Abstract

Introduction:Diabetes and peripheral arterial disease affect many physiological systems and can lead to health problems or commodities. In particular, as individuals with diabetes age, they are at risk of developing diabetes-related cognitivedysfunction.Mildormoderatecognitivede𿿿citshavebeendetected, which may affect performance in everyday tasks. Individuals with diabetes are also 19 times more at risk of undergoing lower extremity amputations (LEA) than the general population. Objectives: To assess cognitive function by using the Montreal Cognitive Assessment Scale in lower limb amputee individuals. Methods: cognitive function assessment using the Montreal assessment scale in lower limb amputee individuals. This study was designed as a cross-sectional survey. Eligible participants were older than 50 years of age for lower limb amputation Results: Questionnaires were distributed among 20 participants, and data were analyzed for 20 participants. Participants’ Demographic details were recorded, and each participant was interviewed individually to complete the data collection. The demographic details of the participants of both groups are given below in Table 1. Participants in the analysis were more likely to be males (65%) and females (35%) with comorbidity diabetes mellitus and hypertension (45%-30%), respectively. They were also likely reported to have a level of education based on literacy and illiteracy (75%-25%) and working status (Employee 20% Unemployment 80%). Conclusions: This study concluded the importance of assessing cognitive function in individuals with lower limb amputation, particularly those with comorbidity conditions like diabetes and hypertension. Cognitive impairments, especially in executive function, attention, and abstraction, can impact rehabilitation outcomes and quality of life.

