Redução da mobilidade funcional e da capacidade cognitiva no diabetes melito tipo 2

Abstract

RESUMOObjetivos: Avaliar a mobilidade funcional e sua relação com a capacidade cognitiva em pacientes com diabetes tipo 2 (DM2) entre 50 e 65 anos de idade, e com menos de 10 anos de diagnóstico. Materiais e métodos: Estudo observacional, analítico e transversal envolvendo indiví-duos não diabéticos e pacientes com DM2 com controle glicêmico inadequado, selecionados por amostra de conveniência. Em ambos os grupos, foram aplicados questionário estruturado, avaliação cognitiva com Miniexame do Estado Mental (MEEM) e teste do relógio (TDR), além da avaliação de mobilidade funcional pelo teste Timed Up & GO (TUG). Resultados: No TUG os pacientes com DM2 apresentaram tempo médio de 11,27 segundos versus 9,52 segundos nos controles (p = 0,013). A associação entre declínio cognitivo e dismobilidade foi positiva nos indivíduos com DM2 (p = 0,037). No subgrupo que apresentou dismobilidade e declínio cognitivo associados, 18% eram portadores de DM2 e 1,6% era do grupo sem DM2 (p < 0,01). Conclusões: Pacientes com DM2 apresentaram pior mobilidade funcional e desempenho cognitivo, favorecendo a hipótese de que o DM2 influencia a mobilidade funcional e capacidade cognitiva antes do aparecimento de complicações vasculares ou neuropáticas. Esses dados sugerem que a hiperglicemia é um fator agravante no desempenho de atividades que exijam funções mentais como atenção, orientação e memória de trabalho. Arq Bras Endocrinol Metab. 2014;58(9):946-52 Descritores Diabetes tipo 2; cognição; acidentes por quedas; aptidão física ABSTRACT Objectives: The aim of the present study was to evaluate the functional mobility and its relationship to cognitive ability in patients with type 2 diabetes (T2DM), age between 50 and 65 years and under 10 years of diagnosis. Materials and methods: An observational, analytical and cross-sectional study, involving no diabetic and type 2 diabetic individuals with inadequate glycemic control, selected by convenience sampling. In both groups, were administered structured questionnaire and cognitive assessment with Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), besides assessment of functional mobility by the Timed Up & Go (TUG). Results: In TUG, DM2 patients presented a mean time of 11.27 seconds versus 9.52 seconds (p = 0.013). The association between cognitive decline and decrease of mobility was positive in individuals with T2DM (p = 0.037). In the subgroup that showed decrease of mobility and associated cognitive decline, 18% were patients with DM2 and 1.6% were individuals without T2DM (p < 0.01). Conclusions: Patients with T2DM presented worse functional mobility and cognitive performance, supporting the hypothesis that DM2 influence functional mobility and cognitive ability, regardless of neuropathic or vascular complications. These data suggest that hyperglycemia is an aggravating factor in the performance of activities requiring mental functions such as attention, working memory and orientation. Arq Bras Endocrinol Metab. 2014;58(9):946-52

Tracking cognitive deficit in elderly with diabetes mellitus

“…It should be emphasized that although it is a very objective instrument, it only tracks cognitive deficiencies and should not be used alone to diagnose 11 . The mean MMSE below the cutoff point of the elderly with DM2 corroborated with the main studies in the literature 4,5 .It is important to emphasize that to date, there is no consensus regarding cut-off points for cognitive decline in Brazil. The Brazilian version of the test used by Bertolucci et.…”

“…In addition to the micro and macrovascular complications that diabetes mellitus can cause, DM2 has been one of the major public health concerns, as evidence indicates a positive relationship between DM2 and cognitive decline. Studies that analyze this association between the prevalence of diabetes and cognitive alterations in the elderly have shown that elderly people with DM2 present worse cognitive performance, suggesting the DM2 as an aggravating factor in the performance of the cognitive capacity in which even without clear pictures of dementia certain cognitive domains such as attention, memory, executive functions and frontal lobe, can be impaired 3,4,5 . The early detection of cognitive alterations contributes directly to the neuropsychological evaluation and the management of pathological cognitive aging, facilitating the therapeutic behavior during the onset of neurodegenerative diseases.…”

Factors associated to the dependence of older adults with diabetes mellitus type 2

“…An analytical and observational study developed with a group of diabetics and a control group, observed that when the fall involves people with diabetes mellitus there is higher incidence of cognitive disorders and functional mobility, in addition to worse mobility on those with greater cognitive decline. The worse functional mobility and worse cognitive performance of patients with diabetes can be a result of poor glycemic control, overlapped to other aspects inherent to the disease (25) . Although pain presented no statistical relation in this study, a population survey with older adults without cognitive deficit, residents in the city of São Paulo, Brazil, showed that the risk of falling was greater (48%) among those with pain and urinary incontinence diagnosis, i.e., the association between chronic pain and urinary incontinence significantly increased the chances of falling (26) .…”

Palmar strength and sociodemographic, clinical-functional, and psycho-cognitive factors in elderly with Diabetes Mellitus

“…An important consequence of the aging of people with DM2 is physical disability, particularly the loss of mobility [2]. This pathology makes the elderly more susceptible to a gradual and successive decrease in functional capacity and reserves.…”