Abstract
Diabetes and aging are independent risk factors for cognitive decline. Self-care is a cornerstone in diabetes management and prevention of complications, including cognitive decline. The presence of ulcers (diabetic foot, DF), represents an increase in self-care burden and in cognitive demands needed for adherence to self-care recommendations (ASC). We examined the association between ASC and cognitive functions in people with diabetes with (GD) and without DF. This case control study included 99 individuals with DF [58y±6.9, diabetes duration (DD) 15.1 ± 7.8, HbA1c 8.8 ± 2.1, 76% males]; and 95 controls [(61y±7, DD 13.4 ± 8.5, HbA1c 7.4 ± 1.3, 76% males]. Groups were matched for DD and gender. ASC was determined using The Summary of Diabetes Self-Care Activities questionnaire; Cognitive function was assessed by Neurotraxâ computerized battery, Digit symbol and Verbal fluency tests. Association between adherence (high/low) and group (GD/DF) on cognitive functions was assessed by a series of ANOVA’s. Adherence to nutrition was found to be positively associated with memory (101.5 ± 11.2 vs 93.5 ± 14.4(**)), phonemic fluency (96 ± 21.1 vs 86.3 ± 19.9*), semantic fluency (99.5 ± 19.9 vs 90.7 ± 15.6*), psychomotor abilities (94.7 ± 13.7 vs 85.2 ± 18.9(***)). A highly significant group effect was found, as DF scored significantly lower than GD in all tested cognitive domains (p<0.0001). No interaction effect was found between group and adherence levels on cognition. Cognition was not associated with adherence to physical activity, blood checks or medication. The results demonstrate the importance of adherence to diet for preserving cognitive functioning in people with diabetes, with and without DF, an issue of special relevance in older age.