Correlation among cognitive functions, mood disturbance, and health-related quality of life in type 2 diabetes mellitus: A cross-sectional survey

Noor Mohammad; Neha Naaz; Nahid Khan

doi:10.4103/abhs.abhs_36_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 2 | Issue : 1 | Page : 31-35

Correlation among cognitive functions, mood disturbance, and health-related quality of life in type 2 diabetes mellitus: A cross-sectional survey

Noor Mohammad¹, Neha Naaz¹, Nahid Khan²
¹ Department of Occupational Therapy, Jamia Hamdard, New Delhi, India
² Department of Physiotherapy, Jamia Hamdard, New Delhi, India

Date of Submission	03-Jun-2022
Date of Decision	15-Dec-2022
Date of Acceptance	19-Dec-2022
Date of Web Publication	25-Jan-2023

Correspondence Address:
Dr. Noor Mohammad
Department of Occupational Therapy, Jamia Hamdard, New Delhi - 110 062
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/abhs.abhs_36_22

Abstract

Background: The purpose of this study was to find the possible correlation among cognitive functions, mood disturbance, and health-related quality of life in people with type 2 diabetes mellitus (T2DM).
Methods: This study was a preliminary cross-sectional survey study carried out on 40 participants diagnosed with T2DM for more than 2 years. The age group ranged between 35 and 55 years. Demographic data were recorded. Cognitive function was assessed using Mini-Mental State Examination, mood disturbance was assessed using the profile of mood states questionnaire and health-related quality of life was assessed using the Euroqol-5d-5l questionnaire.
Results: There was a significant negative correlation between cognitive functions and mood disturbance (r = −0.45, P < 0.05), no correlation between cognitive functions and health-related quality of life (examiner scoring) (r = 0.29, P = 0.06), significant weak positive correlation between cognitive functions and health-related quality of life (participant self-score) (r = 0.37, P < 0.05). Significant strong negative correlation between mood disturbance and health-related quality of life (examiner scoring) (r = −0.66, P < 0.001), significant negative correlation between mood disturbance and health-related quality of life (participant self-score) (r = −0.62, P < 0.001).
Conclusion: Cognitive functions and mood disturbances are important factors that may adversely affect health-related quality of life in people with T2DM. More attention should be given to cognitive function and mood disturbance in people with T2DM to minimize the negative impact of the illness on their health-related quality of life.

Keywords: Cognition, health-related quality of life, mood disturbance, type 2 diabetes mellitus

How to cite this article:
Mohammad N, Naaz N, Khan N. Correlation among cognitive functions, mood disturbance, and health-related quality of life in type 2 diabetes mellitus: A cross-sectional survey. Adv Biomed Health Sci 2023;2:31-5

How to cite this URL:
Mohammad N, Naaz N, Khan N. Correlation among cognitive functions, mood disturbance, and health-related quality of life in type 2 diabetes mellitus: A cross-sectional survey. Adv Biomed Health Sci [serial online] 2023 [cited 2023 Jun 9];2:31-5. Available from: http://www.abhsjournal.net/text.asp?2023/2/1/31/368489

Background

Type 2 diabetes mellitus (T2DM) is a common metabolic disease; it is characterized by hyperglycemia, caused by insulin resistance and an inadequate compensation in the secretion of insulin.[1] It may cause various complications, such as kidney failure, foot ulcer, peripheral neuropathy, and blindness.

T2DM is associated with a high risk of cardiovascular disease and premature death.[2] It has become increasingly evident that diabetes may also affect the central nervous system, a complication referred to as “diabetic encephalopathy.”[3] This complication is reflected in impaired cognitive functioning[4] and is also associated with an increased risk of dementia.[5]

Cognitive functioning comprises multiple cognitive domains, such as memory, information processing speed, language, visuoconstruction, perception, attention, and executive functions, which can be impaired selectively.[6] Many studies on the effect of T2DM on cognitive functioning assessed memory function. Studies reported a cognitive decline in verbal memory for people with T2DM. [7,8]

