319. [PMID: 39044609 PMCID: PMC11344960 DOI: 10.1177/26350106241262720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
PURPOSE The purpose of this study was to examine the association between glucose variability, diabetes self-management, and cognitive function in participants enrolled in a cognitive rehabilitation intervention for people with type 2 diabetes. METHODS Baseline data from the Memory, Attention, and Problem-Solving Skills for Diabetes randomized controlled trial (n = 95; mean age 65.6 years, SD 5.99; 59.3% female; 59% non-Hispanic White) were analyzed and included scores from the PROMIS Cognitive Function version 2, a measure of perceived cognitive function; glucose variability measurements from continuous glucose monitors; and scores on the Summary of Diabetes Self-Care Activities Survey. RESULTS Participants had higher levels of perceived cognitive dysfunction than the US average. Lower PROMIS scores were associated with higher levels of glucose variability. Better perceived cognitive health was related to better diabetes self-management. Glucose variability, measured by the coefficient of variation, was a significant predictor of perceived cognitive function. CONCLUSIONS Perceived cognitive function was associated with diabetes self-management and glucose variability. Understanding this association can support the development of interventions to mitigate effects associated with glucose variability and changes in cognitive function. Including measurements of perceived cognitive function in assessments has the potential to alert health care providers about the need for additional support in diabetes management and the possibility of cognitive impairment that may need further objective assessment.
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Affiliation(s)
| | | | - Robin Hilsabeck
- The University of Texas Health Science Center at San Antonio, Texas
| | - Jeeyeon Kim
- The University of Texas at Austin, Austin, Texas
| | - Shenell Wood
- The University of Texas at Austin, Austin, Texas
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Wood ST, Cuevas H, Kim J, Stuifbergen AK. Development and Use of a Tech-Based Data Management System for a Cognitive Rehabilitation Randomized Controlled Trial for People With Type 2 Diabetes. Comput Inform Nurs 2024; 42:252-258. [PMID: 38206176 PMCID: PMC11006582 DOI: 10.1097/cin.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Successful technology-based interventions to improve patients' self-management are providing an incentive for researchers to develop and implement their own technology-based interventions. However, the literature lacks guidance on how to do this. In this article, we describe the electronic process with which we designed and implemented a technology-based data management system to implement a randomized controlled trial of a comprehensive cognitive rehabilitation intervention to improve cognitive function and diabetes self-management in people with type 2 diabetes. System development included feasibility assessment, interdisciplinary collaboration, design mapping, and use of institutionally and commercially available software. The resulting framework offers a template to support the development of technology-based interventions. Initial development may be time-consuming, but the benefits of the technology-based format surpass any drawbacks.
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Affiliation(s)
| | | | - Jeeyeon Kim
- The University of Texas at Austin, School of Nursing
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Graves LV, Beacham D, Sawitzky N, Lozano J, Weberg M, Reyes K, Vergonia L, Santana A, Hernandez E, Sarsar D, Conaway Z. Informant sex/gender moderates associations between reported functioning and memory performance in Mexican American adults. Clin Neuropsychol 2024; 38:715-737. [PMID: 37571992 DOI: 10.1080/13854046.2023.2246669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023]
Abstract
Objective: In neuropsychological evaluations, assessing cognitive functioning is often achieved using objective neuropsychological measures, whereas subjective informant reports are typically obtained to determine manifest daily functioning. Informant reports of participant functioning and their associations with objective participant performance on neuropsychological testing have been shown to vary based on informant characteristics. However, associations among informant characteristics, reported functioning, and neuropsychological performance have not been adequately examined with Mexican American or other Hispanic/Latino samples, despite these populations' disproportionately higher rates of dementia due to Alzheimer's disease and related disorders. Method: We examined associations of informant characteristics with informant reports of participant functioning (assessed via the Functional Activities Questionnaire [FAQ]), and potential moderating effects of these characteristics on associations between reported functioning and participant performance on neuropsychological testing, for Mexican American adult participants in the National Alzheimer's Coordinating Center cohort (n = 294). Results: Female informants reported significantly worse participant functioning compared to male informants (p = .035, r = .126). Moreover, significant associations between reported functioning and memory performance were observed for participants with female informants, but not for those with male informants (p = .024, r = .138). Higher levels of informant education were associated with significantly worse participant functioning (p = .011, r = .151). However, informant education did not moderate associations between reported functioning and neuropsychological performance (ps > .05). Conclusions: Compared to male informants, female informants may provide subjective reports of Mexican American participant functioning that more closely corroborate objective participant performance in memory.
