Cognitive Dysfunction: Part and Parcel of the Diabetic Foot

Abstract

OBJECTIVEThe presence of a foot ulcer increases the self-treatment burden imposed on the individual with diabetes. Additionally, this condition increases the cognitive demands needed for adherence to medical recommendations. A potential gap could exist between medical recommendations and the individual's ability to implement them. Hence, the goal of this study was to examine whether the cognitive profile of people with diabetic foot ulcers differs from that of people with diabetes without this complication. RESEARCH DESIGN AND METHODSThis was a case-control study. Ninety-nine individuals with diabetic foot ulcers (case patients) and 95 individuals with type 2 diabetes (control subjects) (age range 45-75 years), who were matched for diabetes duration and sex, underwent extensive neuropsychological evaluation using a NeuroTrax computerized battery, digit symbol, and verbal fluency tests. A global cognitive score after standardization for age and education was computed as well as scores in the following six cognitive domains: memory, executive function, reaction time, attention, psychomotor abilities, and estimated premorbid cognition. RESULTSIndividuals with diabetic foot ulcers had significantly (P < 0.001) lower cognitive scores than individuals with diabetes without this complication, in all tested cognitive domains, excluding estimated premorbid cognition. Individuals with diabetic foot ulcers demonstrated a significant difference between precognitive and current cognitive abilities, as opposed to the nonsignificant difference among control subjects. The differences persisted in multivariable analysis after adjusting for depression and smoking. CONCLUSIONSIndividuals with diabetic foot ulcers were found to possess fewer cognitive resources than individuals with diabetes without this complication. Thus, they appear to face more self-treatment challenges, while possessing significantly fewer cognitive resources.The presence of a foot ulcer increases the self-care burden imposed on the individual with diabetes. Recently, the American Diabetes Association and the International Working Group on the Diabetic Foot published a global consensus, evidence-based guidance, on the management and prevention of the diabetic foot (DF) (1,2). These documents emphasize patients' education on appropriate self-care practices and participation in an integrated foot care program as essential elements of the prevention of ulcers and their recurrence. The implications of this guidance is that the individual with a DF is expected to learn and understand new information

Motivational interviewing to improve adherence behaviours for the prevention of diabetic foot ulceration

“…An individual's motivation to adhere to a behaviour may be influenced by attitudes, environmental constraints, emotional responses, anticipated outcomes of behaviour, perceived control over outcomes, societal norms, knowledge and skills, and socioeconomic constraints . Specifically diabetic foot ulceration is known to be associated with socio‐economic deprivation, poor cognitive capability, poor wellbeing, and depression . Further exploration of these potential barriers to adherence may have been required in the Keukenkamp study before moving onto goal setting with participants in a single session.…”

“…These populations include those with diabetes and long‐term conditions that require sustained adherence behaviours . The use of technology to support behaviours is of particular relevance when considering that the cognitive abilities of those who have diabetic foot ulceration are reduced . Mobile devices can play a significant role in prompting and motivating behavioural change where there is a reduced cognitive capacity and a decreased ability to concentrate …”

“…16,[38][39][40] Specifically diabetic foot ulceration is known to be associated with socio-economic deprivation, poor cognitive capability, poor wellbeing, and depression. [41][42][43] Further exploration of these potential barriers to adherence may have been required in the Keukenkamp study 34 before moving onto goal setting with participants in a single session.…”

Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

“…Cognitive function must be considered since increased prevalence has been documented in patients with DFU. 120,121 As the day-to-day care of the wound rests in the hands of the patient, reviewing our behavior, as clinicians, in order to engage, empower, and provide an optimal patient-centered experience for our patients has been shown to influence healing. 118,119 Simple education and knowledge exchange strategies can be effective when managing people who unintentionally do not follow advice, and it is the responsibility of the clinician to ensure the patient is equipped with adequate information and that the type of communication is optimized and individualized.…”

Update diabetischer Fuß 2017

“…In einer Studie wurde geprü , ob sich das kognitive Pro l von Diabetikern mit Fußulzera von jenen ohne Ulkus unterscheidet [2]. Die Patienten mit Ulzera waren zwar jünger, hatten aber mehr Komplikationen, höhere HbA 1c -und BMI-Werte und eine signi kant geringere kognitive Leistungsfähigkeit.…”