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COGNITIVE AND PSYCHOLOGICAL CHARACTERISTICS
IN DIABETIC FOOT PATIENTS
A Marseglia, E Brocco, F Limongi, M Noale, S Maggi
Operative Unit “Diabetic Foot”, Policlinico Abano Terme (Italy)
MGSD 2011
Casablanca, Morocco
• INTRODUCTION Diabetic foot is one of the most disabling complication of Diabetes
Mellitus (DM), which carries a high risk of minor and major amputations. Diabetic foot
has a devastating impact on quality of life and is associated with depression. The
Phantom Limb Sensation (PLS) occurs frequently after an amputation; in some cases, it
can be accompanied by Phantom Limb Pain (PLP).
The few studies available on cognition in diabetic foot patients show an indirect
relationship between cognitive deficit and re-ulceration (Van Gils e Stark, Ostomy
Wound Manage, 2006). However, until now, studies on cognition in diabetic foot do not
exist.
• AIM Investigate cognitive and psychological characteristics of diabetic patients
with minor and major amputations and the prevalence of depressive symptoms.
MATERIAL AND METHODS
A cross-sectional study on patients with type 1 (9%) and type 2 DM with the objective
of studying history of foot ulcers or minor/major amputations
Neuropsychological and Psychological Assessment
Statistical Analysis
•Mini Mental State Examination (MMSE)
•Rey Verbal Auditory Learning Test (RAVLT)
•Attentional Matrices (AM)
•Raven Coloured Progressive Matrices (RCPM)
•Trail Making Test A e B (TMT A-B)
•Connor-Davidson Resilience Scale (CDRS)
•Beck Depression Inventory-II (BDI-II)
•Short-Form Mc Gill Pain Questionnaire (SF-MPQ)
•Body Image Scale (BIS) to evaluate body perception
•Interview about PLS and PLP to evaluate phantom
sensation and phantom limb pain
The association between cognitive and
psychological variables with the type
of amputation was assessed by the χ2 test.
The quantitative variables were compared
through Generalized Linear Model (GLM)
procedure.
The relationship of depressive symptom and
possible risk factors (cognitive and
psychological variable) were studied by
logistic regression model.
The study is still ongoing and preliminary data on a sample of 111 subjects is presented
PRELIMINARY RESULTS
Patients with PLS have a significantly higher
prevalence of depressive symptoms than patients
without PLS
Presence of PLP can be a independent risk factor for
depressive symptoms
Major amputees group get an average score
significantly lower than no amputees group; they
also obtained with respect to the other three
groups, a higher mean score on SF-MPQ, a higher
average score to BIS and a median VAS pain
significantly higher
Patients with pathological
performance in RAVLT have lower
HDL-cholesterol than patients with
normal performance
CONCLUSIONS
In patients with amputation the high prevalence of pain and specifically of phantom
limb pain is an important risk factor for the development of depressive symptoms
Among those with major amputation, depressive symptoms may be exacerbated by
the negative perception of body image, by the non-acceptance of their physical
disability and by the poor resilience that characterizes these patients.