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Affiliation(s)
- Lisa V Graves
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Dora Beacham
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Nicole Sawitzky
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Jennifer Lozano
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Mathilde Weberg
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Karissa Reyes
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Lorraine Vergonia
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Ashley Santana
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Ezekiel Hernandez
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Darya Sarsar
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
| | - Zachary Conaway
- Psychology Department, California State University San Marcos, San Marcos, CA, USA
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Light SW, Tomasino F, Wescott A, Sideman AB, Vela A, Possin KL, Penedo FJ, Wolf MS. Perceptions, beliefs, attitudes, and knowledge of US Latino adults pertaining to dementia and brain health: a systematic review. Aging Ment Health 2024; 28:396-407. [PMID: 37874117 PMCID: PMC10983845 DOI: 10.1080/13607863.2023.2268050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES Latinos in the USA are 1.5 times more likely to develop Alzheimer's Disease and Related Dementias (ADRD) than non-Latino Whites. This systematic review aims to summarize current understanding of the perceptions, knowledge, beliefs, and attitudes about ADRD and brain health of Latinos to inform public health efforts addressing disparities. METHODS Searches were completed across six databases (Medline, PsycINFO, WoS, LILACS, ProQUEST, and CINAHL). Studies were required to capture attitudes and/or knowledge of ADRD or brain health among US-based Latino adults who were not cognitively impaired and were not caregivers or healthcare providers. Results were synthesized narratively. RESULTS A total of 5528 unique records were identified. Following de-duplication and screening, 24 articles met the inclusion criteria for this review. Overall, knowledge about brain health and ADRD among Latinos is quite mixed. A consistent finding was that participants recognized memory loss as a symptom of cognitive impairment, but demonstrated limited recognition of other signs of impairment. The studies also highlighted variable knowledge of protective factors for maintaining brain health. CONCLUSIONS Opportunities exist to increase knowledge of ADRD signs and symptoms, and awareness of risk and protective factors. Given the heterogeneity of Latinos in the USA, more research is warranted to better elucidate nuances in conceptualizations of brain health and aging among diverse Latino subgroups.
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Affiliation(s)
- Sophia W. Light
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Francesca Tomasino
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annie Wescott
- Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Alyssa Vela
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine L. Possin
- Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin, San Francisco, CA, USA
- Weill Institute for Neurosciences, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Frank J. Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, USA
| | - Michael S. Wolf
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wang M, Guan X, Yan J, Michael N, Liu X, Tan R, Lv X, Yan F, Cao Y. Perceptions and responses to cognitive decline in people with diabetes: A systematic review of qualitative studies. Front Public Health 2023; 11:1076030. [PMID: 36875353 PMCID: PMC9981946 DOI: 10.3389/fpubh.2023.1076030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Objective We aimed at summarizing the perceptions and responses to cognitive decline, assessing the disease management, identifying deficiencies and proposing new strategies for improvement in people with diabetes (PWDs). Methods A comprehensive search was performed in the following nine databases: PubMed, EMBASE, Web of Science, The Cochrane Library, PsycINFO, CINAHL, WanFang, CNKI, and VIP. The Joanna Briggs Institute (JBI) Critical Appraisal Tool for qualitative research was utilized to evaluate the quality of included studies. Descriptive texts and quotations relating to patient experience were extracted from the included studies and thematically analyzed. Results Eight qualitative studies met the inclusion criteria and 2 overarching themes were identified: (1) self-perception of cognitive decline referred to perceived cognitive symptoms, lack of knowledge and, impaired self-management and coping in multiple methods; (2) reported benefits of cognitive interventions referred to how cognitive interventions improved disease management, attitudes and needs of PWDs. Conclusion PWDs described misconceptions about their cognitive decline and suffered from them during disease management. This study provides a patient-specific reference for cognitive screening and intervention in PWDs, supporting disease management with cognitive decline in clinical practice.
