title: Cognitive function is not associated with recurrent foot ulcers in patients with diabetes and neuropathy.
abstract: OBJECTIVE
  To study whether there is an association between cognitive impairment and the relapse rate of foot ulcers in diabetic patients and those with previous foot ulcers.
  
  
  METHODS
  This single-center prospective study assessed the association of cognitive function and risk for ulcer relapse in 59 patients with diabetes (mean age 65.1 years, diabetes duration 16.5 years, and A1C 7.4%), peripheral neuropathy, and a history of foot ulceration. Premorbid and current cognitive functions were measured (multiple-choice vocabulary test [Lehrl], number-symbol test, mosaic test [HAWIE-R], and trail-making tests A and B [Reitan]). Prevalence of depression was evaluated retrospectively (diagnoses in patient files or use of antidepressive medication). Patients were re-examined after 1 year.
  
  
  RESULTS
  Three patients (5%) died during follow-up (one of sepsis and two of heart problems). The remaining 56 patients (48%) developed 27 new foot ulcerations (78% superficial ulcerations [Wagner stage 1]). Characteristics of patients with and without ulcer relapse were not different. In a binary logistic regression analysis, cognitive function is not predictive of foot reulceration.
  
  
  CONCLUSIONS
  Cognitive function is not an important determinant of foot reulceration.
authors.affiliation: Department of Medicine III, University Hospital, Jena, Germany. christof.kloos@med.uni-jena.de
authors.forename: Christof
authors.initials: C
authors.lastname: Kloos
authors.forename: Franziska
authors.initials: F
authors.lastname: Hagen
authors.forename: Claudia
authors.initials: C
authors.lastname: Lindloh
authors.forename: Anke
authors.initials: A
authors.lastname: Braun
authors.forename: Karena
authors.initials: K
authors.lastname: Leppert
authors.forename: Nicolle
authors.initials: N
authors.lastname: Müller
authors.forename: Gunter
authors.initials: G
authors.lastname: Wolf
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Müller
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D003071:Cognition; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology; D017719:Diabetic Foot / Q000453:epidemiology / Q000523:psychology*; D003929:Diabetic Neuropathies / Q000150:complications* / Q000523:psychology*; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011446:Prospective Studies; D011581:Psychological Tests; D012008:Recurrence; D012179:Retirement; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014145:Trail Making Test; D044465:White People
chemical_list: D000928:Antidepressive Agents