Attention has also been examined in many studies. The majority of cross-sectional studies that measured executive functioning showed diminished performance of the people with T2DM.[9] Information-processing speed and reaction times in the majority of cross-sectional studies show diminished performance in people with T2DM. Moderate impairments across all cognitive domains are found in T2DM.[10]

Studies have shown a relationship between diabetes and psychiatric disorders. A recent survey showed that the prevalence of depression is approximately 10% higher in diabetic patients.[11] Chronic hypercortisolemia may lead to insulin resistance, which could explain the association between diabetes mellitus and depression and vice versa.[12] Diabetic patients with depression are associated with poorer glycemic control, more complications of the disease, a reduced quality of life, and increased mortality.[13-15] Studies have shown a higher prevalence of depressive episodes, recurrent depressive episodes, dysthymia, mood disorder with psychotic symptoms, and suicidal ideation in T2DM.[16]

Rationale

There is a growing interest to influence aspects of quality of life, such as mental health and general well-being. The effects of the overall quality of life are well established in the general population and have been analyzed in various dimensions of World Health Organization Quality of Life-BREF, including physical and social functioning; subjective well-being, emotion, and mood; self-esteem and self-perception; cognitive performance; and sleep quality.[17]

In order to understand and find the possible association among mood disturbance and cognitive function on quality of life with T2DM. The need was felt for this study to understand the relationship between cognitive functions, mood disturbances, and quality of life with T2DM.

The aim is to study the correlation present among cognitive functions, mood disturbances, and quality of life with T2DM.Alternate hypothesis – there is a correlation present among cognitive functions, mood disturbances, and quality of life with T2DM.Null hypothesis – there is no correlation present among cognitive functions, mood disturbances, and quality of life with T2DM.

Materials and Methods

Participants

The sample size of 40 participants (27 females and 13 males) diagnosed with T2DM was taken from a residential society using convenience sampling. The age group ranged from 35 years to 55 years was taken for the study. Participants had a minimum 2-year history of T2DM with blood glucose (random) 200 mg/dl or above using a self-monitoring blood glucose device (Accu-Chek Active Blood Glucose Glucometer) were included in the study.[18] Participants diagnosed with type 1 diabetes mellitus and blood glucose (random) below 200 mg/dl were excluded from the study. No dropouts were found during the data collection. Demographic data, height, weight, and blood glucose level were recorded.

Study design

The study was designed as a cross-sectional survey study. The study was carried out at the Department of Rehabilitation Sciences, Jamia Hamdard, New Delhi, India. The participants were enrolled in the study from December 2019 to April 2020. Written informed consent was obtained from all the participants.

Procedure

Demographic data, blood glucose level, was measured using a glucometer (beeto meter) under aseptic precautions. Height was measured using a measuring tape, weight was measured using a weighing scale, and duration (history) of diabetes was extracted from their medical records [Table 1]. Cognitive function was assessed using Mini-Mental State Examination,[19] mood disturbance was assessed using the Profile of Mood States Questionnaire,[20] and health-related quality of life was assessed using Euroqol-5d-5l Questionnaire [Table 2].[21]

Table 1: Descriptive analysis (gender, age, body mass index, and duration of diabetes)

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Table 2: Descriptive analysis (blood glucose level, cognitive function, mood and health-related quality of life in 40 adults with type-2 diabetes mellitus)

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Data analysis

Collected data were arranged in the form of a master chart made on Microsoft excel 2007.MS Excel was used for descriptive analysis. IBM, SPSS statistics for windows (version 20, Armonk, New York: IBM Corp.) was used for statistical analysis. Descriptive analysis was performed using mean and standard deviations. Pearson correlation was used to find the relationship between cognitive functions, mood disturbance, and health-related quality of life in people with T2DM [Table 3].

