Cognitive Impairment in People With Diabetes-Related Foot Ulcers: A Multicentre, Case-Control, Observational Study

Cognitive impairment is associated with people with diabetes-related foot ulcers (DFU). However, it is unclear if cognitive impairment is associated with the ulcer itself or other co-existing diabetes-related complications such as peripheral neuropathy. We aimed to investigate cognition in people with diabetes-related peripheral neuropathy and compare those with DFUs to those without DFUs. In this age- and sex-matched, multicentre, case-control, observational study of 89 participants with Type 2 diabetes and peripheral neuropathy, we compared 49 participants with DFUs (cases) to 40 without DFUs (controls). Global cognition scores were assessed using the Montreal Cognitive Assessment tool. Participants with DFUs had similar characteristics to those without DFUs (all, p > 0.05), except for lower body mass index (p = 0.028). Participants with active DFUs had significantly lower global cognition scores compared to those without DFUs (median [IQR] 24.0 [21.0-25.0], 26.0 [24.0-28.0]; p < 0.001). After adjusting for other diabetes-related complications, lower global cognition was independently associated with a DFU, peripheral artery disease, lower physical activity and no family history of diabetes (all, p ≤ 0.019). People with DFUs had lower cognitive scores than those without DFUs, suggesting that the DFU itself is independently associated with cognitive impairment. Future studies should explore causal pathways and targeted management strategies.