Scholars@Duke publication: Ambulatory Cognitive Function and Cognitive Dispersion among Individuals with Type I Diabetes: Examining Biobehavioral and Glycemic Correlates.

Ambulatory Cognitive Function and Cognitive Dispersion among Individuals with Type I Diabetes: Examining Biobehavioral and Glycemic Correlates.

Publication , Journal Article

Smith, PJ; Barker, R; Hassenstab, J; Merwin, RM

Published in: Arch Clin Neuropsychol

December 20, 2025

AIMS: Diabetes mellitus (DM) is widely regarded as an important risk factor for Alzheimer's Disease and Related Dementias (ADRD), with higher blood glucose variability (BGV) associating with greater ADRD risk. Few studies have linked BGV with ambulatory cognitive functioning or cognitive dispersion measures in T1DM. MATERIALS AND METHODS: We conducted a pilot study in which 20 individuals with type-I DM (T1DM) wore a continuous glucose monitor and actigraphy monitor for one week while completing ambulatory measures of cognition. In addition to ambulatory measures, participants completed a 45-min neuropsychological battery consisting of eight standard measures of Executive Functioning, Memory and Learning, and premorbid intellectual functioning. Demographically corrected t-scores were obtained, as well as measures of cognitive dispersion. RESULTS: Cardiovascular risk factors and markers of metabolic function were associated with cognitive function and cognitive dispersion. Higher glucose levels, HbA1c, and body mass, as well as lower physical activity and sleep efficiency all associated with worse ambulatory cognition. CONCLUSIONS: Ambulatory cognitive measures demonstrated robust associations with clinical neuropsychological measures and dynamic associations with ambulatory metabolic function and health behaviors. Greater levels of cognitive dispersion associated with vascular risk factors, worse metabolic function, and worse ambulatory cognitive functioning.