Neuropsychological Profiles of Children With Type 1 Diabetes 6 Years After Disease Onset

Neuropsychological Profiles of Children With Type 1 Diabetes 6 Years After Disease Onset Elisabeth A. Northam , PHD 1 2 , Peter J. Anderson , BA, GRAD DIP (APP PSYCH) 1 2 , Rani Jacobs , BSC, GRAD DIP 1 2 , Matthew Hughes , BBUS, GRAD DIP 1 2 , Garry L Warne , MBBS, MD 3 and George A. Werther , MBBS, MD 3 1 Department of Psychology, Royal Children’s Hospital, Melbourne 2 Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne 3 Department of Endocrinology/Diabetes, Royal Children’s Hospital, Melbourne, Australia Abstract OBJECTIVE —To describe neuropsychological profiles and their relationship to metabolic control in children with type 1 diabetes 6 years after the onset of disease. RESEARCH DESIGN AND METHODS —Children with type 1 diabetes ( n = 90), aged 6–17 years, who had previously been assessed soon after diagnosis and 2 years later, were reevaluated 6 years after the onset of disease. Their neuropsychological profiles were compared with those of individuals in a community control group ( n = 84), who had been assessed at similar intervals. Relationships between illness variables, such as age at the onset of disease and metabolic control history, and neuropsychological status were also examined. RESULTS —Six years after onset of disease, children with type 1 diabetes performed more poorly than control subjects on measures of intelligence, attention, processing speed, long-term memory, and executive skills. Attention, processing speed, and executive skills were particularly affected in children with onset of disease before 4 years of age, whereas severe hypoglycemia was associated with lower verbal and full-scale intelligence quotient scores. CONCLUSIONS —Neuropsychological profiles of children with type 1 diabetes 6 years after the onset of disease are consistent with subtle compromise of anterior and medial temporal brain regions. Severe hypoglycemia, particularly in very young children, is the most plausible explanation for neuropsychological deficits, but the contributory role of chronic hyperglycemia warrants further exploration. CFT, Complex Figure Test COWAT, Controlled Oral Word Association Test IQ, intelligence quotient RAVLT, Rey Auditory Verbal Learning Test SES, socioeconomic status WISC-III, Wechsler Intelligence Scale for Children—3rd edition Footnotes Address correspondence and reprint requests to Elisabeth Northam, Department of Psychology, Royal Children’s Hospital, Parkville, Victoria, 3052, Australia. E-mail: nort