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Case Study: Cognitive Impairment, Depression, and Severe Hypoglycemia

The first 300 words of the full text of this article appear below.

	Introduction

 
The following case study illustrates the clinical role of mental health professionals who specialize in the treatment of people with diabetes. This case describes the diagnostic dilemma presented by a patient with diabetes and a history of severe hypoglycemia complicated by other medical, psychiatric, social, and functional problems.

Cognitive impairment (e.g., memory loss, increased distractibility, and confusion) can present a difficult diagnostic problem for clinicians because it can be symptomatic of many underlying and undetected clinical conditions. Careful diagnosis is crucial because some causes may be progressive and irreversible, whereas other causes may be reversible with medical or psychiatric treatment. Some of the more noteworthy causes are related to medication, alcohol, aging, depression, and, as in this case study, the possible consequences of recurrent severe hypoglycemia related to diabetes.¹ Diabetes, of course, may cause an increase in cognitive decline over the course of time because of vascular risk factors.² Some evidence suggests that acute hyperglycemia may have a negative impact on cognitive performance.³

Depression is the most common of the reversible causes of memory impairment, and people with diabetes are twice as likely to suffer from depression as those without diabetes.⁴ Recent evidence suggests that diabetes may create alterations in regions of the brain that are associated with affect regulation and increase the risk for developing a depressive disorder.⁵ Fortunately, problematic medications can be modified, and alcohol misuse or depression can be treated. Unfortunately, despite its relevance to the course of diabetes, depression is recognized and treated in fewer than one-third of people with diabetes.⁴

The relationship between recurrent severe hypoglycemia and cognitive impairment remains unclear. Both prospective and longitudinal studies of cognitive function have been so plagued by methodological problems that it is difficult to unequivocally determine whether patients who experience repeated episodes of severe hypoglycemia are at risk . . . [Full Text of this Article]

	Case Presentation

 

	Personal history

 

	Medical history

 

	Psychiatric history

 

	Questions

 

	Discussion

 

	Clinical Pearls

 

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