Table 3: Correlation scores (blood glucose level, cognitive function, mood disturbances, and health-related quality of life)

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Results

The study included 40 participants, with 27 (67.25%) females and 13 (32.5%) males. The age ranged between 25 years and 55 years. It was found a significant negative correlation between mood disturbance and cognitive functions (r = −0.45, n = 40, P < 0.005) [Figure 1], no correlation between cognitive functions and health-related quality of life (examiner scoring) (r = 0.29, n = 40, P = 0.06) [Figure 2], significant positive correlation between cognitive functions and health-related quality of life (participant self-score) (r = 0.37, n = 40, P < 0.05) [Figure 3]. A significant negative correlation between mood disturbance and health-related quality of life (examiner scoring) (r = −0.66, n = 40, P < 0.001) [Figure 4], a significant negative correlation between mood disturbance and health-related quality of life (participant self-score) [r = −0.62, n = 40, P < 0.001, [Table 3] and [Figure 5].

Figure 1: Scatter diagram showing relationship between cognition versus mood disturbance (r = -0.45, P < 0.005).

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Figure 2: Scatter diagram showing relationship between cognition versus health related quality of life (EQ-5D; Examiner scoring) (r = 0.296, P > 0.05).

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Figure 3: Scatter diagram showing relationship between cognition versus health related quality of life (EQ-5D; Participant self-scoring) (r = 0.372, P < 0.05).

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Figure 4: Scatter diagram showing relationship between mood disturbance versus health related quality of life (EQ-5D; Examiner scoring) (r = -0.666, P < 0.05).

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Figure 5: Scatter diagram showing relationship between mood disturbance versus health related quality of life (EQ-5D; Participant self scoring) (r = -0.620, P < 0.05)

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Discussion

This study aimed to find the possible relationship between cognitive functions and mood disturbance in people with T2DM and to determine the contribution of these factors in health-related quality of life in people with T2DM. The sample included 40 participants following inclusion criteria, and this study specifically excluded T2DM with neurodegenerative disorders (such as Parkinson's disease and multiple sclerosis). Domains studied in the study were cognitive function, mood disturbances, and health-related quality of life. The mean age of participants of the study was 46.35 years (range 25–55), with the mean duration of T2DM history being 8.15 years (range 2–30).

Findings indicate that cognitive functions and mood disturbances were significantly associated, and they adversely affect the health-related quality of life of people with T2DM. The findings of the study are consistent with the number of other studies suggesting cognitive decline and mood disturbances with T2DM.^{[16],[22],[23]} Factors such as cognitive function and mood disturbances appear to be significant contributors for health-related quality of life.[24-26]

The clinical implication of our findings is that both cognitive functions and mood disturbances need to be addressed to optimize health-related quality of life in people with T2DM. Interventions for T2DM should also include coping strategies to address independent determinants of health-related quality of life. Future longitudinal studies are required to identify other factors influencing health-related quality of life in people with T2DM. Occupational therapy, coping strategies, and psychological interventions need to be included in the interventions of people with T2DM to provide a holistic approach.

Conclusion

Cognitive functions and mood disturbances are important factors that may adversely affect health-related quality of life in people with T2DM. More attention should be given to cognitive function and mood disturbance in people with T2DM to minimize the negative impact of the illness on their health-related quality of life.

Study limitations

This study has several limitations; first, the sample size was relatively small, and we found meaningful results related to the correlation among cognitive function, mood disturbances and health-related quality of life, but the results are not generalizable. Further study with a larger sample size in various age ranges is needed for systematic analysis to obtain implications. Second, data collected in this study were from a limited geographical reach, therefore suggesting a need for future study. This study was one-time survey based, that would not track changes in blood glucose levels, and it should be done to find levels of deterioration in cognitive functions, mood disturbances, and health-related quality of life with time.

Authors' contributions

NM conceived the research concept, developed the research design, prepared the first draft, and all reviewers reviewed and approved the final draft of manuscript, NN conducted Data Collection and or Processing, Analysis and or Interpretation, NK Critically Reviewed manuscript. All authors are responsible for the contents and integrity of this manuscript.

Data availability statement

All the original contributions presented in this manuscript are included in the article.

Conflict of interests

No conflict of interests declared.

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