Brognara Lorenzo, Volta Iacopo, Cassano Vito Michele, Navarro-Flores Emmanuel, Cauli Omar
Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy.
Azienda Sanitaria Locale Toscana Nord-Ovest, Unitá Operativa Professioni della Riabilitazione, Cittadella della Salute, 55100 Lucca, Italy.
Pathophysiology. 2020 Nov 25;27(1):14-27. doi: 10.3390/pathophysiology27010003.
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 ( < 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 ( < 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.
糖尿病与认知功能损害有关，这可能会使坚持自我护理行为变得复杂。我们评估了糖尿病患者认知障碍的发生率，以确定糖尿病足（约10%的糖尿病患者会出现的一种并发症）、对临床医生建议的依从性、血糖控制和认知功能之间关联的强度。对居住在三家养老院的老年糖尿病足患者的概率样本进行了一项前瞻性研究。通过简易精神状态检查表（MMSE）、连线测验（TMT）和密歇根神经病变筛查工具（MNSI）评估认知功能。认知功能与神经病变或足部改变之间没有显著关联，尽管糖化血红蛋白（HB1Ac>7%）在1个月的随访中与MMSE和治疗依从性显著相关（<0.05）。受试者工作特征曲线分析表明，HB1Ac和MNSI评分均能显著（<0.05）区分随后对足部并发症治疗的依从性，敏感性分别为80.0 - 73.3%和特异性为70.6 - 64.7%。糖尿病患者足部并发症的适当控制涉及适当的血糖控制和不太严重的神经病变，似乎与认知功能障碍无关，有必要进一步研究以便为中枢和周围神经系统疾病量身定制适当的治疗方法。血糖控制不佳（Hb1Ac水平>7%）和MNSI中神经病变评分为5.5是区分糖尿病足并发症患者对临床医生自我护理行为建议依从性差的最佳切点。在本研究中，我们观察到足部疾病与老年患者（年龄≥65岁）的整体认知功能受损有关。足病医生和内科医生在糖尿病足的管理中应将认知功能障碍视为一种重要的慢性并发症。
