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Thinking Clearly: Rehabilitating Cognitive Deficits in Individuals with Diabetes

Posted: Dec. 1, 2017

Heather Cuevas, PhD, RN, ACNS-BC and assistant professor of clinical nursing

Problems in cognitive performance, or cognitive deficits, are common in people with both type 1 and type 2 diabetes, evidenced by a slowing of mental processing speed, psycho-motor speed, executive function and attention. In some cases, learning and memory problems also exist. Heather Cuevas, PhD, RN, ACNS-BC and assistant professor of clinical nursing, hopes to find how and why this is.

“Cognitive dysfunction is more prevalent in this population than the general population and starts at an earlier age,” Cuevas said. “We know diabetes has devastating effects on multiple organs in the body, and there could be several reasons why it affects cognitive function. Despite the damage caused, however, there hasn’t been much research on how to improve cognitive function in diabetes.”

She intends to change that.

Cuevas recently completed a small study funded by the School of Nursing’s Cain Excellence Fund that looked at the relationship between perceived cognitive function and diabetes self-management. She is now hard at work on a new study funded by the School’s NIH-funded Center for Transdisciplinary Collaborative Research in Self-Management Science that adapts the Memory, Attention and Problem Solving Skills for persons with multiple sclerosis (MAPSS-MS), a computer-assisted cognitive rehabilitation intervention.

This intervention has shown great promise as a means of improving memory, use of compensatory strategies, and performance of cognitive and instrumental activities of daily living for individuals with MS, and Cuevas thinks it will be equally helpful for diabetics who suffer these same impairments.

The eight-week MAPSS-DM program includes two components: four weekly group sessions focused on building efficacy for use of cognitive compensatory strategies and a computer-assisted cognitive rehabilitation program with homebased training. Participants complete a self-report questionnaire and are asked if they are having trouble remembering to take medications and check sugar levels, all of which are critical to their well-being. They also complete a questionnaire regarding memory, executive function and self-efficacy.

In the group sessions, Cuevas teaches strategies to improve day-to-day cognitive function, such as reducing noise levels when trying to improve attention. Participants are also given weekly goals and encouraged to maintain a healthy diet and exercise regimen. In addition to helping rehabilitate their cognitive abilities, the study seeks to assess the role self-management plays in improving cognitive function and vice versa.

“I want to know why people are making the decisions they are about self-management, but also want to hear from people who are unable to make such decisions,” Cuevas said. “The participants are very interested in doing what they can to improve or prevent this complication. They want to know what steps they can take to improve their situation.”

Cuevas recently published the article “Perceived cognitive deficits are associated with diabetes self-management in multiethnic samples” in the Journal of Diabetes and Metabolic Disorders. She has submitted a grant proposal to the National Institute of Nursing Research, which calls for functional MRIs at the beginning and end of the study, and neuro-psychological testing rather than self-reporting. Dean Alexa Stuifbergen will be mentoring Cuevas as she takes this next step in her research career.

“When I became a nurse, I didn’t originally intend to study cognitive impairment in people with diabetes, but the more I discovered about it, the more I wanted to understand it and help people live more functional lives,” Cuevas said. “These deficits are serious for anyone, but as an added complication of diabetes, with all of its other complications, it’s paramount that nursing science find answers and provide helpful strategies to patients who are affected.”

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