Author: Woo, Cheuk Wai
Title: Impact of diabetic peripheral neuropathy on cognition and quality of life in older people with diabetes
Advisors: Cheing, Gladys (RS)
Degree: DHSc
Year: 2019
Subject: Older diabetics -- Health and hygiene.
Diabetic neuropathies
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: vii, 139 pages : color illustrations
Language: English
Abstract: Introduction: Diabetes mellitus (DM) is a major cause of morbidity and mortality in Hong Kong. Diabetic peripheral neuropathy (DPN) is a common complication of DM that affects up to 50% of DM patients (Vinik et al 2000). An association between type 2 DM and cognitive deficits has been identified in a population-based study of older people in Sweden (Marseglia et al 2016). Cognitive impairment in elderly with diabetes may affect their ability in daily self-management of the disease, such as glycaemic monitoring, nutrition, mobility and medication management (Hopkins et al 2016). DPN is the damage to peripheral nerves due to chronic hyperglycaemia and poor microcirculation. A similar pathophysiological mechanism might be suspected to undermine higher brain function. People with DM and developed complication of DPN, being already exposed to common pathogenic mechanism, may exhibit more serious cognitive impairment, compared to people with DM without DPN. Indeed, the presence of peripheral neuropathy has been linked to cognitive deficiency in DM patients. There is scarce literature and no clear consensus on the impact of DPN on cognition. Literature on the impact of complications of DM on Quality of Life (QoL) in people with DM is available. Yet, none had explicitly evaluated the contribution of DPN to QoL.
Objectives: The present thesis was set out to 1a) characterize the cognitive impairment in community-dwelling people with DM using a subset of tests selected from the CANTAB (Cambridge Neuropsychological Test Automated Battery) for specific cognitive domains, 1b) investigate the impact of DPN on patients who have a diagnosis of DM with DPN on their cognitive deficits as compared to those without DPN and 2) examine the impact of DPN on QoL as compared to the same cohort of DM subjects recruited.
Methodology and setting: This was a cross-sectional study design with three-group comparison conducted at the Diabetes Clinic in Specialist Outpatient Clinic of Queen Elizabeth Hospital from 1 June 2017 to 31 May 2018.
Subjects: Nineteen subjects with DM (with DPN) and twenty-one subjects with DM (without DPN) were recruited. Eight healthy subjects without DM were recruited as control by convenient sampling.
Outcome Measures: Cognitive function was tested by the use of modular tasks (Reaction Time Task, Spatial Working Memory and One Touch Stockings of Cambridge) of Cambridge Neuropsychological Test Automated Battery (CANTAB) for the assessment of psychomotor speed, spatial working memory and executive function. QoL was assessed by the Chinese (Hong Kong) 12-item Short-Form Health Survey (version 2) questionnaire.
Results: DM (with and without DPN) subjects presented with significantly slower in reaction time (p=0.01) compared to healthy controls. DM (with DPN) subjects also made significantly more errors (p=0.05) and solved significantly less problems at the first attempt (p<0.01) as compared to health controls. While DM (with DPN) subjects performed slower in reaction time, made more errors and solved less problems on the first attempt as compared to DM (without DPN) subjects, however, the group difference did not reach statistical significance. DM (with DPN) subjects had significantly lower self-perceived physical health compared to healthy controls (p=0.04).
Conclusion: While unable to reach significant level, probably due to insufficient sample size, our findings did observe a tendency of link between DPN and cognitive impairment and QoL in DM subjects, in specific domains of reaction time, spatial working memory, executive function and self-perceived physical health. We also provided the groundwork for the potential use of self-administered neuropsychological screening of DM-related cognitive decline in persons with DM.
Rights: All rights reserved
Access: restricted access

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