糖尿病相关足部并发症中的认知功能障碍：一项队列研究。
Cognitive dysfunction in diabetes-related foot complications: A cohort study.
作者信息
Nguyen Mai Loan, Wong Dana, Barson Elizabeth, Staunton Eva, Fisher Caroline A
机构信息
School of Psychology and Public Health, La Trobe University, Bundoora, VIC 3086 Australia.
Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Grattan Street, Parkville Victoria, 3052 Australia.
出版信息
J Diabetes Metab Disord. 2024 Jan 22;23(1):1017-1038. doi: 10.1007/s40200-023-01381-4. eCollection 2024 Jun.
OBJECTIVE
Mild-moderate cognitive impairment has been identified in general diabetes, and early evidence indicates cognitive reductions may be more pronounced in those with diabetes-related foot complications (DRFC). Cognitive difficulties may impede treatment engagement and self-management. This requires further explication to optimise patient care and outcomes. The current study aimed to characterise cognitive function in people with DRFC using comprehensive cognitive measures.
METHOD
This cross-sectional cohort study recruited 80 adult participants ( = 63.38, SD = 11.40, range = 30 - 89) from the Royal Melbourne Hospital Diabetic Foot Unit in Victoria, Australia, all with DRFC. Each completed a comprehensive cognitive battery (memory, attention, executive functions) and scores were calculated using age-matched population norms, where available.
RESULTS
On the majority of tasks, DRFC participants performed significantly worse than age-matched norms, with the largest decrements seen in inhibition control, verbal memory, verbal abstract reasoning and working memory. Small to moderate reductions were also seen in visual learning, verbal fluency, processing speed and premorbid functioning. Demographic (lower education, male gender) and clinical factors (higher HbA1c, macrovascular and microvascular disease, longer diabetes duration) were associated with poorer cognitive functioning.
CONCLUSIONS
Marked reductions in cognitive functioning were found in individuals with DRFC, predominantly in the domains of verbal memory and executive functioning. Lower education, male gender and indicators of diabetes severity, such as vascular disease, are associated with heightened risk for poorer cognitive functioning. As DRFCs are a serious complication with devastating outcomes if not successfully managed, cognitive barriers to self-management must be addressed to optimise treatment.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40200-023-01381-4.
目的
一般糖尿病患者中已发现存在轻度至中度认知障碍，早期证据表明，糖尿病相关足部并发症（DRFC）患者的认知功能减退可能更为明显。认知困难可能会妨碍治疗参与和自我管理。这需要进一步阐释以优化患者护理和治疗结果。本研究旨在使用全面的认知测量方法来描述DRFC患者的认知功能。
方法
这项横断面队列研究从澳大利亚维多利亚州皇家墨尔本医院糖尿病足病科招募了80名成年参与者（平均年龄=63.38岁，标准差=11.40，年龄范围=30 - 89岁），所有参与者均患有DRFC。每个人都完成了一套全面的认知测试（记忆、注意力、执行功能），并在可行的情况下使用年龄匹配的人群常模计算得分。
结果
在大多数任务中，DRFC参与者的表现明显低于年龄匹配的常模，在抑制控制、言语记忆、言语抽象推理和工作记忆方面下降最为明显。视觉学习、言语流畅性、处理速度和病前功能也有轻度至中度下降。人口统计学因素（低教育水平、男性）和临床因素（较高的糖化血红蛋白、大血管和微血管疾病、糖尿病病程较长）与较差的认知功能相关。
结论
DRFC患者存在明显的认知功能减退，主要体现在言语记忆和执行功能方面。低教育水平、男性以及糖尿病严重程度指标（如血管疾病）与较差认知功能的风险增加有关。由于DRFC是一种严重并发症，如果管理不当会导致毁灭性后果，因此必须解决自我管理中的认知障碍以优化治疗。
补充信息
在线版本包含可在10.1007/s40200-023-01381-4获取的补充材料。
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