Diabetic Foot Complications Linked to Cognitive Decline

Diabetic foot ulcers and necrosis may be associated with cognitive decline.

In the first study to examine cognitive function in people with diabetic foot, researchers at Ben-Gurion University of the Negev in Beer-Sheva, Israel, found patients with this complication also had significant cognitive impairment. Diabetic foot is a serious, but preventable complication of diabetes that causes necrosis and ulcers that do not heal, and can lead to amputation.

The case controlled study measured cognitive function in 99 patients with diabetic and foot complications and 95 control participants who had diabetes but no foot complications.

They found that people with diabetic foot could remember less, had difficulty learning new things, had decreased concentration, decreased inhibition, slower cognitive and psychomotor responses, and decreased verbal fluency. The findings suggest that these patients have cognitive difficulties above and beyond those seen in the general population of people with diabetes.

"This study shows a clear correlation between diabetes and cognitive deterioration," said Rachel Natovich, PhD, a recent Ben-Gurion graduate and co-author of the study. "Diabetes is a multi-system condition that affects the brain, and the risk of a diabetic developing dementia is twice that of a 'normal' person. Diabetic foot is a symptom that the diabetes is causing deterioration of the entire cardiovascular system."

Although it is known that diabetic foot is caused by systemic vascular changes, this is the first study to examine the effects of those changes in the brain. Current research generally focuses on epidemiology, prevention, and treatment of diabetic foot, Natovich said.

This new observation has important implications for diabetes care. "Successful adherence to medical recommendations requires considerable cognitive abilities like intact concentration, memory and executive functions," the authrs wrote

Natovich recommended that health care providers routinely monitor patients with diabetic foot for signs of cognitive decline, to enable proper intervention, and, along with caregivers, take a more active role in caring for the patient. Memory and attention deficits can make self-management of diabetes more difficult.

This study was presented at the 75th Scientific Sessions of the American Diabetes Association, in Boston earlier this year.

Natovich completed her PhD under Prof. Talma Kushnir of the Department of Public Health, Faculty of Health Sciences and Dr. Ilana Harman-Boehm from Soroka University Medical Center. Dr. Natovich was awarded several prizes for this research including the diabetic foot best presentation award from the American Diabetes Association.