Diabetes mellitus and cognitive impairments

Table 1 Neurocognitive domains and some examples for their assessment[8,9]

Cognitive domain	Examples of assessments
Complex attention (sustained attention, divided attention, selective attention, processing speed)	Sustained attention: Maintenance of attention over time Selective attention: Maintenance of attention despite competing stimuli and/or distractors Divided attention: Attending to two tasks within the same time period Processing speed can be quantified on any task by timing it
Executive function (planning, decision making, working memory, mental flexibility)	Planning: Ability to find the exit to a maze; interpret a sequential picture Decision making: Performance of tasks that assess process of deciding in the face of competing alternatives (e.g., simulated gambling) Working memory: Ability to hold information for a brief period and to manipulate it (e.g., adding up a list of numbers or repeating a series of numbers or words backward) Mental/cognitive flexibility: Ability to shift between two concepts, tasks, or response rules
Learning and memory [immediate memory, recent memory (including free recall, cued recall, and recognition memory), very-long- term memory (semantic, autobiographical), implicit learning]	Immediate memory span: Ability to repeat a list of words or digits. Note: Immediate memory sometimes subsumed under “working memory” (see “Executive Function”) Recent memory: Assesses the process of encoding new information (e.g., word lists, a short story, or diagrams) Free recall (the person is asked to recall as many words, diagrams, or elements of a story as possible Cued recall (examiner aids recall by providing semantic cues such as “list all the food items on the list” Recognition memory (examiner asks about specific items, e.g., “Was ‘apple’ on the list?”) Semantic memory (memory for facts) Autobiographical memory (memory for personal events or people) Implicit (procedural) learning (unconscious learning of skill)
Language [expressive language (including naming, word-finding, fluency, and grammar and syntax) and receptive language]	Expressive language: Confrontational naming (identification of objects or pictures) Fluency [e.g., name as many items as possible in a semantic (e.g., animals) or phonemic (e.g., words starting with “f”) category in 1 min] Grammar and syntax (e.g., omission or incorrect use of articles, prepositions, auxiliary verbs) Receptive language: Comprehension, performance of actions/activities according to verbal command
Perceptual-motor (includes abilities subsumed under the terms visual perception, visuoconstructional, perceptual-motor, praxis, and gnosis)	Visual perception: Line bisection tasks can be used to detect basic visual defect or intentional neglect Visuoconstructional: Assembly of items requiring hand-eye coordination, such as drawing, copying, and block assembly Perceptual-motor: Integrating perception with purposeful movement (e.g., rapidly inserting pegs into a slotted board) Praxis: Integrity of learned movements, such as ability to imitate gestures (wave goodbye) or pantomime use of objects to command (“show me how you would use a hammer”) Gnosis: Perceptual integrity of awareness and recognition, such as recognition of faces and colors
Social cognition (recognition of emotions, theory of mind)	Recognition of emotions: Identification of emotion in images of faces representing a variety of both positive and negative emotions Theory of mind: Ability to consider another person’s mental state (thoughts, desires, intentions)

Table 2 Memory loss and cognitive impairment etiology[9]

Degenerative disorders including Alzheimer’s disease

Vascular dementia

Depression and anxiety

Medication side effects

Disturbed sleep

Hormones

Metabolic disorders

Diabetes

Alcohol abuse

Lyme disease

Hippocampal sclerosis

Subdual and epidural hematomas

Vitamin B12 deficiency

Seizures

HIV associated neurocognitive disorder

Hashimoto’s encephalopathy

HIV: Human immunodeficiency virus.