Tutor Blog Post

“How does Diabetes affect the cognitive performance in older people?” RESEARCH PAPER NURSING

31 Mar 2019 24 Views Sarah

CHCPOL003 Research and apply evidence to practice

Research Topic:

Plan the research activity

“How does Diabetes affect the cognitive performance in older people?” is the decided research topic. This research topic has been prepared from two important areas of diabetes mellitus and older people.   

 

This topic has been chosen as diabetes is the key risk factor for developing dementia of both neurodegenerative (Alzheimer) and vascular etiology. The Type 2 diabetes is directly linked with over 1.5- to 2.5-fold rise in the dementia risk. Greater later-life cognitive decline has been linked with prediabetes, longer disease duration, and poor control (Munshi, 2017). Type 1 diabetes patients reported diminished mental flexibility and slower mental speed in older people. Moreover, the type 2 diabetes patients represent decline in their attention, executive function, psychomotor efficacy, memory, and learning. This needs deeper research on the presented topic because as per Australian Bureau of Statistics (ABS) 2014–15 National Health Survey (NHS), over 1 in 6 people of age 65years are diabetic (ABS, 2015). Diabetes rate increases with age having highest prevalence as 19.4% in people of age 85years and above. Thus, the chances of cognitive decline also increase in this age group (AIHW, 2017). The mental health and diabetes specialists must work together to define how diabetes impact cognitive functions in older people.

Identify the reason(s) for undertaking your research.

This research has been conducted to extend one’s knowledge for strengthening … nursing role to provide improved mental healthcare education and service provision to older diabetic people in Australia. This defined research study will support in understanding the mental healthcare models most suitable to support older people with diabetes health problem in the aged care service centres.

Write a clear statement highlighting your research question or hypothesis.

“How does Diabetes affect the cognitive performance in older people?”

Establish and define the general research objective.

The research aims at examining the impact of diabetes and its treatment on the change of the measures of the cognitive domains in older people. It will also seek to find whether the cognitive impairments are same or different in older people with and without diabetes problem.

Identify ONE (1) other discipline that could be connected to this research activity.

The first discipline connected to this research activity is gerontology which is the key focus workplace. The other discipline connected to this research activity could be mental health as the research topic is directly related with cognitive issues in older people due to diabetes issues.  

List two (2) sources you may use for this assignment.

Source 1à Pubmed Central- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853928/

Source 2à Brain Foundation Organization- http://brainfoundation.org.au/images/stories/applicant_essays/2013_essays/Dementia_Diabetes_Brodtmann_Amy.pdf

Evaluate and select a maximum of two (2) methods of gathering information you think would be most appropriate to answer your research question.

This research data will be gathered from two different methods of conducting the deep literature review and also making use of multiple search engines with the application of the accurate and highly suitable keywords relevant for the research study. This process has the initial step of conducting the clear and precise search through keywords which will be followed by the conduct of literature review. These two methods have been cost and time efficacious providing more data with higher relevance in terms of the research topic. Other available methods to collect data are quite time consuming and expensive.  

Select 4 sources

Article1-

Herath, P.M., Cherbuin, N., Eramudugolla, R. and Anstey, K.J., 2016. The effect of diabetes medication on cognitive function: evidence from the PATH Through Life study. BioMed research international2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853928/

The article is relevant as its research objective is directly linked with the prepared resrecah topic objective. The aim is of this research paper is to examine the effect of diabetes treatment on change of measures of specific cognitive domains over 4 years. It has become more relevant as it has sampled the research population from a cohort study in Australia and measured their cognitive health through 10 neuropsychological tests. This assures high quality and reliable data. The article becomes more applicable and relevant as its authors have been supported by the Centre for Research in Ageing Health and Wellbeing from the Australian National University.

Article 2-

Samaras, K. and Sachdev, P.S., 2012. Diabetes and the elderly brain: sweet memories?. Therapeutic advances in endocrinology and metabolism3(6), pp.189-196. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539178/

The article is revenant as it summarizes the evidence in terms of changes that occur in the brain function as well as structure in the type 2 diabetes mellitus primarily focused on studied conducted on aged population. The systematic review conducted in this research is valuable as it has reviewed the literature by collecting and critically comparing multiple research studies from different decades. The data provided by this research is appreciable and relevant for inclusion because its authors belong to the Garvan Institute of Medical Research in the Department of Endocrinology from St Vincent’s Hospital in Australia. Its data is generalizable to Australian elderly population.

