Assessment of Cognitive Function in type 2 Diabetic patients in a rural tertiary healthcare facility

Velmurugan, R V S (2018) Assessment of Cognitive Function in type 2 Diabetic patients in a rural tertiary healthcare facility. Masters thesis, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur.

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Abstract

BACKGROUND: Diabetes Mellitus is a complex metabolic disorder with increasing prevalence both in urban and rural areas and it poses a great public health disaster requires a greater responsibility on health care system for early detection and management of the Micro and Macrovascular complications studied extensively but cognitive dysfunction is one of the least noted and poorly recognised complication of both type 1 and type 2. Several factors including Insulin resistance mediates cognitive impairment and neurodegeneration. Chronic Hyperglycemia, increased duration of Diabetes, and increasing age of the patients are the three important factors influencing the impairment of cognition. Additional factors like gender, lifestyle factors, smoking, alcohol consumption, psychosocial factors, Vitamin D deficiency, Testosterone deficiency, and subclinical thyroid dysfunction have still to be elucidated. Glycemic status – particularly, which affects peripheral nerves in the somatosensory system and auditory system which in turn slows psychomotor responses and has cognitive effects all of which may affect. Reaction Time both Auditory and Visual are considered as ideal tool for measuring sensory motor association and performance of an individual and also has physiological significance and is a simple and non invasive test for peripheral as well as central neural structures studied. AIM OF THE STUDY: The purpose of the study is to assess the prevalence of Cognitive dysfunction in Type 2 Diabetic Patients in a Rural Tertiary Healthcare Facility and to correlate cognitive function through MMSE and visual and auditory reaction time with respect to multiple factors like age, sex, gender, education, BMI, lifestyle factors, smoking, alcohol and diet. MATERIALS AND METHODS: This is a Cross sectional study done in 376 Type 2 Diabetic patients aged 30-60 years of both gender, after getting approval from the Institutional Ethics Committee in the OPD & IPD of our institution. After explaining the need and the procedures involved in the study and getting written consent, the study participants are subjected to the detailed general and systemic examination. Biochemical parameters are noted with the available record. Cognitive function was assessed using Mini Mental State Examination [MMSE] and Visual and Auditory Reaction time assessed using the apparatus “Reaction time analyser_501-004-TR [Psychotronics, Bangalore]. The data recorded were analysed using appropriate statistical tests after testing for normality, using SPSS 17.0. A probability value of <0.05 is considered to be statistically significant with 95% confidence limit. RESULTS AND DISCUSSION: With the mean age group of 51.47±8.04years and male: female ratio of 211:165, the prevalence of cognitive dysfunction was found to be 62.8% (mild cognitive impairment - 41.3% and 21.5% - severe cognitive impairment. The median scores of MMSE were 22 (10-30). Diabetic men found to have better MMSE scores (23.00 ± 5.87 Vs 20.52 ± 4.2; p <0.0001) and lower visual and auditory reaction time (521.22 ± 199.89 Vs 560.25 ± 185.59, p – 0.05 for VRT_ Red light and 417.33 ± 160.20Vs 468.47 ± 187.67, p- 0005 for ART, respectively). BMI shows positive correlation with MMSE scores (r=0.143, p=0.006). Smokers showed decreased MMSE scores ( p=0.001) and alcoholics showed decreased MMSE scores (p=0.0001) and increased visual and auditory reaction time (VRT_Green – p =0.03, VRT_Red – 0.02 and ART -0.02). HbA1C, fasting and post-prandial blood sugar levels were positively correlated with reaction time. As the level of Literacy decreases, cognitive impairment increases. Diet, physical activity and duration of diabetes were not significantly associated with cognitive impairment. CONCLUSION: In this cross-sectional study on cognitive functions diabetic patients we found higher prevalence of cognitive impairment. Gender, glycaemic control, obesity, literacy, smoking, alcohol have been shown to associate with cognitive impairment.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cognition ; BMI, Education ; Glycaemic control ; MMSE ; Reaction time and Type 2 diabetes mellitus.
Subjects: MEDICAL > Physiology
Depositing User: Subramani R
Date Deposited: 17 Aug 2018 03:55
Last Modified: 17 Aug 2018 03:56
URI: http://repository-tnmgrmu.ac.in/id/eprint/9287

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