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

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Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
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Azienda Sanitaria Locale Toscana Nord-Ovest, Unitá Operativa Professioni della Riabilitazione, Cittadella della Salute, 55100 Lucca, Italy
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Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain
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Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
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Chair for Healthy, Active and Participative Aging, University of Valencia, 46010 Valencia, Spain
*
Author to whom correspondence should be addressed.
Pathophysiology 2020, 27(1), 14-27; https://doi.org/10.3390/pathophysiology27010003
Received: 30 October 2020 / Revised: 23 November 2020 / Accepted: 23 November 2020 / Published: 25 November 2020
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. View Full-Text
Keywords: neuropathy; diabetes; skin diseases; diabetic foot complication; executive function; cognition; HbA1c neuropathy; diabetes; skin diseases; diabetic foot complication; executive function; cognition; HbA1c
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MDPI and ACS Style

Brognara, L.; Volta, I.; Cassano, V.M.; Navarro-Flores, E.; Cauli, O. The Association between Cognitive Impairment and Diabetic Foot Care: Role of Neuropathy and Glycated Hemoglobin. Pathophysiology 2020, 27, 14-27. https://doi.org/10.3390/pathophysiology27010003

AMA Style

Brognara L, Volta I, Cassano VM, Navarro-Flores E, Cauli O. The Association between Cognitive Impairment and Diabetic Foot Care: Role of Neuropathy and Glycated Hemoglobin. Pathophysiology. 2020; 27(1):14-27. https://doi.org/10.3390/pathophysiology27010003

Chicago/Turabian Style

Brognara, Lorenzo, Iacopo Volta, Vito Michele Cassano, Emmanuel Navarro-Flores, and Omar Cauli. 2020. "The Association between Cognitive Impairment and Diabetic Foot Care: Role of Neuropathy and Glycated Hemoglobin" Pathophysiology 27, no. 1: 14-27. https://doi.org/10.3390/pathophysiology27010003

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