Article 3-

Moore, E.M., Mander, A.G., Ames, D., Kotowicz, M.A., Carne, R.P., Brodaty, H., Woodward, M., Boundy, K., Ellis, K.A., Bush, A.I. and Faux, N.G., 2013. Increased risk of cognitive impairment in patients with diabetes is associated with metformin. Diabetes care36(10), pp.2981-2987. http://care.diabetesjournals.org/content/36/10/2981

This article is presenting efficient data to explore because it is investigating the associations of metformin, calcium supplements, and serum vitamin B12 with the cognitive impairment in diabetic patients with diabetes. This article becomes highly critical and valid because the participants had been recruited from popular two prospective studies of the Australian Imaging, Biomarkers and Lifestyle (AIBL) study of aging and the Prospective Research in Memory (PRIME) clinics study. Moreover, it has studied 862 participants between 2001 and 2011 defining more accurate results and generalizable outcomes. The use of mini-mental status examination (MMSE) format assures the outcomes to be more appropriate because it is a standardized mental health assessment tool. Moreover, the support of the University of Melbourne, Barwon Health, National Ageing Research Institute, Deakin University School of Medicine, University of New South Wales, Prince of Wales Hospital, Heidelberg Repatriation Hospital, the Queen Elizabeth Hospital, Centre of Excellence for Alzheimer’s Disease Research & Care, Austin hospital, and Hollywood Private Hospital in this study makes this article attain the peak of standardization, criticality, and reliability.

Article 4-

Han, M., Huang, X.F., Xiu, M., Kosten, T.R. and Zhang, X.Y., 2013. Diabetes and cognitive deficits in chronic schizophrenia: a case-control study. PloS one8(6), p.e66299. http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1880&context=smhpapers

This article is relevant primarily due to its case control pyramid of evidence. It has compared the diabetic and non-diabetic patients with schizophrenia to define the differentiation in their cognitive impairments. This presents this article to be quite analytical in approach. The relevance of the study increases to the peak with its application of standardized tools like repeatable battery for the assessment of neuropsychological status (RBANS) and following the criteria proposed by DSM-IV. The results of this article are highly applicable in the defined research topic also because two psychiatrists with >5years of clinical practice experience and blind to the participant’s clinical status and treatment conditions were made responsible to assess their psychopathology with the use of PANSS (Positive and negative syndrome scale). There is no factor to define that any part of this study is irrelevant or unreliable. The authors have been a key stakeholder in University of Wollongong and Peking University enhancing data worth.

Briefly explain why one (1) piece of your information is particularly relevant according to your objectives and your workplace requirements.

The study by Han et al. (2013) is found to be most relevant for its high quality pyramid of evidence and analytical approach. It has compared the diabetic and non-diabetic patients with schizophrenia to present if diabetes results in more cognitive decline than non-diabetic people or not. Moreover, it is totally supporting the research topic with association with the research topic’s objective. In the aged care workplace, several cases of diabetic people with disturbed mental health have been reported specifically in people of age 50years and more. Even this study has presented the comparison of cognitive prevalence in younger and older people because it studied people of age 25 to 70years.      

Prioritise information based on the research objectives.

Two (2) articles prioritised for support for the rest of the assignment are:

1.     Herath, P.M., Cherbuin, N., Eramudugolla, R. and Anstey, K.J., 2016. The effect of diabetes medication on cognitive function: evidence from the PATH Through Life study. BioMed research international2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853928/

2.     Han, M., Huang, X.F., Xiu, M., Kosten, T.R. and Zhang, X.Y., 2013. Diabetes and cognitive deficits in chronic schizophrenia: a case-control study. PloS one8(6), p.e66299. http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1880&context=smhpapers

Compare and contrast two (2) sources of information

 

Article 1

Herath, P.M., Cherbuin, N., Eramudugolla, R. and Anstey, K.J., 2016. The effect of diabetes medication on cognitive function: evidence from the PATH Through Life study. BioMed research international2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853928/

 

Article 2

Han, M., Huang, X.F., Xiu, M., Kosten, T.R. and Zhang, X.Y., 2013. Diabetes and cognitive deficits in chronic schizophrenia: a case-control study. PloS one8(6), p.e66299. http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1880&context=smhpapers

 

Currency

2016

2013

Study Findings

The comparison of the cognitive function present between the diabetes treatment groups represented no significant effect of pharmacological treatment type on population’s cognitive function in comparison to the diet only group or also known as the no diabetes group. Out of these, the oral hypoglycaemic treatment only group with participants using metformin alone presented improved cognitive function at baseline in terms of the verbal learning, executive function, and working memory domains compared to the participants on other kinds of diabetic treatment. 

