She saw this with her own aunt: she did the MMSE (-Mental State Examination) thee times and was reassured three times. However, in the end she turned out to have Alzheimer’s disease. Jolien: "The MMSE is particularly suitable as a test if the doctor already suspects that someone has a cognitive disorder and that this disorder seems to limit their daily functioning. The MMSE can then confirm the diagnosis of “dementia. In mild disorders or early-onset dementia, especially in higher educated patients, the MMSE is not always sensitive enough and extra alertness is needed. We propose to use a more sensitive test in that case."

Clock-drawing Test
When people come to the doctor with the question if they’re experiencing the early-onset of dementia, the doctor will first have a conversation with them and a loved one, before administering a test. Right now that's always been the MMSE for every patient. However, Jolien advises GPs to use three different tests instead, depending on the outcome of the conversation. "We have reviewed all available literature and selected the most appropriate tests on the basis of predetermined criteria. If, after conversations with the patient and the loved one, a cognitive disorder seems unlikely, the clockwise sign test is a quick check." This test requires the patient to draw a clock. If there are no abnormalities, it is “very unlikely” that someone has dementia or another cognitive disorder.

MoCa Test
If the drawn clock does show deviations, then it is a good idea to administer the MoCa (Montreal Cognitive Assessment) test. If the doctor has doubts beforehand, the MoCa can be used immediately. Jolien: "The MoCa is more capable than the MMSE of detecting mild cognitive impairment and early-onset dementia." Often, dementia is not recognized or is recognized late. Although the disease can’t yet be cured, it’s important to have the diagnosis established. A diagnosis gives a person with dementia the right to help and support.

Type 2 Diabetes
People with type 2 diabetes have a twice as high increased risk of dementia and are also more likely to have mild cognitive impairments. For her PhD, Jolien studied the impact of these disorders on the lives of people over 70 with type 2 diabetes. "We found that these people have twice as many depressive symptoms and go to the doctor's office outside office hours twice as often." Jolien: "This group needs extra attention. Depressive symptoms and memory problems can cause them to take their medication incorrectly. Insulin administration is very difficult and blood sugar levels that are too low or too high are dangerous."

Active Detection
Jolien concludes that the over-70s with type 2 diabetes and cognitive disorders form an extra vulnerable group, who would probably benefit from an appropriate treatment of their disease. In order to actively detect cognitive disorders in elderly people with diabetes, she found two suitable tests that people with type 2 diabetes can complete themselves in a few minutes, for example just before a consultation with the doctor or nurse practitioner: Test-Your-Memory en Self-Administered-Gerocognitive-Examination. If the results indicate this, further examination may take place and the treatment may be adjusted if necessary. This is important, because the number of people of advanced or very advanced age with type 2 diabetes and possible cognitive disorders is already high and is expected to rise sharply.

Jolien Janssen is a doctor in training and researcher and she obtained her PhD on Tuesday, 29 October with her doctoral thesis, Impairment in type 2 diabetes: Opportunities for diagnosis, prevention and management. She conducted her doctoral research for the Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde (Julius Center for Health Sciences and Primary Medicine) and the Hersencentrum (Brain Center) of the University Medical Center (UMC) Utrecht.