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The Association between Cognitive Impairment and Diabetic Foot Care : Role of Neuropathy and Glycated Hemoglobin

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The Association between Cognitive Impairment and Diabetic Foot Care : Role of Neuropathy and Glycated Hemoglobin

dc.contributor.author	Brognara, Lorenzo
dc.contributor.author	Volta, Iacopo
dc.contributor.author	Cassano, Vito Michele
dc.contributor.author	Navarro Flores, Emmanuel
dc.contributor.author	Cauli, Omar
dc.date.accessioned	2022-02-14T14:16:26Z
dc.date.available	2022-02-14T14:16:26Z
dc.date.issued	2021
dc.identifier.citation	Brognara, Lorenzo Volta, Iacopo Cassano, Vito Michele Navarro Flores, Emmanuel Cauli, Omar 2021 The Association between Cognitive Impairment and Diabetic Foot Care : Role of Neuropathy and Glycated Hemoglobin Pathophysiology, vol 27, n. 1, 1-14 pp.
dc.identifier.uri	https://hdl.handle.net/10550/81603
dc.description.abstract	Diabetes mellitus is associated with impairment in cognitive functions which can complicate adherence to self-care behaviors. We evaluated the incidence of cognitive impairment in patients with diabetes mellitus to determine the strength of the association between diabetic foot (a complication that occurs in about 10% of diabetic patients), adherence to the clinician's recommendations, glycemic control, and cognitive function. A prospective study was carried out in a probabilistic sample of older patients with diabetic foot living in three nursing homes. Cognitive functions were evaluated by the MMSE (Mini-Mental State Examination), the Trail Making test (TMT), and the Michigan neuropathy screening instrument (MNSI). There were no significant associations between cognitive function and neuropathy or foot alterations, although glycated hemoglobin (HB1Ac > 7%) significantly (p < 0.05) associated with MMSE and adherence to treatment in the 1 month follow-up visit. Receiver operating characteristic curve analysis showed that both HB1Ac and the MNSI score significantly (p < 0.05) discriminate subsequent adherence to treatment for foot complication, with a sensitivity of 80.0-73.3% and specificity 70.6-64.7%, respectively. Proper control of foot complications in diabetic patients involves appropriate glycemic control and less severe neuropathy, and seems to be unrelated to cognitive dysfunction, and warrants further studies in order to tailor appropriate treatments to central and peripheral nervous system disorders. Poor glycemic control (Hb1Ac level > 7%) and a neuropathy score of 5.5 in the MNSI are the best-cut off points to discriminate poor adherence to the clinician's recommendations for self-care behaviors in people with diabetic foot complication. In this study, we observed that foot disorders were associated with impaired global cognitive function in elderly patients (aged ≥ 65). Podiatrists and physicians should consider cognitive dysfunction as an important chronic complication in the management of diabetic foot.
dc.language.iso	eng
dc.relation.ispartof	Pathophysiology, 2021
dc.subject	Diabetis
dc.subject	Extremitats
dc.title	The Association between Cognitive Impairment and Diabetic Foot Care : Role of Neuropathy and Glycated Hemoglobin
dc.type	journal article	es_ES
dc.date.updated	2022-02-14T14:16:27Z
dc.identifier.doi	10.3390/pathophysiology27010003
dc.identifier.idgrec	144098
dc.rights.accessRights	open access	es_ES