The Impact of Peripheral Neuropathy and Cognitive Decrements on Gait in Older Adults With Type 2 Diabetes Mellitus

Objective: To investigate the effect of peripheral neuropathy and cognition on gait performance in older adults with type 2 diabetes mellitus. Design: Cross-sectional study. Setting: Community and residential aged care setting. Participants: Older adults (N=101; 56 patients with diabetes, 28 with peripheral neuropathy and 28 without peripheral neuropathy; and 45 matched controls). Interventions: Not applicable. Main Outcome Measures: Spatiotemporal gait parameters were recorded under 3 conditions: simple, counting backward by 3 from 40, and reciting animal names. The Mini-Mental State Examination and the clock drawing test were used to estimate cognitive impairment levels. Results: Compared with controls, older adults with diabetes walked slower, took shorter strides during all walking conditions, and showed more gait variability especially during dual-task conditions. Gait patterns did not differ between participants suffering from diabetes mellitus with and without neuropathy. Compared with normal walking, dual-task conditions affected all gait parameters similarly in all groups. Backward counting affected gait more than animal naming in participants with diabetes but not in healthy controls. Additional analyses in older adults with diabetes showed that participants with impaired cognitive function walked slower, took shorter strides, had shorter double support time, and increased gait variability compared with participants with intact cognitive function. Conclusions: This study showed that gait parameters are affected in older adults with type 2 diabetes. Gait was further affected by reduced cognitive function, irrespective of the presence of neuropathy. (C) 2013 by the American Congress of Rehabilitation Medicine