• 1.   Frengopoulos C., Burley J., Viana R., Payne MW, Hunter SW. Association between Montreal cognitive assessment scores and measures of functional mobility in lower extremity amputees after inpatient rehabilitation. Archives of Physical Medicine and Rehabilitation. 2017 Mar 1; 98(3): 450-5.
• 2.   Frengopoulos C., Payne M.W., Viana R., Hunter SW. MoCA domain score analysis and relation to mobility outcomes in dysvascular lower extremity amputees. Archives of Physical Medicine and Rehabilitation. 2018 Feb 1; 99(2): 314-20.
• 3.   Smith T., Gildeh N., Holmes C. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. The Canadian Journal of Psychiatry. 2007 May; 52(5): 329-32.
• 4.   Nasreddine Z.S., Phillips N.A., Bédirian V., Charbonneau S., Whitehead V., Collin I., Cummings J.L., Chertkow H. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society. 2005 Apr; 53(4): 695-9.
• 5.   Chen J.J., Lee C.H., Lin L.Y., Liau C.S. Determinants of lower extremity amputation or revascularization procedure in patients with peripheral artery diseases: a population-based investigation. Angiology. 2011 May; 62(4): 306 9.
• 6.   Sansam K., Neumann V., O’Connor R.J., Bhakta B. Predicting walking ability following lower limb amputation: A systematic review of the literature. Journal of rehabilitation medicine. 2009 Jun 2; 41(8): 593-603.
• 7.   Nasreddine Z.S., Phillips N.A., Bédirian V., Charbonneau S., Whitehead V., Collin I., Cummings J.L., Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society. 2005 Apr; 53(4): 695-9.
• 8.   PhillipsN.A.,Mate-KoleC.C.Cognitivede𿿿cits in peripheral vascular disease: a comparison of mild stroke patients and normal control subjects. Stroke. 1997 Apr; 28(4): 777-84.
• 9.   Pelletier C., Dai S., Roberts K.C., Bienek A. Report summary Diabetes in Canada: facts and𿿿guresfromapublichealthperspective. Health Promotion and Chronic Disease Prevention in Canada. 2012 Dec. 1; 33(1).
• 10.   American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003; 26(12): 3333-3341
• 11.   McCrimmon R.J., Ryan C.M., Frier B.M. Diabetes and cognitive dysfunction. The Lancet. 2012 Jun 16; 379(9833): 2291-9.
• 12.   Ruderman N.B., Gupta S., Sussman I. Hyperglycemia, diabetes, and vascular disease: an overview. Hyperglycemia, Diabetes, and Vascular Disease. 1992: 3-20.
• 13.   Petersen R.C., Doody R., Kurz A., Mohs R.C., Morris J.C., Rabins P.V., Ritchie K., Rossor M., Thal L., Winblad B. Current concepts in mild cognitive impairment. Archives of neurology. 2001 Dec 1; 58(12): 1985-92.
• 14.   Petersen R.C. Mild cognitive impairment. Continuum: Lifelong Learning in Neurology. 2004 Feb 1; 10(1): 9-28.
• 15.   Petersen R.C., Smith G.E., Waring S.C., Ivnik R.J., Tangalos E.G., Kokmen E. Mild cognitive impairment: Clinical characterization and outcome. Archives of neurology. 1999 Mar 1; 56(3): 303-8.
• 16.   Chertkow H. Mild cognitive impairment. Current opinion in neurology. 2002 Aug 1; 15(4): 401-7.
• 17.   Thompson S.A., Hodges J.R. Mild cognitive impairment: a clinically useful but currently ill-defined concept?Neurocase. 2002Dec 1; 8(6): 405-10.
• 18.   Chiti G, Pantoni L. Use of Montreal Cognitive Assessment in patients with stroke. Stroke. 2014 Oct; 45(10): 3135-40.
• 19.   Toglia J., Fitzgerald K.A., O’Dell M.W., Mastrogiovanni A.R, Lin C.D. The Mini Mental State Examination and Montreal Cognitive Assessment in persons with mild subacute stroke: relationship to functional outcome. Archives of physical medicine and rehabilitation. 2011 May 1; 92(5): 792-8.
• 20.   Verdelho A., Madureira S., Ferro J.M., Basile A.M., Chabriat H., Erkinjuntti T., Fazekas F., Hennerici M., O’Brien J., Pantoni L., Salvadori E. Differential impact of cerebral white matter changes, diabetes, hypertension and stroke on cognitive performance among non disabled elderly. The LADIS study. Journal of Neurology, Neurosurgery & Psychiatry. 2007 Dec 1; 78(12): 1325-30.
• 21.   Coffey L., O’Keeffe F., Gallagher P., Desmond D., Lombard-Vance R. Cognitive functioning in persons with lower limb amputations: a review. Disability and rehabilitation. 2012 Nov 1; 34(23): 1950-64.
• 22.   O’Neill B. Cognition and mobility rehabilitation following lower limb amputation. In Psychoprosthetics 2008 (pp. 53-65). London: Springer London.
• 23.   Alagiakrishnan K., Zhao N., Mereu L., Senior P., Senthilselvan A. Montreal Cognitive Assessment is superior to Standardized Mini Mental Status Exam in detecting mild cognitive impairment in the middle-aged and elderly patients with type 2 diabetes mellitus. BioMed research international. 2013; 2013(1): 186106.
• 24.   Montero-Odasso M., Muir S.W. Simplifying detection of mild cognitive impairment subtypes. Journal of the American Geriatrics Society. 2010 May; 58(5): 992-4.
• 25.   Murdoch G. Levels of amputation and limiting factors. Annals of the royal college of surgeons of England. 1967 Apr; 40(4): 204.
• 26.   Resnik L., Borgia M. Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error. Physical therapy. 2011 Apr 1; 91(4): 555-65.
• 27.   Xu G., Meyer J.S., Thornby J., Chowdhury M., Quach M. Screening for mild cognitive impairment (MCI) utilizing combined mini mental-cognitive capacity examinations for identifying dementia prodromes. International journal of geriatric psychiatry. 2002 Nov; 17(11): 1027-33.
• 28.   Ravaglia G., Forti P., Maioli F., Martelli M., Servadei L., Brunetti N., Pantieri G., Mariani E. Conversion of mild cognitive impairment to dementia: predictive role of mild cognitive impairment subtypes and vascular risk factors. Dementia and geriatric cognitive disorders. 2005 Dec 15; 21(1): 51-8.
• 29.   Busse A., Bischkopf J., Riedel-Heller S.G, Angermeyer M.C. Mild cognitive impairment: prevalence and incidence according to different diagnostic criteria: Results of the Leipzig Longitudinal Study of the Aged (LEILA75+). The British Journal of Psychiatry. 2003 May; 182(5): 449-54.
• 30.   Sherwin B.B. Mild cognitive impairment: potential pharmacological treatment options. Journal of the American Geriatrics Society. 2000 Apr; 48(4): 431-41.

Data Sharing Statement

Funding