SEVERE DETERIORATION IN COGNITIVE FUNCTION AND PERSONALITY IN 5 PATIENTS WITH LONG-STANDING DIABETES - A COMPLICATION OF DIABETES OR A CONSEQUENCE OF TREATMENT

Changes in mood, personality, and social function were examined in a g roup of five Type 1 diabetic patients, aged 50 to 66 years, with durat ion of diabetes from 24 to 47 years. Information on medical history wa s obtained from their carers and hospital records. All patients had ex perienced multiple episodes of severe hypoglycaemia and had impaired a wareness of hypoglycaemia. Cerebral dysfunction predated the developme nt of minimal diabetic complications and had been apparent for between 1 and 17 years. The carers assessed the pre-morbid and present behavi our and personality of the patients using standard questionnaires. Sig nificant deteriorations were demonstrated in cognitive (p = 0.04) and social functions (p = 0.04), compared with assessment of pre-morbid fu nction. Patients had tended to become more neurotic (p = 0.08) and les s extravert (p = 0.07). All of the patients and three of the carers re corded scores suggestive of psychiatric morbidity on the General Healt h Questionnaire. The patients had experienced loss of employment and t he carers described a reduction in the patients' social interactions. Although the aetiology of their cerebral dysfunction can not be defini tely ascertained this case series emphasizes the need for long-term pr ospective studies in patients with diabetes of long duration to assess the impact of the disorder on cognitive and social abilities particul arly where there is evidence of cerebral dysfunction. The need for pro fessional support for the carers of such patients should be recognized .