COGNITIVE AND PSYCHOLOGICAL CHARACTERISTICS IN DIABETIC FOOT PATIENTS A Marseglia, E Brocco, F Limongi, M Noale, S Maggi Operative Unit “Diabetic Foot”, Policlinico Abano Terme (Italy) MGSD 2011 Casablanca, Morocco INTRODUCTION Diabetic foot is one of the most disabling complication of Diabetes Mellitus (DM), which carries a high risk of minor and major amputations. Diabetic foot has a devastating impact on quality of life and is associated with depression. The Phantom Limb Sensation (PLS) occurs frequently after an amputation; in some cases, it can be accompanied by Phantom Limb Pain (PLP). The few studies available on cognition in diabetic foot patients show an indirect relationship between cognitive deficit and re-ulceration (Van Gils e Stark, Ostomy Wound Manage, 2006). However, until now, studies on cognition in diabetic foot do not exist. AIM Investigate cognitive and psychological characteristics of diabetic patients with minor and major amputations and the prevalence of depressive symptoms.

MATERIAL AND METHODS A cross-sectional study on patients with type 1 (9%) and type 2 DM with the objective of studying history of foot ulcers or minor/major amputations Neuropsychological and Psychological Assessment Mini Mental State Examination (MMSE) Rey Verbal Auditory Learning Test (RAVLT) Attentional Matrices (AM) Raven Coloured Progressive Matrices (RCPM) Trail Making Test A e B (TMT A-B) Connor-Davidson Resilience Scale (CDRS) Beck Depression Inventory-II (BDI-II) Short-Form Mc Gill Pain Questionnaire (SF-MPQ) Body Image Scale (BIS) to evaluate body perception Interview about PLS and PLP to evaluate phantom sensation and phantom limb pain Statistical Analysis The association between cognitive and psychological variables with the type of amputation was assessed by the χ2 test. The quantitative variables were compared through Generalized Linear Model (GLM) procedure. The relationship of depressive symptom and possible risk factors (cognitive and psychological variable) were studied by logistic regression model. The study is still ongoing and preliminary data on a sample of 111 subjects is presented

PRELIMINARY RESULTS Major amputees group get an average score significantly lower than no amputees group; they also obtained with respect to the other three groups, a higher mean score on SF-MPQ, a higher average score to BIS and a median VAS pain significantly higher Patients with PLS have a significantly higher prevalence of depressive symptoms than patients without PLS Presence of PLP can be a independent risk factor for depressive symptoms

Patients with pathological performance in RAVLT have lower HDL-cholesterol than patients with normal performance CONCLUSIONS In patients with amputation the high prevalence of pain and specifically of phantom limb pain is an important risk factor for the development of depressive symptoms Among those with major amputation, depressive symptoms may be exacerbated by the negative perception of body image, by the non-acceptance of their physical disability and by the poor resilience that characterizes these patients.