Screening of Neurocognitive and Executive Functioning in Children, Adolescents, and Young Adults With Type 1 Diabetes
National and international treatment guidelines recommend regular psychological screening of children and youth with type 1 diabetes. In this article, the authors argue that neurocognitive screening is another important yet neglected aspect of the care of youth with diabetes. Mild neurocognitive dysfunction is an underrecognized complication of diabetes that can have considerable effects on school performance, activities of daily living, and diabetes self-management. This article offers suggestions for screening and management of neurocognitive dysfunction in pediatric type 1 diabetes patients in various settings, as well as recommendations for future research.
Children, youth, and young adults with type 1 diabetes face many challenges and complications as a result of their disease. One of the less well-recognized problems is an increased incidence of mild to moderate neurocognitive dysfunction: acquired deficits in psychomotor speed, mental efficiency, attention, visual-motor skills, memory, and learning. (See related article by Cato and Hershey on p. 197 of this issue.) In general, these deficits are relatively subtle, with effect sizes reported in the small to moderate range (1). Thus, many individuals who have cognitive dysfunction will have scores on standardized tests that fall within the average range, although the functional impact of small deficits can still be substantial. Children with cognitive dysfunction have an increased likelihood of prob-lems at school (2) and difficulties with diabetes management (3,4) that place them at risk for poor glycemic control. Diabetes-related neurocognitive dysfunction therefore has important implications for the lives and long-term outcomes of individuals with diabetes. Just as psychosocial screening is important for standard diabetes care, so too is identifying individuals who are at risk for developing cognitive deficits or are currently experiencing cognitive dysfunction (5).
One way to identify cognitive declines is to monitor youth through comprehensive neuropsychological evaluation (6). Although adopting this strategy could help inform …