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Affiliation(s)
- Meijuan Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Xiangyun Guan
- Department of International Medical Department, Qilu Hospital of Shandong University, Jinan, China
| | - Jingzheng Yan
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Nyagwaswa Michael
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Xueyan Liu
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Ran Tan
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaoyan Lv
- Department of International Medical Department, Qilu Hospital of Shandong University, Jinan, China
| | - Fei Yan
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China.,Department of Nursing, Qilu Hospital of Shandong University, Jinan, China.,Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, China
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Cuevas H, John-Miller L, Zuñiga J. Factors affecting cognitive dysfunction screening for Latinx adults with type 2 diabetes. J Clin Transl Endocrinol 2022; 27:100294. [PMID: 35386420 PMCID: PMC8978099 DOI: 10.1016/j.jcte.2022.100294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/26/2022] Open
Abstract
Aim To examine influences on screening of Latinx adults with type 2 diabetes for cognitive problems by identifying patient-, clinician-, and clinic-level factors. Methods This was a mixed methods study consisting of semi-structured interviews with Latinx adults with type 2 diabetes (n = 30; mean age = 68; 57% Mexican American) and surveys and interviews with health care providers (n = 15) in Central Texas. Data were examined with thematic analysis (interviews) and descriptive statistics (surveys and inventories). Results For the interviewed patients, screening was important, but inability to work related to a possible diagnosis of dementia was a concern. Both providers and patients agreed that other health issues (e.g., hyperglycemia) took precedence over cognitive screening. Providers (96.7%) were expected to screen patients but lacked clinic support and time; they relied on patients for initial prompts. Only one clinic required staff education on cognitive screening, with an emphasis on potential cultural differences in test results and adequate resources related to dementia for Latinx adults. Conclusions Clinics serving Latinx adults have a responsibility to deliver appropriate care. Leadership should consider innovative practices such as the creation, with patients, of educational materials for screening-a need highlighted by most participants.
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Affiliation(s)
- Heather Cuevas
- The University of Texas at Austin, School of Nursing, 1710 Red River, Austin, TX 78712, United States
| | - Luryn John-Miller
- The University of Texas at Austin, College of Liberal Arts, 116 Inner Campus Drive, Austin, TX 78712, United States
| | - Julie Zuñiga
- The University of Texas at Austin, School of Nursing, 1710 Red River, Austin, TX 78712, United States
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Huang YC, Cuevas HE, Zuñiga JA, García AA. Predictors of Subjective Cognitive Decline Among People With Diabetes: Data From the Behavioral Risk Factor Surveillance System. Sci Diabetes Self Manag Care 2021; 47:207-215. [PMID: 34000913 DOI: 10.1177/26350106211001761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine the prevalence of subjective cognitive decline (SCD) and SCD-related functional limitations among people with diabetes and to identify socioeconomic and comorbidity risk factors associated with SCD. METHODS This study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) with background variables (race, gender, education, and age), health-related factors (self-rated health, BMI, insurance, and comorbid conditions), and health behaviors (smoking, exercise, alcohol consumption) entered simultaneously to estimate logistic regression models of SCD. RESULTS Within the sample (n = 5263 adults with diabetes), 48% were age ≥65 years; 50% were male; 55% were non-Hispanic White; and of the 15% who reported having SCD, 57% had functional limitations. Increased odds of reporting SCD were observed among individuals who were Hispanic (odds ratio [OR] = 2.21, P < .001), male (OR = 1.47, P < .01), depressed (OR = 3.85, P < .001), or had arthritis (OR = 1.43, P < .03). Participants with better self-rated health had a reduced likelihood of SCD (OR = 0.51, P < .001). CONCLUSIONS Health care providers should assess high-risk patients for self-rated cognitive dysfunction and offer early interventions.
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Affiliation(s)
- Ya-Ching Huang
- St. David's School of Nursing, Texas State University, Round Rock, Texas
| | - Heather E Cuevas
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Julie A Zuñiga
- School of Nursing, The University of Texas at Austin, Austin, Texas
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Kim MJ, Fritschi C. Relationships Between Cognitive Impairment and Self-Management in Older Adults With Type 2 Diabetes: An Integrative Review. Res Gerontol Nurs 2020; 14:104-112. [PMID: 33306809 DOI: 10.3928/19404921-20201117-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cognitive impairment is common in older adults with diabetes and is likely to negatively affect their daily diabetes self-management behaviors (DSMB). The primary aim of this integrative review was to summarize and synthesize the current state of knowledge about relationships between cognitive impairment and DSMB in older adults with type 2 diabetes. The review was guided by Whittemore and Knafl's 2005 framework, and study quality was evaluated using the Crowe Critical Appraisal Tool. Of 27 studies reviewed, 24 were quantitative, and three were qualitative. Heterogeneity was noted in study design, participant characteristics, and measures of cognitive function and DSMB. Overall, global cognitive impairment and executive function impairment related particularly to poor medication management and glucose self-monitoring. The findings supported the need for routine cognitive assessment of older adults with diabetes, but more longitudinal and interventional studies are needed to better define cognitive impairment-DSMB relationships. [Research in Gerontological Nursing, 14(2), 104-112.].
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