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Depressive symptoms and quality of life after screening for cognitive impairment in patients with type 2 diabetes: observations from the Cog-ID cohort study
  1. Jolien Janssen1,
  2. Paula S Koekkoek1,
  3. Geert-Jan Biessels2,
  4. Jaap L Kappelle2,
  5. Guy E H M Rutten1
  6. On behalf of the Cog-ID study group
    1. 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
    2. 2 Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
    1. Correspondence to Dr Jolien Janssen; j.janssen-5{at}


    Objectives To assess changes in depressive symptoms and health-related quality of life (HRQOL) after screening for cognitive impairment in people with type 2 diabetes.

    Design A prospective cohort study, part of the Cognitive Impairment in Diabetes (Cog-ID) study.

    Setting Participants were screened for cognitive impairment in primary care. People suspected of cognitive impairment (screen positives) received a standardised evaluation at a memory clinic.

    Participants Participants ≥70 years with type 2 diabetes were included in Cog-ID between August 2012 and September 2014, the current study includes 179 patients; 39 screen positives with cognitive impairment, 56 screen positives without cognitive impairment and 84 participants not suspected of cognitive impairment during screening (screen negatives).

    Outcome measures Depressive symptoms and HRQOL assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), 36-Item Short-Form Health Survey, European Quality of Life-5 Dimensions questionnaire and the EuroQol Visual Analogue Scale. Outcomes were assessed before the screening, and 6 and 24 months after screening. An analysis of covariance model was fitted to assess differences in score changes among people diagnosed with cognitive impairment, screen negatives and screen positives without cognitive impairment using a factor group and baseline score as a covariate.

    Results Of all participants, 60.3% was male, mean age was 76.3±5.0 years, mean diabetes duration 13.0±8.5 years. At screening, participants diagnosed with cognitive impairment had significantly more depressive symptoms and a worse HRQOL than screen negatives. Scores of both groups remained stable over time. Screen positives without cognitive impairment scored between the other two groups at screening, but their depressive symptoms decreased significantly during follow-up (mean CES-D: −3.1 after 6 and −2.1 after 24 months); their HRQOL also tended to improve.

    Conclusions Depressive symptoms are common in older people with type 2 diabetes. Screening for and a subsequent diagnosis of cognitive impairment will not increase depressive symptoms.

    • primary care
    • dementia

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    • Patient consent for publication Not required.

    • Contributors PSK, G-JB, JLK and GEHMR designed the study. PSK coordinated the study. PSK and JJ managed the study and data collection. JJ, PSK and G-JB were involved in the data collection. JJ wrote the first manuscript. All authors read, commented and approved the final draft of the manuscript. JJ is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding EFSD/Lilly Mental Health and Diabetes programme of the European Foundation for the Study of Diabetes (EFSD).

    • Disclaimer The funder of the study had no role in study design, data collection, data interpretation, data analysis or writing of the report.

    • Competing interests GJB consults for and receives research support from Boehringer Ingelheim and has received speaker’s fees from Eli Lily. Compensation for these activities is transferred to his employer, the UMC Utrecht. The other authors report no conflict of interest.

    • Ethics approval The Cog-ID study was conducted according to the principles of the Declaration of Helsinki and in accordance with the Dutch law on Medical Research Involving Human Subjects Act (WMO). This study was approved by the medical ethics committee of the University Medical Centre Utrecht, the Netherlands. Written informed consent was obtained from all patients.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All of the individual participant data collected during the trial, after de-identification, are available to researchers who provide a methodologically sound proposal. The study protocol is available on request.

    • Collaborators Jolien Janssen, Paula S. Koekkoek, Minke Kooistra, Guy E.H.M. Rutten from the Julius Centre for Health Sciences and Primary care; Geert Jan Biessels, L. Jaap Kappelle, Esther van den Berg, J. Matthijs Biesbroek and Onno Groeneveld from the Neurology department.