Comparison of Cognitive and Motor Dual Task Performance in Individuals With Prediabetes and Diabetes

Study Overview
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Brief Summary
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The aim of this study is to compare the dual task task in individuals with prediabetes and diabetes. According to the results of this study, if there is a difference in dual-task performances and other conditions between people with prediabetes and people with diabetes, it will be a reference study for intervention studies accordingly.

Detailed Description
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Diabetes is a chronic, broad-spectrum metabolic disorder that requires continuous medical care, in which the organism cannot adequately benefit from carbohydrates, fats and proteins due to insulin deficiency or defects in the effect of insulin. The number of diabetes cases worldwide has increased rapidly over the past four decades, rising from 108 million in 1980 to 422 million in 2014 . An aging population, physical inactivity, and rising obesity rates are recognized as driving factors for the rapid growth of diabetes . Diabetes is a leading cause of mortality and is a strong risk factor for both microvascular and macrovascular complications . Adequate glycemic control, cardiovascular risk factors management, early treatment of complications and related comorbidities are required for appropriate Type 2 Diabetes management . Complications of Type 2 Diabetes include heart and blood vessel disease, neuropathy, kidney disease, skin and eye damage, sleep apnea, bone metabolism disorders, mood disorders, and cognitive impairment. Therefore, it is essential to maintain a healthy lifestyle with weight control, balanced diet, smoking cessation, and physical activity The concept of prediabetes includes individuals who do not meet the criteria for a diagnosis of diabetes, but whose blood sugar is above normal limits. In other words, it can be called the pre-diabetic period when glucose metabolism begins to deteriorate. In a study conducted by the Centers for Disease Control and Prevention (CDC) in the United States in 2014, it was shown that there are 29 million adults with diabetes and 86 million adults with prediabetes in the United States. In another study, it was predicted that there would be more than 470 million individuals with prediabetes worldwide in 2030. Prediabetic individuals are more likely to develop diabetes than healthy individuals. Although the rate of progression varies in the literature, it has been reported that 5-10% of prediabetic individuals become diabetic every year. At the same time, many studies conducted around the world have shown that the risk of many comorbidities in diabetes and prediabetes is the same and affects all age groups. In conclusion, prediabetes is a toxic cardiometabolic condition associated with an increased risk for microvascular and macrovascular complications. Given the millions of people with prediabetes worldwide, identifying and responding to at-risk prediabetic populations is critical to contain the increased risks of cardiometabolic disease and conversion rates to diabetes.In a 10-year follow-up study conducted in prediabetes and diabetics, a linear relationship was found between individuals' HbA1c levels and cognitive decline. At the same time, evidence has shown that poor glycemic control is strongly associated with the development of cognitive dysfunction. Cerebral and peripheral vascular complications (eg, neuropathy, white matter disease, stroke, myocardial infarction, peripheral artery disease) that develop as a result of chronic exposure to hyperglycemia have been associated with cognitive impairment in Type 2 diabetes. Affected cognitive areas are reported as decreased psychomotor speed, impaired memory, executive processes, and attention. Executive processes are higher-level functions that monitor and control other cognitive processes. These capacities are thought to underlie activities such as planning, making decisions, switching tasks, goal-directed behavior, and coordinating ongoing activities (for example, doing two things at once or planning a series of activities). More importantly, it is critical for sensory integration used to coordinate executive function, balance, and gait motor output.Dual task paradigms are used to examine the degree of automaticity of movement. In these paradigms, a primary task is undertaken, often such as walking, which is the main focus of attention. Secondary tasks are added and the resulting impact on both tasks is examined. In everyday situations it is normal to undertake multiple tasks at once, such as walking and talking, so these situations are essentially dual-task paradigms. If two (or more) tasks undertaken together exceed the available attention capacity, there will be insufficient capacity to optimally perform both tasks and the performance of one or both of the tasks will deteriorate. Impairments in executive function lead to the dual-task paradigm. Dual tasks can be motor-cognitive, cognitive-cognitive, or motor-motor. In a previous study, a negative effect of dual assignment on gait parameters in Type 2 diabetes was observed. It suggests that impaired dual-task capacity in type 2 diabetes may explain the higher incidence of falls in this populationGiven the changes in cognitive function identified in people with poor glycemic control, dual-task testing may provide a functional biomarker for movement impairment and fall risk. A previously published meta-analysis suggested that dual-task testing in people with diabetes better emphasizes deficiencies in functional performance rather than single-task testing, and that dual-task testing can be used to identify people who will start rehabilitation interventions to improve functional performance and reduce the risk of falls. However, although cognitive function declines are common in prediabetic individuals, dual-task performance has not been evaluated and compared with diabetic individuals in previous studies to show the effect of these declines on functional performance. Therefore, the aim of this study is to compare cognitive and motor dual-task performance in individuals with prediabetes and diabetes.

