Problem

Diabetes is a chronic metabolic disease requiring lifelong treatment. With the improvement of the peoples’ life level, there is an upward trend in the incidence of the disease. WHO (2004 Wild S) show that the number of global diabetes patients was 171 million (prevalence of 2.8%) in 2000,and it was expected to rise to 366 million (prevalence of 4.4%)in 2030. Incidence of diabetes continued to arise along with the growth of the age. According to statistics, 12% of diabetes patients was at the aged of65-70, in 2000, 15% of patients over the age of 80. and diabetes were the independent risk factors for eye disease, kidney disease, cardiovascular and nervous system diseases. Some studies had shown that diabetes is closely related to cognitive dysfunction, especially in elderly patients. Diabetic cognitive dysfunction brought the family caregiversa lot of pain and inconvenience, and increased the difficulty of treatment and nursing, greater economic burden for the society. At present, "five sets of the carriage" for treatment of diabetes was put forward: health education, diet, exercise therapy, medication and blood glucose monitoring. In these,Health education as the main way to control the disease got more and more attention. Both at home and abroad, studies were proved that knowledge had positive effect on control of the disease. Self-management could be achieved effectively through health education, then improved the compliance of treatment, so to reduce the complications, economic burden of family and improve the quality of life. However in the process of the implementation of health education, the medical staff found that learning and memory ability were poor for some diabetic patients, and seriously affect the education result. This might be associated with cognitive dysfunction. Cognitive function in diabetes patients Was firstly focus on in 1960s, at that time, "diabetic encephalopathy” was proposed , and it thought that diabetes encephalopathy was caused by progressive cognitive impairment, characterized by acquired cognitive behavioral deficiency, learning, memory, and complex information processing ability, seriously caused dementia. Recently some scholars pointed out that "diabetic cognitive dysfunction". A large number of researches had shown the relationship between between diabetes and cognitive dysfunction. Some studies had considered diabetic cognitive dysfunction was related with glucose toxicity , insulin resistance and toxicity of fat, its pathogenesis was complex, but couldn’t be ignored in the process of diabetes diagnosis and treatment .Diabetic cognitive dysfunction mainly affect learning ability, memory loss, language, understanding and judgment ability. Of course, the disorder of learning and memory were the main performances. Most of the studies showed that diabetes patients had lower scores then non-diabetic patients in Simple Intelligent Mental State Scale (MMSE) and the Revised Wechsler Intelligence scale , and its cognitive function probability was 1.5 times of the patients. The Honolulu asian-american elderly research (HAAS) found that compared with the course of less than 5 years, more than 20 years of duration of diabetes patients had more hypothalamus atrophy and brain white matter high signal (reflect the vascular injury and brain atrophy), these all suggest that diabetes was closely related to cognitive function decline. In our studies, according to cognitive dysfunction in diabetes patients, We adopted the Chinese Revised Wechsler Memory scale to evaluate the logical and visual memory ability, then cognitive dysfunction was divided into four grades: normal, mild, moderate disorders and severe obstacles. According to the different levels of memory ability, we confirmed the level of health education pattern - "differential-range of health education mode”, to make the patients understand and accept the health education content extremely, then better promote the self-management behavior. So it could promote the effect of health education and save manpower to achieve win-win situation of patients and medical staff.

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