Cognitive impairment is associated with poor diabetic foot ulcer outcomes

Up to one-third of individuals with diabetes develop diabetic foot ulcers (DFU), and cognitive impairment affects up to 34 % of this population. This study evaluates the impact of cognitive impairment on ulcer outcomes.

This six-year retrospective study analyzed ICD-9/10 codes from a large tertiary health system. Eligible patients had DFU and at least six months of follow-up. Exclusions were made for those without an ulcer and not seen by a podiatrist. For the cohort without cognitive impairment, patients were excluded if they screened positive for cognitive impairment or dementia in the five years prior to diagnosis. Clinical outcomes were assessed using the Wound, Ischemic, Foot Infection classification, focusing on healing rates, time to healing, amputation events, and hospital admissions. Logistic regression determined associations between cognitive impairment and DFU outcomes.

Of 631 charts reviewed, 123 patients were included: 56 with cognitive impairment (mean age 71.9) and 67 without (mean age 58). Healing rates at six months were lower for those with cognitive impairment (39 % vs. 72 %, p < 0.001). They had higher rates of major amputations (17.8 % vs. 5.9 %, odds ratio 4.5, p < 0.05) and foot-related admissions (p = 0.01).

Individuals with DFU and cognitive impairment were at higher risk of major amputation, foot-related admissions, and nonhealing, underscoring the need for targeted interventions.