Cognitive dysfunction and diabetes: implications for primary care.

It is increasingly recognized that diabetes mellitus can lead to long-term complications in the brain. Clinically, these complications are manifested in alterations in cognitive functioning. This paper offers an overview on the impact of diabetes on cognition and provides leads for the evaluation and management of cognitive disturbances in patients with diabetes in a primary care setting. The main message is that while some patient groups appear to be at increased risk of cognitive impairments, in the majority of patients diabetes is not associated with the development cognitive decrements that would be regarded as clinically relevant. Frank impairments of cognition mainly occur in patients above the age of 65, often in association with vascular co-morbidity. Other groups at risk for cognitive decrements are children with an early age at diabetes onset and patients with clinically manifest retinopathy or other microvascular complications. No specific treatment options are available, but for now treatment of vascular risk factors and attention for glycaemic control appears to be a logical approach. Given the recent progress in this field, new treatments to prevent cognitive impairment in patients with diabetes may hopefully become available in the near future.