Cognitive Impairment with Diabetes: Caregiver

Managing diabetes can be a daunting task for you and your loved one. As their caregiver, it's important to understand the many self-care tasks involved. These include checking blood sugars and ensuring they eat healthy and get regular exercise. They need to take medicines as prescribed and attend frequent appointments with their healthcare provider. They may also need help with foot checks and getting vision exams. These tasks are all vital to prevent complications of diabetes, including cognitive impairment (decline).

Cognitive impairment affects a person's ability to think and reason. It leads to difficulty remembering, understanding, planning, and communicating. It can also hamper their problem-solving skills and decision-making abilities. Together, these may result in poor diabetes control. To prevent or delay cognitive impairment, work closely with their healthcare team to simplify and support their care.

What causes cognitive impairment in diabetes?

High blood sugar levels (hyperglycemia) can damage blood vessels in the brain, reducing blood and oxygen to the brain. High blood sugar causes inflammation. This may damage brain cells and cause dementia to develop. But the brain needs enough glucose to work. So, low blood sugar levels (hypoglycemia) can also damage the brain.

What are the symptoms of cognitive impairment?

Symptoms of cognitive impairment in diabetes include:

• Forgetfulness

• Difficulty finding the right words

• Easily distracted

• Poor judgement

• Trouble making decisions

• Mood and personality changes

• Losing train of thought

• Asking the same questions over and over

These symptoms can be caused by many things, so it's important to work with their healthcare provider to rule out other conditions.

Starting at age 65, your loved one's healthcare provider should screen them yearly for cognitive changes.

How is cognitive impairment treated?

Treatment for mild cognitive impairment from diabetes centers on keeping blood sugar levels within the target range and taking medicines to help cognitive function, such as those used to treat Alzheimer’s. Other parts of treatment include the following:

• Make lifestyle changes. These include getting regular physical activity and eating healthy snacks and meals.

• Manage other conditions, such as high blood pressure and cholesterol.

• Simplify your medicine plan. Try once-a-day medicine or automatic insulin delivery devices.

• Use continuous glucose monitoring (CGM).

• Get preventive vaccinations, such as those for pneumonia, flu, and COVID-19.

• Use reminders, calendars, and written instructions.

As a caregiver, it's essential to learn as much as you can about diabetes and cognitive changes to support your loved one. Work together to maintain their independence, avoid isolation, prevent financial problems, and minimize the risk of accidents. If you notice any issues with their thinking or reasoning, talk with their healthcare provider to create a treatment plan as soon as possible.

How can I care for my loved one?

• Encourage and help with memory aids like notes, alarms, and calendars.

• Break down complex tasks into smaller, more manageable steps.

• Create a structured routine for the person, with clear daily schedules and goals.

• Provide time for socialization and doing activities that the person enjoys.

• Be patient. Don’t rush or pressure the person.

• Address your loved one directly. Ask yes or no questions. Use clear and simple language. Avoid jargon or abstract concepts.

• Don’t correct or argue with the person. This may cause frustration or confusion.

• Consider professional help. A cognitive therapist, for example, can assist with cognitive exercises and training.