The present review integrates findings of published studies that have evaluated the cognitive function of treated and untreated type 2 diabetic patients and provides a detailed overview of the neuropsychological assessments conducted. Cognitive deficits are observed in older people with glucose intolerance or untreated diabetes but these deficits appear to be attenuated by treatments that improve glycemic control. Cognitive decrements in treated type 2 diabetic patients are most consistently observed on measures of verbal memory (35% of the measures) and processing speed (45% of the measures) while preserved function is observed on measures of visuospatial, attention, semantic and language function. Some studies suggest that deficits in cognitive functions are associated with poorer glycemic control. A number of other factors, such as depression, cardiovascular and cerebrovascular disease, increase these deficits. We conclude that, in diabetic patients who achieve and maintain good glycemic control, type 2 diabetes only has a small impact on cognitive functions before the age of 70 years. However, early onset of type 2 diabetes, poor glycemic control and the presence of micro- and macrovascular disease may interact to produce early cognitive deficits. In older adults (70 years and over), diabetes likely interacts with other dementing processes such as vascular disease and Alzheimer's disease to hasten cognitive decline.

The four IADL score could be incorporated into the screening procedure for dementia in elderly community dwellers.

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An epidemiological survey of self-reported memory complaints and memory performance [assessed with Benton''s visual-retention test (BVRT) and the Wechsler paired-associates test (WPAT)] was undertaken in a community sample of 2,726 noninstitutionalized subjects aged 65 and over living in Gironde (southwestern France). A significant relationship was observed between the presence of self-reported memory problems and lower performance on the BVRT and the WPAT. However, beyond this relationship, there was significant discordance between the two evaluations, explained in part by the fact that the correlates of memory functioning were not related with similar strength to self reports and to actual performance. In general, females and subjects who scored above the depressive symptomatology threshold reported more problems, while lower performances were related to older age and low educational level. The discordance between self reports and actual performance may suggest anosognosia of mild memory deficits and could possibly be a predictor of future intellectual deterioration.