Self- or physician-reported diabetes, glycemia markers, and cognitive functioning in older adults in Germany.

OBJECTIVES: To assess the association of different diabetes-related variables, including self- and physician-reported information, as well as biomarkers, with cognitive functioning in the elderly general population in Germany. DESIGN: Cross-sectional observational study. SETTING AND PARTICIPANTS: A total of 1,697 subjects with a mean ± standard deviation age of 74 ± 2.8 years were included. These were recruited from among the participants of an ongoing epidemiological study of the elderly general population in Saarland state and had been recruited 5 years earlier on the occasion of a health screening exam by their general practitioners. MEASUREMENTS: Cognitive functioning across six subdomains was assessed using the Cognitive Telephone Screening Instrument. Data on prevalent diabetes at baseline were obtained from the study participants and their general practitioners. Baseline fasting glucose was assessed as part of the screening exam, and baseline HbA1c was determined centrally by standardized methods. RESULTS: The association of cognitive functioning with self-reported diabetes (N = 189) was more pronounced than with physician-reported diabetes (N = 280). HbA1c showed a nonlinear association with cognitive functioning, with a peak of cognitive performance in the central quintile of HbA1c. In the case of fasting glucose, lower cognitive functioning was only observed in the highest quintile. The estimates were robust in confounder-adjusted models, but attentuated when excluding subjects with baseline prevalent or follow-up incident diabetes. CONCLUSIONS: Future studies of diabetes-related biomarkers and cognition should take possible nonlinearity of the relationships into account, as the strength of the associations otherwise might be underestimated.

Reducing heavy drinking in college males with the decisional balance: analyzing an element of Motivational Interviewing.

The decisional balance, a brief detailing of the advantages and disadvantages of behavior change, serves as a key component to interventions in Motivational Interviewing. The impact of this component alone is not well understood. Forty-seven men completed a Timeline Followback interview assessing alcohol consumption and unsafe sexual practices. They then completed a decisional balance, listing the Pros and Cons of decreasing their drinking, but not one for safer sex. One-month follow-up data showed that they had statistically significant and clinically meaningful increases in their motivation to alter drinking and decreases in the number of drinks that they intended to drink, the actual drinks consumed per month, the days per month that they drank, their maximum number of drinks consumed on one occasion, and their average number of drinks per occasion. They did not alter their sexual behavior or their motivation to increase safe sex behavior. These results suggest that the decisional balance plays an important role in Motivational Interviewing and could serve as a quick and efficient intervention by itself.