Cognition and Understanding of Neuropathy of Inpatients Admitted to a Specialized Tertiary Diabetic Foot Unit With Diabetes-Related Foot Ulcers

Abstract

This study investigated cognitive functioning and understanding of peripheral neuropathy in a cohort of individuals with diabetes-related foot ulcers requiring hospitalization. The aim was to examine the association between cognition, understanding of peripheral neuropathy, and diabetic health variables. Thirty inpatients referred to the Diabetic Foot Unit Clinical Psychology service, at the Royal Melbourne hospital, were assessed using the Montreal Cognitive Assessment (MoCA) and the Patient Interpretation of Neuropathy (PIN) questionnaire. Relevant demographic and medical information was collected. In this predominantly middle-aged, male cohort, the average MoCA score (22.37, SD = 3.65) fell below the general population age-matched mean, and a quarter of the MoCA patient scores were consistent with those seen in early dementia samples (<20). There appeared to be several misperceptions regarding peripheral neuropathy, less accurate attributions of blame to self or practitioners, and more accurate attributions of control of ulcer management to practitioners. Correlation analysis indicated that individuals with stronger MoCA scores tended to provide more accurate answers on the Acute Foot Ulcer Onset PIN scale. Individuals with diabetes-related foot ulcers requiring hospitalization demonstrate reduced cognitive functioning and this may affect their understanding of peripheral neuropathy, particularly information regarding foot ulcer onset. Routine screening of cognitive functioning in this cohort may be useful so that health education and care management can be adjusted according to individual patients’ cognitive capabilities.

Neurocognitive Dysfunction and Diabetic Foot

“…Thus, the cohort was younger than in the Marseglia et al [43] study, but with poorer diabetes control, based on HbA1c results. The education corrected total mean MoCA score in the Corbett et al [45], study was 22.37 (SD 3.65), and range 12 to 27, with no patients achieving a full score of 30/30. Recommended MoCA cut-off scores to demark mild cognitive impairment vary from study to study [50][51][52][53].…”

“…Relative to the general diabetes literature, fewer research studies have been conducted that have investigated neurocognitive functioning specifically in people with diabetes and foot ulcers [43][44][45][46]. The research that is available appears to indicate attenuated functioning, at a group level, and significant impairments in a proportion of patients.…”

“…A recently published study by Corbett and colleagues investigated neurocognitive functioning in individuals with diabetic foot ulcers using a newer, and increasingly widely used, cognitive screening measure, the Montreal Cognitive Assessment (MoCA) [45]. The like the MMSE, the MoCA is a quick (5-10 min) assessment tool that provides an overview of cognitive functioning, and is designed to detect cognitive decline.…”

“…is harder overall) [49]. The study by Corbett et al [45] reported on MoCA and Patient Interpretation of Neuropathy (PIN) data in 30 patients with diabetic foot ulcers admitted to a specialist hospital unit for inpatient management of their foot wounds. The mean age of the study cohort was later middle age (m = 58.37 years, 10.64 SD), and the sample predominantly male (83%).…”

“…The Australian MoCA results from the Corbett et al [45] study can be further compared with existing studies that have used the MoCA for cognitive screening assessment in other diabetes cohorts [31,54,55], see Table 1. Participants in one of the comparison studies were Japanese inpatients receiving training on diabetes management [31], in another they were Canadian patients at diabetes education clinics [55], and in the third it is not reported where the Turkish subject group were recruited from [54].…”