Cognitive Impairment Among Older Adults With Diabetes Mellitus in Puducherry: A Community-Based Cross-Sectional Study

Background Cognitive impairment is a global public health problem in the elderly population. There is increasing evidence that diabetes mellitus predisposes to cognitive impairment. Early diagnosis and management of cognitive impairment can delay the onset of dementia, thereby improving self-care and quality of life of diabetic patients. This study intends to assess cognitive impairment, and the factors influencing cognitive impairment among older adults with diabetes mellitus in Puducherry. Methods A community-based cross-sectional study was conducted in field practice areas of a Government Medical College in Puducherry between April and June 2019. After obtaining ethical approval, 240 registered diabetic patients aged 55 years and above were randomly selected. Data on demographic profile and clinical variables were collected using a semi-structured questionnaire. Cognitive function was assessed using the Hindi Mental State Examination (HMSE) tool, and participants who scored below 26 were considered to have cognitive impairment. Results Among 240 participants, 67.9% were aged 60 years and above, 62.5% were females, and 83.8% were unemployed. The proportion of cognitive impairment among older adults with diabetes was 30.0% (95% confidence interval (CI): 24.5-36.03). The mean ± standard deviation of the HMSE Score was 26.13 ± 3.8, and the median score was 27. Female gender (P= 0.02, adjusted prevalence ratio (aPR) = 5.31, 95% CI: 1.34-21), widowhood status (P= 0.005, aPR= 2.71, 95% CI: 1.34-5.46), illiteracy (P<0.001, aPR= 3.55, 95% CI: 1.78-7.07), and presence of probable symptomatic hypoglycemia (P=0.02, aPR= 2.18, 95% CI: 1.13-4.20) were significant predictors of cognitive impairment in the study population by multivariate analysis. Conclusion Almost one-third of older adults with diabetes were found to be at risk of cognitive impairment. Older diabetic patients with identified risk factors may be prioritized for a screening of cognitive impairment at the primary care level.