OBJECTIVE -To evaluate the association between cognitive dysfunction and other barriers and glycemic control in older adults with diabetes.RESEARCH DESIGN AND METHODS -Patients over the age of 70 years presenting to a geriatric diabetes clinic were evaluated for barriers to successful diabetes management. Patients were screened for cognitive dysfunction with the Mini Mental State Examination (MMSE) and a clock-drawing test (CDT) scored by 1) a method validated by Mendez et al. and 2) a modified CDT (clock in a box [CIB]). Depression was evaluated with the Geriatric Depression Scale. Interview questionnaires surveyed activities of daily living (ADLs) and instrumental ADLs (IADLs), as well as other functional disabilities.RESULTS -Sixty patients (age 79 Ϯ 5 years, diabetes duration 14 Ϯ 13 years) were evaluated. Thirty-four percent of patients had low CIB (Յ5), and 38% of patients had low CDT (Յ13). Both CIB as well as CDT were inversely correlated with HbA 1c , suggesting that cognitive dysfunction is associated with poor glycemic control (r ϭ Ϫ0.37, P Ͻ 0.004 and r ϭ Ϫ0.38, P Ͻ 0.004, respectively). Thirty-three percent of patients had depressive symptoms with greater difficulty completing the tasks of the IADL survey (5.7 Ϯ 1.7 vs. 4.6 Ϯ 2.0; P Ͻ 0.03). These older adults with diabetes had a high incidence of functional disabilities, including hearing impairment (48%), vision impairment (53%), history of recent falls (33%), fear of falls (44%), and difficulty performing IADLs (39%).CONCLUSIONS -Older adults with diabetes have a high risk of undiagnosed cognitive dysfunction, depression, and functional disabilities. Cognitive dysfunction in this population is associated with poor diabetes control.

Eight patients, five with chronic granulocytic leukaemia and three with severe aplastic anaemia, developed moderately severe airflow obstruction after allogeneic bone marrow transplantation. All eight had clinically and radiologically normal lungs before undergoing transplantation. Treatment in the patients with chronic granulocytic leukaemia before transplantation included high dose total body irradiation. All eight patients developed acute and chronic graft versus host disease after transplantation. The pulmonary syndrome consisted of cough, dyspnoea, and wheezing beginning six to 20 weeks after transplantation, with ratios of forced expiratory volume in one second (FEV1) to vital capacity (VC) falling to 60% or less of predicted values. The three patients with severe aplastic anaemia had relatively mild graft versus host disease and acute chest infection may have initiated or contributed to their airways obstruction, which subsequently resolved. The five patients with chronic granulocytic leukaemia had more severe graft versus host disease and more progressive respiratory problems; two died and three continued to have persistent airflow obstruction 11, 15, and 20 months after transplantation. None of those with chronic granulocytic leukaemia improved. Transfer factor (TLco) was reduced in all patients after bone marrow transfer and did not improve; in the patients with chronic granulocytic leukaemia the reduction in TLCO preceded the fall in FEV1/VC ratio. Open lung biopsy in one of the patients with chronic granulocytic leukaemia showed obliterative bronchiolitis with lymphocytic infiltration consistent with graft versus host disease. Bronchodilators were of no benefit in the management of these patients, but prompt treatment of infection and early use of corticosteroids may have contributed to the improvement seen in the patients with severe aplastic anaemia.Allogeneic bone marrow transplantation is used in the treatment of patients with aplastic anaemia and acute and chronic myeloid leukaemias.' 2 Pulmonary complications are, however, a major source of morbidity and death in patients undergoing transplantation. Opportunistic infections with viruses, fungi, and protozoa are common.3 An interstitial pneumonitis in the absence of evidence of infection also occurs, particularly in those who have received higher doses (>8 Gy (800 rad)) and dose rates of

Invasive pulmonary aspergillosis is a life-threatening infection in lung transplant

On the one hand, in older adults, executive dysfunction detected by objective tests is associated with poor glycaemic control and may be considered before prescribing complex treatment regimens. On the other hand, self-reported executive dysfunction is associated with risk and fear of falls, and more affective symptoms, which may indicate higher awareness of subtle deficits.

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