Official Title
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Comparison of Cognitive and Motor Dual Task Performance in Individuals With Prediabetes and Diabetes

Conditions
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Diabetes Mellitus

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: be 65 years or older Being diagnosed with type 2 diabetes or prediabetes Volunteer to participate in the study Ability to participate in tests independently Getting a score of 24 or higher on the Mini Mental State Test Being literate Being able to communicate Exclusion Criteria: Cancer patients known to be life-threatening Severe respiratory, central, vascular, peripheral and uncontrolled metabolic problems Using drugs known to affect the postural control system (eg benzodiazepines) Those with peripheral neuropathy Those with severe hearing and visual impairments

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| prediabetes<br> | |
| diabetes<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Timed Get Up and Go Test-Motor and Cognitive Task: | The timed up-and-go test is a widely used clinical test to evaluate balance and mobility. The clinical benefit of the test is that it can monitor transitions that require balance control, and mobility skills such as sitting up and walking straight. As the primary task, the participant stands up with the command Start from a 46cm standard height chair and walks 3 meters, then turns 180⁰ back and sits on the chair. As a secondary task, he is asked to carry a standardized glass of water without spilling it during the test. As a cognitive task, the participant stands up with the Start command from a 46cm standard height chair as the primary task and walks 3 meters, then turns 180⁰ back and sits on the chair. As a secondary task, he is asked to count backwards from 100 by sevens during the test. He will be allowed to practice cognitively in his seat before starting the test. The time elapsed during the test will be recorded. | 15 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short Physical Performance Battery: | The Brief Physical Performance Battery is a test used to summarize physical performance based on lower extremity performance, used in populations designated for epidemiological studies of the elderly. It consists of 3 objective tests evaluating lower body function. These; It is a 4 meter walking, standing and standing balance test. | 10 minutes | 
| Muscle Strength Measurement | Muscle strength will be assessed by hand grip strength for the upper extremity. Individuals' standard grip strength will be measured with a Jamar hand dynamometer (Baseline Evaluation System, New York, USA). The measurement will be made in the test position standardized by the American Association of Hand Therapists, with the patient sitting upright in a chair without arm support, with the shoulder in adduction, the elbow in 90° flexion, the forearm in neutral position, the wrist in 0-30° extension and 0-15° ulnar deviation. While performing the assessment, individuals will be asked to tighten the dynamometer with all their strength and then let it loose completely. This procedure will be repeated in the dominant hand with 1 minute interval between each measurement and the average of these values will be taken in kg/force. | 5 minutes | 
| Mini Mental State Test | Mini Mental State Test (MMDT) was used in our study for cognitive status assessment. MMDT was first described by Folstein et al. (23) in 1975. The scale was produced as a cognitive assessment tool that can be applied in a short time in the examination of the elderly. The scale has limited specificity for distinguishing clinical syndromes; however, it is a short, useful, valid and standardized method that can be used to evaluate the cognitive level in general. | 10 minutes | 
| Fatigue Assessment | Fatigue was assessed with the Visual Analog Scale (VAS). VAS, Are you tired? It was used to determine the severity of fatigue in elderly individuals who answered yes to the question. VAS is a simple to use, effective, validity and reliability measurement scale (22). In order to determine their fatigue, individuals will be asked to mark the severity of fatigue on a 10 cm scale where the numbers 0 (no fatigue) and 10 (I am unbearably tired) are shown. | 2 minutes | 
| Pain Assessment | Pain was assessed with the Visual Analogue Scale (VAS). VAS, Do you have pain? It was used to determine the severity of pain in elderly individuals who answered yes to the question. VAS is a simple to use, effective, validity and reliability measurement scale (21). Individuals will be asked to mark the severity of pain on a 10 cm scale where the numbers 0 (no pain) and 10 (unbearable pain) are displayed to determine body pain. | 2 minutes | 
| Biochemical Analysis | The most up-to-date results of blood test results given by individuals within a maximum of 6 months will be recorded by looking at the system. Results of fasting glucose levels, total cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol, hemoglobin values, urea, creatinine levels of individuals in the research group will be recorded. | 15 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes, Prediabetes, Double task performance