 

In comparison to healthy controls, every patient group had substantially decreased total as well as five index RBANS scores (all p,0.01–p,0.001), leaving the visuospatial/constructional index. Diabetes with schizophrenia performed worse in comparison to without diabetes and schizophrenia in immediate memory (p,0.01) along with total RBANS scores (p,0.05). This also represented reduced attention trend (p = 0.052) and visuospatial/constructional capacity (p = 0.063). As per the regression analysis, the RBANS presented modest correlations with PANSS scores of schizophrenia, including their current antipsychotic treatment duration, and diabetes diagnosis. More cognitive impairment was seen in people with schizophrenia and having co-morbid diabetes as compared to schizophrenia without diabetes and diabetes only, certainly in attention and immediate memory.

Strength of Study

It is a longitudinal cohort study that falls under the unfiltered resource. It has three cohorts including young (aged 20–24 years at baseline/Wave 1), midlife (aged 40–44 years at baseline/Wave 1), and older (aged 60–64 years at baseline/Wave 1). All the cohorts have been followed up twice at the 4 yearly intervals. This strength is efficient at reviewing the existing data to ensure its reliability and validity.

It is a case control study. It is a kind of observational study wherein two existing groups differed in outcome  are identified and compared as per the supposed casual attribute. It is an unfiltered resource. It is the first stage of testing observations. It helps in identifying variables that can predict a condition.  

Relevance to Objectives

High- responsiveness to research question.

Moderate responsiveness towards the research question.

Reliability

High

§  Heterogeneous sample with three different age group cohorts.

§  Test-retest reliability is definitely high due to its longitudinal study basis and participants have been followed up twice at 4yearly intervals. This helps in measuring stability of results.

§  Higher level of variability.

§  Measured participant’s cognitive health via 10 neuropsychological and standardized tests:

à Immediate Recall (first list of California Verbal Learning Test) 

à Wechsler Memory Scale-Digit Span Backward 

à Spot-the-Word (STW) Task 

à Symbol-Digit Modalities Test (SDMT)

à Simple Reaction Time (SRT)

à Choice Reaction Time (CRT)

àTrail Making Test, part A and part B, 

à Purdue Pegboard Test (both hands) (PPEG test)

àUK Whitehall II study questionnaire

High

§  Heterogeneous sample (regions & characteristics).

§  While recruitment, the diagnoses for every patient was made by two experienced and independent psychiatrists and properly confirmed by the Structured Clinical Interview for DSM-IV (SCID).

§  Higher level of variability.

§  Used the standardized assessment tool for measuring neuropsychological status (RBANS).

§  Higher inter-rater reliability because participant’s psychopathology has been assessed and analyzed by two psychiatrists with >5years of clinical practice experience and blind to the participant’s clinical status and treatment conditions with the use of PANSS (Positive and negative syndrome scale).

Validity

High

Internal validity- Almost zero number of flaws as the PATH Through Life model has been followed to conduct this longitudinal cohort study of participants sampled from the electoral roll of the Australian Capital Territory and Queanbeyan. This provided reliable and valid details about the participants and even helped in examining multiple cognitive domains. But, small follow up duration might have influenced the findings.  

External validity- Generalized results because of studying a big sample of 1814 participants with no reported selection bias.  

Moderate

Internal validity- Recruited participants by using a cross-sectional naturalistic design to avoid any bias.

External validity- It is only generalized to regional people of Beijing and Tangshang cities due to very small sample.

Benefits

This is the first study which has examined the impact of metformin on multiple cognitive domains within the longitudinal cohort study design. Metformin appears to be protective against cognitive function, but exact mechanisms are unclear.

It has given clear and concise knowledge about the evidence that Schizophrenia with co-morbid diabetes have more cognitive

decline or impairment as compared to schizophrenia without diabetes and diabetes only, certainly within the areas of attention and immediate memory.

Risks

Applying this study and its results in the aged care workplace will demand authority permission and might even get rejected due to lack of solid base of this foundation.

It will be complex to apply these findings in the aged care workplace because schizophrenia suffering patients have never been reported here. Majority of the nurses working for aged people are also not aware of this disorder and its key impacts on health.

Feasibility associated with information

The findings are surely applicable in every healthcare workplace because of data assessed from standardized tools and analysis through IBM SPSS (Version 22), and Generalized Linear Models (GLZM).

These findings are not directly applicable in the workplace because this workplace has no patient suffering from schizophrenia or any history of this mental disorder.

Conclusion

It is quite evident that diabetic people in older population have more cognitive decline as compared to non-diabetic people. It is essential to observe significant effect of any form of pharmacological treatment for diabetes over the cognitive function, other than the evidence available for metformin showing significant protective effect over the defined domains of verbal learning, executive function, and working memory. Moreover, schizophrenia in co-morbid diabetic people has higher cognitive impairments that must be paid attention in aged care homes and mental health hospitals.